Dollars, Doctors, and Disease

"Society must look forward to providing for health on the same basis as education, or else leave the medical profession in its present unfortunate plight."
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I

A score of recent books, all of which might have been entitled Alice in Blunderland, have to do with the causes of our industrial depression. Why must so many thousands go hungry? Because we have produced too much corn and wheat, too many apples and potatoes, too much food of all kinds. Why must anybody suffer from cold? Because we have produced far too much coal and fuel oil, too much wool, too many woolen mills, too much clothing. Why must anybody live in shabby houses? Because we have surplus lumber, steel, copper, cement, hardware, and surplus carpenters, plumbers, painters, masons, architects, and contractors. But if we have surplus men and materials in one part of the country and not enough in other parts, why don’t we move the surplus to the parts where it is needed? The answer to that question is plainest of all. It is because we have too many railroads, too many ships, too many trucks.

Precisely the same conditions now affect the medical profession. At least one hundred thousand persons in the United States sorely need hospital care to-day, but are not getting it. Why not? The answer seems to be that only two thirds of the beds in our private hospitals are in use, and the hospitals do not know what to do with their surplus capacity.

At least fifty million persons in the United States whose teeth are decaying are not receiving adequate dental care. Why not? That is because this country leads the world in dental science and has tens of thousands of partially unemployed dentists.

Many millions of men, women, and children suffer from other preventable diseases. Why is nothing done about that? The answer is that the science of preventive medicine has made marvelous advances in recent years, and tens of thousands of competent physicians are eager to use their new knowledge and their idle hours to save humanity from needless suffering.

These are mad riddles of the Mad Hatter. The riddles and the answers provide another chapter for Alice in Blunderland.

Evidently, the problem of providing adequate medical and dental care for all the people is in one essential the same as the problem of providing adequate food, clothing, shelter, and transportation. The main question is how we are to enable the people to pay for the commodities and services which already we are fully able to provide. Under present conditions, the best medical care is available, where it is available at all, only to the very poor and the very rich. The Committee on the Costs of Medical Care, which has just published its final report, has shown wisdom, therefore, in centring its recommendations about that fundamental question. Already we have Doctors and Diseases in superabundance, and the supply of Dollars is wholly subject to human control. The main problem is to maintain, in the right channels, a sufficient flow of Dollars to enable the Doctors to deal adequately with the Diseases.

II

Six years ago, seventy-five leading citizens, both inside and outside of the profession of medicine, were consulted concerning this problem. They were virtually unanimous in favoring the organization of a committee to carry on a five-year programme of research in the economic aspects of medical care. A committee of fifty was appointed, representing the fields of private practice, public health, medical institutions, social sciences, and the public. A slight majority of this committee are doctors of medicine or doctors of dental surgery. Dr. Bay Lyman Wilbur, who is chairman of the committee, has a unique combination of qualifications for that position. As a former medical practitioner, as a former President of the American Medical Association, and as President of Stanford University and Secretary of the Interior, he well represents both the profession and the public.

The committee’s research staff, which has been maintained in Washington during the past five years, has produced twenty-six volumes. These volumes, dealing exclusively with facts, have been published by the University of Chicago Press. The value of these studies, regardless of the worth of the recommendations of the committee (to be discussed presently), abundantly justifies the committee’s expenditure of its own time and of its budget of seven or eight hundred thousand dollars.

The committee has been unable, however, to carry out certain lines of research, the importance of which has been revealed by its own investigations; and the committee goes out of existence the first of January. It is highly important that some other organization, formed for the purpose of promoting, coordinating, and making useful further research in this field, shall now take up the work. It is also important that some organization should endeavor immediately to promote demonstrations and experiments in various communities, in accordance with the major recommendations of the committee.

III

‘Why is the committee chiefly concerned with the costs of medical care?’ writes one of our critics. ‘The trouble is not chiefly economic. Who wants to visit a dentist, anyway? If the workers had more money, they would buy more candy, cosmetics, and chewing gum, but not more dental services. The main reason why they neglect their teeth is not lack of money.’

The researches of the committee do not support this contention. They show, on the contrary, that in the course of a year 90 per cent of the members of families which have incomes of less than $1200 receive no dental care whatever, whereas the figure is only 40 per cent among families with incomes of over $10,000. One member of the committee, Dr. Michael M. Davis, finds that, even in prosperous times, 61 per cent of working-class families in Boston, New York, and Philadelphia spend nothing for dental care. In this study, the causal connection between family incomes and neglect of the teeth is evident. Three fourths of the families with incomes of less than $100 spend nothing, while only one fourth of the families with incomes of $2500 a year spend nothing. The main trouble is not lack of intelligence, but lack of money.

In further proof of this conclusion, Professor Jessica B. Piexotto cites the expenditures of ninety-six families of faculty members at the University of California. All these families, undoubtedly, are fully aware of the importance of dental care; the struggling young instructors know as much about that as the old professors on full salaries. Yet here again the amount of dental care purchased varies directly with the salaries.

In the United States there is approximately one dentist to every 1800 persons. Since a single dentist, however, cannot render adequate service to more than 30 per cent of this number, about 70 per cent of the needed dental services, even in prosperous times, are not rendered at all. To-day the extent of the neglect is nearer 80 per cent. Certainly, any plan which overcame the economic causes of this neglect would more than double the number of persons who receive adequate dental care, no matter what the effect might be meanwhile on the consumption of candy, cosmetics, and chewing gum.

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