This post was erroneously omitted from the series.
In earlier blogs, we noted that the CCMC wanted a health care system founded on community health centers organized around a hospital and managed by a citizen/public non-profit board of directors.
But, the Committee did not intend to eliminate the private practice of medicine; “….the proposed medical centers will never supersede or embrace all the existing medical institutions and agencies. Individual private practice, particularly among the well to do, may continue indefinitely; public health activities are a permanent governmental responsibility; industrial organizations will continue sanitary and preventive services to employees and governmental provision of hospitalization for tuberculosis and mental patients will probably increase…the work of the medical centers should be coordinated with the work of all other agencies.” (CCMC, pg. 66)
Each community, therefore, would have a local coordinating body to examine and address the preventive and therapeutic medical services of the community and to limit unnecessary activities. They saw the need for a comparable agency at the state level. This state agency would also supervise the development of medical centers and their branches and stations across the state.
The Committee recognized that the medical centers and their branches and stations would differ by community because of difference of maturity in existing centers and that compensation of physicians would vary by costs of living in different communities. They estimated, however, that the costs of services would be somewhere between $20 and $40 per capita per year.
Paying for Services: Everyone Pays
The Committee thought these costs could be met in one of three ways: 1) insurance paid for in full by families and individuals “with or without the assistance of their employers;”
2) from taxes at the local or state levels, or both; and 3) by a combination of insurance and taxes.
The problem, however, is one that remains today. How to pay for those who could not afford these premiums. They went on to say about taxation as a source of funding as follows: “Although taxation might spread the cost in a fairly equitable manner, it would relieve patients of all direct individual financial responsibility. While this has been a reasonably satisfactory plan for the financing of education, highway development, and certain community activities, most members of the Committee believe is not desirable for medical service when other plans are practicable.” (CCMC op.cit., pg. 67).
The Committee opted instead for the third method—a combination of taxes and insurance. Each person would be required to pay something to have “a direct financial responsibility on the part of each patient.” (CCMC op,cit., pg. 68).
If there were funds necessary to fill the gaps, it would come from taxes at the state or federal level. They imagined that taxes would be necessary to pay for services.
However, the Committee could not reach agreement on whether insurance should be voluntary or compulsory. The insurance model proposed also required medical organizations to maintain adequate reserves and practice medicine on an actuarially sound basis.
Their insurance model differed from European models in that it 1) was predicated on services provided by organized medical groups rather than individual practitioners; 2) economies would be realized in group practices that cannot be found in individual practices; 3) the insurance is completely divorced from any system of income protection. “Many of the worst abuses of health insurance abroad have arisen because of the desire of insured persons for financial rather than medical assistance. Unquestionably, there is a need for income protection, but any system of cash benefits should be separate from the provision of medical services.” (CCMC, op.cit., pg.70). 4) This insurance also differed from those provided abroad because it included full medical services for prevention, early care of incipient disease, and preventive and curative dentistry.
The Committee’s recommendations for a group practice model, however, was subject to it being a non-profit model and that the practitioners be fairly compensated with regard to their education, responsibilities and community status.
The Committee’s recommendations, they concluded: “Society as a whole would receive substantial and hitherto unrealized dividends from its investment in needed medical research and education. With the facilities of the country more effectively utilized, there would be marked improvement in the health, happiness and peace of mind of the American people.” (CCMC op.cit. pg, 71).
But, that was never to happen. Despite concurrence among over 50 of the Committee’s members, it took only 11 members in two different minority reports to prevent the Committee’s work from seeing the light of day.
Coming Next Week: The Final Recommendations.