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NTI ULL SHILA mn

FEATURE

Tonight there has been shown the
most interesting case ever presented to
this Society. It is the case of “‘the People
versus the Doctors.’ We are acting both
. as defendant and Judge. It behooves us
to apply our minds with the utmost ob-
jectivity to this question. The case is an
ethical and moral problem in the field of
social and political economics, and not
medical economics alone. Medicine
must be envisaged as embedded in the
social fabric and inseparable from it. It is
the product of any given social environ-
ment. The basis of any social structure is
economic. Theeconomictheoryand prac-
tice in this country is termed capitalistic.
It is founded on individualism, competi-
tion and private profit. This capitalistic
system is undergoing an economic crisis
— commonly called the depression. This
is not a temporary illness of the body
politic, but a deadly disease requiring
systematic treatment. Systematic treat-
ment is called, by the timid, radical re-
medies. Those palliative measures as
suggested by most of our political quacks
are aspirin tablets for a syphilitic head-
ache. They may relieve, they will never
cure.

Medicine is a typical, loosely or-
ganized, basically individualistic in-
dustry in this ‘catch as catch can’ capital-
istic system, operating as a monopoly on
a private profit basis. Now, it is in-
evitable that medicine should undergo
much the same crisis as the rest of the
capitalistic world and should present
much the same interesting and un-
comfortable phenomena. This may be
epitomized as ‘‘poverty of health in the
midst of scientific abundance of knowl-
edge of disease.’ Just as thousands of
people are hungry in a country which
produces more food than the people can
consume (we even burn coffee, kill hogs
and pay farmers not to plant wheat and
cotton), just as thousands are wretchedly
clothed though the manufacturers can
make more clothing than they can sell, so
millions are sick, hundreds of thousands
suffer pain, and tens of thousands die
prematurely through lack of adequate
medical care, which is available but for
which they cannot pay. The problem of
medical economics is a part of the prob-
lem of world economics and is insepara-
ble and indivisible from it. Medicine, as
we are practising it, is a luxury trade. We
are selling bread at the price ofjewels . . .

Where Do We Go From Here?

Permit a few categorical statements.
Dogmatism has a role in the realm of
vacillation.

1) The best form of providing health
protection would be to change the eco-
nomic system which produces ill-health,
and liquidate ignorance, poverty and
unemployment. The practice of each in-
dividual chasing his own medical care
does not work. It is unjust, inefficient,
wasteful and completely out-moded.
Doctors, private charity and philan-
thropic institutions have kept it alive as
long as possible. It should have died a

natural death a hundred years ago, with
the coming of the industrial revolution in
the opening years of the 19th century. In
our highly-geared, modern industrial
society there is no such thing as private
health — all health is public. The illness
and maladjustments of one unit of the
mass affects all other members. The pro-
tection of the people’s health should be
recognized by the Government as its
primary obligation and duty to its citi-
zens. Socialized medicine and the aboli-
tion or restriction of private practice
would appear to be the realistic solution
of the problem. Let us take the profit, the
private economic profit, out of medicine,
and purify our profession of rapacious
individuals. Let us make it disgraceful to
enrich ourselves at the expense of the
miseries of our fellow man. Let us or-
ganize ourselves so that we can no longer
be exploited as we are being exploited by
our politicians. Let us re-define medical
ethics — not as a code of professional
etiquette between doctors, but as a code
of fundamental morality and justice be-
tween medicine and the people. In our
medical society let us discuss more often
the great problems of our age and not so
much interesting cases; the relationship
of medicine to the State; the duties of the
profession to the people; the matrix of
economics and sociology in which we
exist. Let us recognize that our most im-
portant contemporaneous problems are
economic and social and not technical
and scientific in the narrow sense that we
employ those words.

2) Medicine, like any other organ-
ization today, whether it be the Church
or the Bar, is judging its leaders by their
attitude to the fundamental social and
economic issues of the day. We need
fewer leading physicians and famous
surgeons in modern medicine and more
far-sighted, socially-imaginative states-
men.

The medical profession must do this —
as the traditional, historical andaltruistic
guardians of the people’s health: let us
present to the Government a complete,
comprehensive program of a planned
medical service for all the people, then,
in whatever position the profession finds
itself after such a plan has been evolved,
that position it must accept. This appa-
rent immolation as a burnt offering on the
altar of ideal public health will result in
the profession rising like a glorious
Phoenix from the dead ashes of its
former self.

Medicine must be entirely re-organ-
ized and unified, welded into a great
army of doctors, dentists, nurses, tech-
nicians and social service workers, to
make a collectivized attack on disease
and utilizing all the present scientific
knowledge of its members to-that end.

Let us say to the people not — “‘how
much have you got?’’, but — “‘how best
can we serve you?’’ Our slogan should

10 e PACIFIC TRIBUNE, SEPTEMBER 24, 1986

be “‘we are in business for your health’’.

3) Socialized medicine means that
health-protection. becomes “Ist public
property, like the post office, the army,
the navy, the judiciary and the school;
2nd: supported by public funds; 3rd: with
services available to all, not according to
income but according to need. Charity
must be abolished and justic substituted.
Charity debases the donor and de-
bauches the recipient; 4th: its workers to
be paid by the State with assured salaries
and pensions; 5th: with democratic self-
government by the health workers them-
selves.

Twenty-five years ago it was thought
contemptible to be called a Socialist.
Today it is ridiculous not to be one.

the realities of the present econon |
crisis. The world is cherie bare ae
very eyes and already the :
gulatite is beginning to be felt beneathits
keel the great surge and movement 0 one
rising world tide which is sweeping
obliterating old landscapes 40 be
beaches. We must go with the tide 0

wrecked. -

5) The contest in the world oat ]
between two kinds of men: tno at q
believe in the old jungle individu: ve Ee
and those who believe in coopera for.
forts for the securing of a better H

all.

de
The people are ready for Sf > the
medicine. The obstructionists 4

Medicine is a typical, loosely organized, pasical!’ |
individualistic industry in this ‘catch as catch :
capitalistic system, operating as a monopoly on

private profit basis.

f

can

Medical reforms, such as _ limited
Health Insurance schemes, are not so-
cialized medicine. They are bastard
forms of Socialism produced by a belated
humanitarianism out of necessity.

The three major objections which the
opponents of socialized medicine em-
phasize are Ist: loss of initiative. Al-
though the human donkey probably
needs, in this state of modern barbarism,
some sort of vegetable dangled in front of
his nose, this need not be a golden car-
rot but a posy of prestige will do as well.
2nd: Bureaucracy. This can be checked

by democratic control of organization ~

from bottom to top. 3rd: the importance
of the.patient’s own selection of a doctor.
This is a myth; its only proponents are
the doctors themselves — not the pa-
tients. Givena limited choice — say of 2 or
3 doctors, then if the patient is not satis-
fied, send him to a psychiatrist. Sauce
for the goose is sauce for the gander —
the doctor must also be given his own
selection of patients. 99 per cent of pa-
tients want results not personalities.

4) Our profession must arouse itself
from its scientific and intensely personal
preoccupation and, becoming socially-
minded, realize the inseparability of
health from economic security.

Let us abandon our isolation and grasp

Norman Bethune: Mural painted by Avrom Yanovsky and presented by him to Norman Bethune Centre in Toronto.

head
thio
e wi . It

’ ra ; li
people’s health-security Mie fact.

rofession itself. Recoginze = EHO
the all-important fact of the situa
These men with the mocking yee
reactionary or the listlessness. iples,
futilitarian, proclaim their P!
under the guise of “maintenanc’ {
sacred relationship between ie not
patient,’ ‘‘inefficiency of ot ee th
profit nationalized enterprises: dom
danger of Socialism,”’ “‘the ee ies
individualism.” These are the M© rhe
the people and make no mistake-
are the enemies of medicine t0°-

ti

The situation which is coniror
medicine today is a contest ole the i
in medicine itself. One holds th®’ ¢ out
portant thing is the maintenanc” ate

vested historical interest, on nds
property, our monopoly of be fun”
bution. The other contends that! {
tion of Medicine is greatet jon.
maintenance of the doctor's oe t
that the security of the people Sights

our primary duty, and that huma the
are above professional privilege® acteh
old challenge of Shakespeare’ S07" he |
in Henry IV still rings out ae eZ” ;
centuries: ‘‘Under which Kin® —
nian stand or die’.

enema ee