Medicine: The A.M.A. & the U.S.A.

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Dr. Larson was first named to A.M.A.'s House of Delegates in 1940. Ten years later, he made the board of trustees, and in 1958 became its chairman. He was already chairman of the commission that had been studying group-practice panels for 2½ years. When he presented its unanimous 15-man report on them in 1959, he did so from a position of great strength: A.M.A. mossbacks did not openly oppose the man who seemed headed for the presidency. In a massive report covering all forms of group practice and sparing none of their shortcomings, the Larson commission paid tribute to the principle of free choice of physician. But it held that this principle is not violated if the patient has free choice between an inde pendent physician and a panel.

If Dr. Larson sounded rigidly traditional in his attacks on King-Anderson last week, he is actually quite flexible on other issues in the provision of medical care. As a group practitioner, he naturally favors group practice, and Quain & Ramstad makes no bones about the fact that it pays salaries to 32 of its doctors, though it charges patients on a fee-for-service basis. Moreover, Dr. Larson believes that "if we're going to keep Government out of the practice of medicine, we're going to have to provide more coverage through prepayment plans—and, if possible, at lower cost."

Working Plans. Group practice and the increased specialization that goes with it are already well along in the U.S.; 16,000 doctors practice in 1,151 groups; and the proportion of specialists (27 varieties) is steadily rising. To make prepayment possible, pioneering groups all across the U.S. have worked out an interesting assortment of ways to get medicine to people on a local, private basis. Examples:

¶ New York's H.I.P., covering 620,000 people under 200,000 subscribers' contracts, for premiums ranging from $3.56 a month (single man) to $10.68 (family) now runs 32 centers with 1,100 physicians (two-thirds of them specialists). Emphasizing the benefits of preventive medicine, H.I.P. subscribers have a hospital admission rate 20% lower than other New Yorkers.

¶ Washington's Group Health Association, set up in 1937, covers 47,000 individuals, has spread in monthly rates from $7.25 (standard, single) to $24.20 (de luxe family), covers both hospital and medical costs. In 1939, G.H.A. doctors were barred from Washington hospitals until the District Medical Society and A.M.A. were convicted of violating the Sherman Antitrust Act.

¶ United Mine Workers of America, a massive operation in 26 states, financed entirely by a royalty of 40¢ on every ton of coal mined. It runs ten hospitals in three states, gives miners and their families little choice of physician. It has closed its panels against physicians and surgeons whom it accuses of doing unnecessary services and padding fees.

¶ Henry J. Kaiser's Foundation Medical Care Program, with eleven hospitals, 800 doctors and 800,000 subscribers in the Pacific Coast states and Hawaii, offers womb-to-tomb care, hospital and medical (including psychiatry), for $15.55 a month for family.

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