Cushing, Richard J.

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The Linacre QuarterlyVolume 16 | Number 4 Article 210-1-1949On the National Health and Socialized MedicineRichard J. CushingFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCushing, Richard J. (1949) "On the National Health and Socialized Medicine," The Linacre Quarterly: Vol. 16: No. 4, Article 2.Available at: http://epublications.marquette.edu/lnq/vol16/iss4/2On the National Health and Socialized MedicineCover Page FootnoteAn address delivered at the meeting of the National Gastroenterological Association, in Boston,. Mass.,October 24, 1949.This article is available in The Linacre Quarterly: http://epublications.marquette.edu/lnq/vol16/iss4/2THE LINACRE QUARTERLY On the National Health and Socialized Medicine 7 HI. Excellency. the Most Rey. Richard J. Cushing. D. D. . Archbishop of 'oston An address delivered at the ~neeting of the National Gastro-enterological Association, in Boston,. Mass., October ~4, 1949. I I T WAS suggested that I might talk to you tonight about some of the problems you and we-the medical and the moral 'advisors of the community - have in common. One such problem is the question of "socialized medicine." It is of particular interest to you because it is concerned with medicine and medicine, its theory and its practice, is your business. It also pertains to. the area of philosophy and ethics, which is the concern of the moral teacher, because it involves a definite theory of the nature and functions of 'society and of society's relationship to the. individual person. I Socialized medicine in anything like a full sense of the term would profoundly influence the present status and future develop-ment of your profession; it would no less certainly create new and l~omplex problems for the hospitals and other institutions which fulfill the religious obligation of the Church to practice the spirit-ual and corporal works of mercy. Hence the instinctive reaction of disfavor in both our camps toward proposals for socialized medical programs which might I:esult in a strictly Socialist state. We think that such a state would mean the paralysis of profes-sional and personal progress; we know it would be the death of freedom. But I do not propose to denounce the Socialist state tonight nor to discuss the problems which might come with socialized medicine. I am persuaded that the so-called "welfare state" need not evolye here in America if certain real and present problems are met alike by ourselves and by proper government action. The \'ery real and pressing problem of pertinent interest to you and to me tonight is that of national health.-, . I Ii. ',' 1 !~ I • I ! I I I, t .. , .. ~! . ', ,. 8 THE LINACRE QUARTERLY , , '¥hatever your opinion of socialized medicine or of any specific I national health progl'llm, the faet is that there does exist II l ·national health problem. The further fact is that this problem is j social. Tuberculosis, polio, contagion of any kind is a socilll problem; it is not merely personal to the individual who is afflicted I by it. The causes of many diseases are beyond the control of the I individual; so is their cUl'e way beyond his personal possibilities. II Hence the social nature of the , problem of disease and of the ; correlated problem of heuIth. The heulth problem in ,the United States is neither established nor stuted in terms of druft rejection stutistics. Critics of COIll-pulsory health insurunce, for example, ure on good ground when they chullenge the arguments for sociulized medicine based on reports growing out of draft board rejections. Rejections during World W' ar II umounted to thirty-six percent of the men called for duty. If the figure were un accurate index of our public health, we would really be in a hud way . . But that is not the whole truth hy any manner nor means. Many rejections were for non-medical cuuses. Others involved conditions which could not have been prevented by any form of • medicul treutment. Men were eliminuted for illiteracy, mental deficiency, and insanity-for minor difficulties such as eye trouble, defective hearing, lind even for flat feet. There was quite /.l bit of venereal disease, and that is a moral before it is a medical problem . These items covered sixty percent of the rejections in some places. , Moreover, the army exuminations were for combat duty-not to determine whether the men were in good general health, nor even whether they were fit for civilian employment or for life in a nor- ' mal society. They do not provide a fair picture of national health . But nonetheless there is still a very reul nationul heaIt.h problem. The real problem can be stuted in terms of the tremendous • number of the chronic sick for whom there are no proper places at any price or who cannot pay the prices of the only places thllt f there ure. It can be stu ted in terms of the high cost of maternit)· which for millions means the high cost of morality. It can be t stuted in terms of the high cost for many and the limited fucilities for all in the fields of preventative and diagnostic medicine. It can THE LINACRE QUARTERLY 9 he st.ated in terms of the almost. prohibit.ive eost. of certain . forms, ("'rn common forms of surgery. Last week a national magazine carried a clever but. not entirely funny cartoon. A doctor is advising a patient-and he says: "You are faced with long hospitalization and a serious operation. My advice to you is to resign your job, sell your property, abandon \"Imr family, go to England, become a British citizen and fall in iine outside the Ministry of Health." Silly-but sometimes illogical lines of reasoning run from not-so-silly problems to worse-than-silly solutions. The solution of socialized medicine is unwelcomc--but so is the situation at which that solution is aimed. And so, as a dispassionate and objective basis for the discussion of socialized or other medical programs I propose an honest appraisal of the real health problem in the United States and I I('ave to you the question of what the profession is doing about it. The first and fundamental consideration in approaching the problem of the Nation's health is to determine definitely. and dellrly the shortages which now exist in terms of institutional facilities, personnel and technical services required to meet an adequate standard of health and physic III well-being. The second ('onsideration is to work out a program which will eliminate the rxisting shortages most effectively without violating sound social principles. Many surveys have demonstrated these shortages. For ('xllmple, the Ewing Report on "The Nation's Health" as of September 2, 1948 states that our country needs at the present time 90,000 more hospital beds for the care of acute sickness in general hospitals; a large increase is also critically needed to meet the shortage of beds in our chronic hospitals which serve the mentally afflicted, the tubercular, orthopedic, and similar cate-gories of the disabled and the afflicted. The same Report also sta tes that whereas there are 190,000 physicians qualified to practice medicine at present, the number udually required to meet the needs of the American people within the immediate future is 254,O(}O, lll'o"ided t.he same rat.io is main-tuined for t.he country as a whole which now prevails in the top b ·cl states. It must be remembered furthermore, that only 5,60() 10 THE LIN ACRE QUARTERLY graduates become available each year from our medical schools, whereas 4,000 retire from practice, because of death, disability or transfer to other activities. Clearly something systematic must be done about this, and if not by the profession then by whom? The :Ewing Report reveals further that whereas we have at present. 75,000 dentists, we need within the immediate future 95,000 in order to meet adequate health standards for the Ameri-can people. The present ratio is approximately one dentist for every 1,850. Unless the number of dentists graduating annually from our dental colleges is increased, we shall hav~ a worse shortage ill t he years to come. Finally, the Ewing R epOl·t states that our present supply of nurses is only 318,000 for the nation, whereas 443,000 are needed in the immediate future. The American Nurses' Association has estimated the current shortage of' nurses at 42,000. 1."lany more i thousands will be needed by 1960 to staff the many new hospitals I and local health centers which must be built. Built by whom? Critics of "socialized medicine" proposals which would empower ) the State to solve all these problems by direct action are persuaded that such proposals run count.er to long-tested American social principles. They are also pe)·suaded that these proposals fail in practice to solve the shortages-the real heart of the health \ problem. For example, I earnestly commend for your study the observations on this shortage problem made by the health bureau of the National Catholic Welfare Conference in their booklet • entitled: "A Voluntary Approach to a National Health Program." This report is critical of the proposals for national compulsory health insurance--but it offers a constructive alternative approach to the problem, an approach which in very great measure depends on our doctors and hospitals as well as on the government for its ultima te success. . There are many and prudent reasons for a cautious, critical attitude towards political proposals which might establish a "welfare state" here in America. All state socialism, however mild, sooner or later creates serious problems for independent, private interest.s. It becomes impossible for programs supported by what is sometimes called the charity dollar, the dollar freely given by private persons to support independent organizations, to compete 1 t ; I THE LlNACRE QUARTERLY 11 with the so-called tax dollar, the dollar raised by taxation and spent by Federal or other State agencies for organized social service agencies, for hospital programs, or for education schemes . which are state-supported and state-controlled. The charity dollar . cannot long compete with the tax dollar once the tax dollar · becomes a weapon in the hands of a socialist state. In the first place, it is very easy to collect tax dollars. All the prestige and the police power of the state is behind their collection. It is always harder to collect charity dollars~and it becomes increasingly hard, almost to the point of impossible, to collect charity dollars in a socialist state when so many tax dollars are being collected from the same people to finance increasing state-subsidized and state-controlled community works which, as they multiply, require Jet more taxation. In the case of Socialist programs fol' health there are added reasons for caution and concern. The late "Al" Smith used to have a formula for riveting attention on a question which called for honest appraisal. He used to say: "Let's take a look at the record!" Well, political programs of socialized medicine have a certain amount of history behind t.hem-and t.hat history deserves careful study before we decide too definitely one way or another. Bismarck introduced an exdusi\'e State medieal program ill Germany in 1883. He had no interest in the common man as such 1I0r in social reform for its own sake. But he was interested in .~ocialized medicine because it. would strengthen the monarchy by making the people dependent on the Stat.e. The German system spread to Austria in 1888. It was introduced in France III a modified form in 1918. Under this essentially German-Nationalist program medical CUl'e was free--at least it was free in the sense that the patient made no direct payment for the service. The entire cost was paid by the State. It came out of u fund mised by general taxation. When the French took over that system with the Province of Alsace after VVorld War I, they found it involved in huge deficits lind widespread corruption. They substituted a medical reimburse-ment plan under which the patient paid the bill Hnd then applied f.or a refund from the State. The sen'ice did not improve. Deficits continued. Medical care was free. The people abused their privilege 12 THE LINACRE QVARTERLY I I lind took ad,·antage of the system. That 'seems to be its history ·j in New Zealand, too. I think Americans will prefer something l else here. I In any case, I am only contending this evening that there is needed honest talk, great prudence and sincere study before we decide for or against any program for solving the national health program. For my own part, I believe the Bureau of Health and Hospitals of the National Catholic Welfare Conference has offered a plan of positive merit in its booklet on the voluntary approach to the problem. I have' brought a number of these booklets for Jour study if you care to take them with you. I will be glad to supply others to any who write me. The national Catholic health and hospital groups have given careful consideration to the yaried phases of a national health program, and in formulating their conclusions they approach the problem not frolll a negative but from a positive viewpoint. They emphasize the right. of private initiative and professional indepen-dence, but they also insist on the responsibility of private initiative to help solye the other fellow's problems, and t.hey are anxious that the pmfession keep its nncient reputation for the special care of the poor. They recognize the existence of government responsi-bilit.ies but at the same time they reject the concept of an exclusive state responsibility for the health and physical well-being of the American people. They arc as suspicious of an exclusive State health program as the)' would be of an education program totally and by universal compulsion in the hands of the State. Steering II salle middle course between State socialism and irresponsible liberalism, the Catholic group takes the position that II partnership bet.ween the stllte and yolunt.ary associations pro- , yides a solution whit'll is practical !lnd also consistent with Chris- ~ tian idealism and American tradition. It is the function of the ' democrat.ic state to help-not to monopolize-to assist where ' assistance is needed, not to "take over." State monopoly means control-and polit.ical control, howe,'er kindly, means despotism. Part.nership lIle(tJ!S freedom-and bot.h doctors and patients desire the greatest· Illcasurc of freedom consistent with God's Law and man's need .. 

On the National Health and Socialized Medicine

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