Friday, March 26, 2010

New York Times article from 1910: doctor complains, medical prices are too low

I've transcribed the text of this New York Times article since it's a bit hard to read in the scanned version. This is worth a read because it helps with one of the most important questions about the price of health care: why is health care expensive?

Though it almost kills me, I have not highlighted the sections that I find the most telling. Note, that the American Medical Association formed within a handful of years of this particular article with the purpose of making the medical profession pay better by reducing the number of doctors.

Please let me know about any typos in the transcription.


Medical Profession Degraded, He Says, by the Wholesale Work Done for Societies.


Regular Practitioners Hardly Able to Make a Living Now -- Lodge Doctors Canvass for Their Election

The complaint is made by a physician of the lower east side, through the medium of one of the standard weekly medical publications, that the "lodge practice evil" is hammering medical progress and efficiency in that section of the city and depriving a large number of worthy and capable practitioners of the fruits of diligence and a protracted course of study which they feel they have a right to expect.

The complaining physician is Dr. Morris Joseph Clurman of 142 Rivington Street. In the course of an article in the Medical Record, entitled "The Lodge Practice Evil on the Lower East Side," he says: "Among the local medical community, especially of the lower east side, there has sprung up of the late years an evil so virile, so powerful, and so destructive toward medical ideals, that in time only a mythical Perseus will have to spring forth to destroy this Gorgon Medusa if concerted action on the part of the east side medical profession is not taken to check it now.

"This alarming evil is nothing more nor less than the existing state of east side lodge practice with its concomitant train of manifold degradations to the local medical fraternity. At the present time there are in existence downtown somewhere between 1,500 and 2,000 lodges, societies, and benevolent associations founded mainly by the poorer class of workingmen for a double purpose: namely, social intercourse and mutual aid or benevolence.

"An iron-bound practice or custom has arisen for4 each society to elect some physician to take care of the health of the society members -- for a consideration. What this consideration amounts to we shall see later.

"Twenty years ago, when lodge practice was in its infancy, societies would send humble delegates to some physician and ask him to accept the office of lodge doctor for a fair and reasonable consideration. In most cases the physician would think twice before entering into such an agreement, since, very naturally, routine family practice, with its direct returns for every call, seemed more remunerative than cheap contract practice. However, young and ambitions medical tyros naturally sought some means of getting patients to come to them, and this seemed an easy way to help make both ends meet, and also to obtain what seemed to be a legitimate and ethical way of advertising one's self.

"The lodge doctor found that he cam in contact at the sickbed with a large class of patients who would not have patronized him in any other way. In time, however, the lodge physician, after establishing a reputation as a busy practitioner -- and, perhaps, as a good one -- became more or less independent.

"Hand in hand with the increasing number of physicians on the east side a keen competition now arose among them to be elected as lodge physician in as many societies as possible. Many sought these positions, and it now seemed that another Eldorado had been discovered.

"But now the guilt had been reversed. It was the doctors who sought after the societies, and not vice versa, as formerly. The societies found that, inasmuch as physicians were so anxious to be their lodge doctors, they could well afford to discriminate and choose from the numerous candidates.

"What a degrading spectacle it is to see three or four medical men at one of these society elections. Each candidate comes fully prepared with printed ballots bearing his name, which he distributes among the lodge members. while the vote is going on and the ballots are being counted, these physicians sit like culprits and await the result of the election. It is difficult to say who should feel more chagrined after the count is over -- the lucky (?) winner or the defeated candidates.

"To-day there is scarecely an east side workingman who is not a member of some association which has a physician to take charge of its members. Let us see what are the average rates of remuneration for the lodge doctor. With very few exceptions the market price 'per head' is as follows: One dollar a year for each unmarried member and $3 a year for every married member, including his family. And let us not forget that the east side workingman when married does not believe in race suicide.

"For these terms he is supposed to make as many professional visits in time of sickness as he is called upon to do. very often he may be called upon forty or even fifty times during the year by one family. Time and again he is called for the most trivial of complaints, since his presence is so easily obtained. What a shame and degradation that our noble profession should become so cheapened.

"As a natural result the lodge doctor becomes careless and slipshod in his medical ways. His diagnostic ability not only remains at a dead standstill, but from 'disuse-atrophy' retrogrades so far that his advice is of no more value than that of the corner druggist.

"We are in too enlightened an age not to be able to remedy or at the least make lighter most evils, and the evil of lodge practice is one that can be solved and eradicated. To do this vigorous and strenuous action must be taken by the east side physicians."

No comments: