Note: These principles were a complete surprise to me. It was a surprise in terms of the thoughtfulness of these principles; the recognition of the limitations of the recommendations; and their heartfelt tone. We would be well served now to keep these principles as a possible framework for current health care reform efforts.
We would also actually be well served now to have a comparable Committee to oversee implementation of health care reform: a Non-Partisan Citizen’s Advisory and Oversight Committee for Health Care Reform. It is possible and it is not too late to do so.
Perhaps the eight foundations that funded the Committee on the Costs of Medical Care, and others, could find their way to fund this for at least three years. We don’t need more research studies. We do need independent oversight and integrity, outside Congress.
These are the 10 principles that drove their recommendations:
1) The problem of providing satisfactory medical service to the people of the United States at costs within their means is one of paramount importance. Its solution will be of immense economic and social significance.
2) Some of the social problems facing civilization today present almost insuperable barriers, barriers arising from the very biological nature of man. This problem is not among them. It can be solved.
3) The problem is complicated and differs from one region to another. No panacea is available; no solution is applicable to all areas of the country….Forty-five percent of the population of the continental United States in 1930, lived in cities or metropolitan areas containing at least 100,000 persons.….
4) Goals are more important than institutions, since service is the only purpose of organizations. None of the recommendations proposed subsequently is value, in the Committee’s estimation, except in so far as it contributes to providing the people with satisfactory medical service or assists them in meeting the costs of such services….
5) The recommendations vary in importance, in scope and in immediate applicability. Some are applicable only to urban areas; others only partially solve the problem….The Committee believes that its obligations require it to think ahead for twenty or thirty years, as well as for the next five or ten years and to present distant as well as immediate goals.
6) The Committee’s obligation is not merely to recommend those steps which it deems immediately expedient but also those which, in the judgment of the Committee, communities must eventually take if they are to solve the problem.
7) An evolutionary process is now going on in medical practice and in the relationships between medical science and medical practice. This process is greatly influenced by rapidly changing economic and social conditions….
8) The present economic depression is forcing economy in nearly all expenditures, no matter how desirable their object. The Committee does not propose the immediate adoption of programs which involve sudden large increases in expenditures from public or private funds.…
9) The interests of the 1,100,000 persons in the United States who furnish medical services and the 123,000,000 who receive it are clearly interwoven. The professional standards of physicians, dentists, nurses, pharmacists, hospitals and other practitioners and agencies which furnish medical care must be carefully guarded in behalf of the people who are served, as well as in behalf of those who provide services.
10) The Committee is not dogmatic in its recommendations. They are based on the study of certain groups of facts which have revealed needs or which give ground for believing that methods tested in some undertakings will be of benefit if wisely applied on a larger scale. The aim should be to adopt objectives which at present seem sound, and to develop definite and purposeful, experimental methods of approaching those objectives, preserving, insofar as it is compatible with effective service, the maximum amount of local self-government and self-control, and the greatest freedom consistent social welfare, for the professions and the agencies involved. Although too great decentralization of authority limits competence and threatens economic effectiveness, too great centralization of authority in any plan carries with it elements of ultimate weakness. (CCMC op.cit. pp 104—108)
Note: These principles and recommendations were from a Committee of over 50 people from physicians and dentists and nurses, to bankers, economists, and consumers. It took two minority reports of 10 members to take it down. Which we will get to in two weeks.
When you review the Committee’s recommendations, many of them have been recognized and implemented, using different terms. The ideological harangues, however, have not.
American health care reform is like a record with a stuck grove–you hear the same notes over and over, when you should just turn it off and change the record.
We have that chance.
Coming Next Week: The Final Recommendations.