SSS ? RRR ot 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