1978

To The Editor:

Some time agoit was noted in the National Review that public and privateexpenditures on health, education, and welfare now consume as large ashare of the gross national product as does all the manufacturing. Itwryly remarked that if the trend continues, we will eventuallymanufacture nothing at all, but we will be the healthiest, besteducated bunch if welfare recipients in the whole world.

Today theamount of money expended by the government to improve the health careof our citizens is astronomical, yet Sen. Kennedy and PresidentCarter are contemplating spending even greater sums! The lessons ofyesterday that virtually all of the government's previous effortshave come to naught have not registered on the minds of our "liberal"representatives in Congress. They seem to have forgotten the fate ofthe Regional Medical Planning Programs, the fate of "Health, Cancer,and Stroke," the Health Manpower Act, the numerous other programsthat have been also devised.

They shouldalso be aware of the huge sum of moneys being spent today to promoteHealth Maintenance Organizations and Health Systems Agencies. Many ofthese are designed not to provide better medical care for ourcitizens, but only to provide the infrastructure for a NationalHealth Insurance Program!

The qualityof medical care rendered to the American public today is the highestin the world, but admittedly there are areas where the availabilityis less than acceptable; witness the quality delivered in the poorghettos and the people inhabiting run down and unsafe urban areas.The number of doctors are now more than adequate to meet ourcountry's needs and the only problem is redistribution. Theintroduction of a national health insurance program will do nothingto improve the present quality of our care but would enormouslyincrease the cost of its rendition, and the country can no longerafford to keep spending more and more for less and less.

One of thepoints constantly being made by the president is that he willincrease the efforts made to improve health education and to promotepreventive medicine. The long-term effects of a program of this typeare largely illusory! In fact, the things that affect our longevityand health are heredity, environment, and lifestyle. There is nothingone can do about the first, little about the second, and there isvery little desire on the part of most people to do much aboutchanging their life style; witness smoking, drinking, speeding,etc.

Dr. HelenHackman who recently resigned from her post as director of theArlington County Department of Health Resources in Arlington, V.A.,remarked that "each new health plan rediscovers prevention. Witnessthe 100 pages of the recently published health plan of the NorthernVirginia Health Systems Agency, as it spews out the same tiredrecommendations - more health education in schools, more seminars,more lectures, more of everything, which does not work. There hasbeen very little data accumulated documenting either the cost benefitor the cost effectiveness of devoting more resources to personalpreventive medicine. Yet, the government's drums beat on!"

Dr. Hackmancorrectly adds that, "Longevity and well-being depend only slightlyon the active efforts of individuals. Collective health improvementsin the community derive from the great sanitary advances; a purewater supply, adequate sewage, and food inspection that bringsreasonably safe and sanitary food to our stores, restaurants, andhomes. Adequate housing, heat, clothing, and food also contributegreatly. Immunization against specific diseases either by mandate aswith smallpox, or in the face of a dreaded and imminent threat suchas polio, are indispensable and such programs should be improved andexpanded."

Preventivemedicine as being planned by the government today through its healthsystem agencies is largely a myth. It will do little to improve thehealth of our citizens nor contain the ever escalating costs formedical care.

The realimprovement in medical care will come trough the results of medicalresearch in our medical school laboratories such as those at Harvard,John Hopkins, Stamford, to mention only a few, and through researchefforts at the National Health Institute and the National CenterInstitute and the research departments at such renoun clinics as theMayo Clinic, lahey Clinic, Memorial Hospital, etc. As our knowledgeof the basic sciences improves, practical applications for this newknowledge will be applied in our medical practice.

The CrashProgram adopted by the government several years ago was entitled,"Heart Disease, Cancer, and Stroke," accomplished nothing that wouldnot have been discovered normally with the passage of time andthrough the continuation of our research efforts in our numerousmedical institutions.

Charles E. Jacobson Jr., M.D.

45 Wyllys St.

Manchester, CT