Dollars for Doctors

One exception to Parkinson's Law that everything which is tends to persist and everything that does tends to expand and take on bigger things is the Blue Cross. With rising hospital costs and a corresponding need to raise premiums sicklying o'er the healthy hue of resolution, most Blue Cross plans have responded to inflation by restricting benefits rather than extending them. And this loss of "pioneering spirit" has become a matter of concern to prominent Blue Cross and voluntary hospital officials.

Not only do these individuals feel stagnated, but the desire of unions and large business organizations to form nation-wide insurance plans, and the vague but omnipresent threat of compulsory national health insurance has resulted in a desire for a larger and more effective Blue Cross. Two events in the last few weeks have outlined the crisis in the organization's structure and purposes.

National health insurance plans have been adopted by almost all of the major nations of the world, and the United States can be saved from a similar fate only if voluntary organizations prove adequate. This is the thesis on which John R. Maddax, executive vice president of the Blue Cross of Northeast Ohio, based his plea for an American Blue Cross in a speech to the American Hospital Association. According to Maddix, such an organization would have Presidential appointees from the fields of agriculture, labor, and management as trustees, and would be able to provide nationwide benefits on a service basis, with wider rural and urban coverage and special rates for the retired and unemployed.

Shortly after Maddix's speech, New York City labor leader Harry A. Van Arsdale, Jr. charged Blue Cross with "tolerating excessive hospital costs" and keeping labor out of its administration. Unless they can have more of a say in Blue Cross, labor leaders claim they will start their own health plans and hospitals. (It might be added that hospital officials thought the "tolerating excessive costs" charge ironic in view of the attempt of unions to organize underpaid non-professional hospital workers last spring.) Furthermore, national health insurance, while not a political football at present, could easily become so with enough encouragement from labor leaders.

But labor criticism of Blue Cross fails to point out all the present inadequacies of the organization. Drugs and X-rays, if used for diagnosis, are not covered. Tuberculosis, mental illness, and old age are also outside the program. In Maddix's view, until everyone can pay for medical bills from "out of his pocket," there will be room for health insurance expansion.

A compulsory federal plan still seems a long way off, but it would be a shame to allow lack of cohesion to destroy the local administrative machinery of Blue Cross, Blue Shield, and their counterparts, if a national superstructure could be set up to deal with the problems of nation-wide coverage. Such supplementary programs as Connecticut's C.M.S. program to cover non-hospital medical expenses for families earning less than $7000 could be expanded similarly. One can only regret that voluntary insurance plans have taken so long to find out that Americans will take any steps necessary to avoid paying the doctor.