Sunday, November 16, 2008

Michael Crichton, M.D. 1942 - 2008

May he rest in peace.

Although it is well-known that Crichton trained as a physician it's likely most people think of him as an author. My first encounter with any of his writings was in
this March 1970 Atlantic Monthly article. Crichton was 27 years old when he wrote it.

The article is lengthy but you really should read the whole thing. Here is a sampling:

1. "Most research scientists in history are alive today; therefore most of the discoveries in history are being made today. But the consequences of this vast outpouring of information and technology have yet to be grasped. Major questions are raised in such widely diverse subjects as medical education and euthanasia."

2. "welfare reimbursements are always less than the true costs of care. In this situation, the hospital makes ends meet by overcharging private patients and their insurance companies to cover the welfare deficit-in the case of the MGH, roughly $10 [15%] a day overcharge."

3. "to pass on costs to insured patients and make them augment insufficient tax funding for welfare . . . all works out to the same thing: one can pay the money either in taxes or in higher health insurance premiums. But in such a situation, it is probably more efficient to choose one or the other -- and the trend is toward universal health insurance in this country, unmistakably. "

4. "the American medical system . . . has never been able to structure the kind of competitive situation which encourages and rewards economies. Nor has American medicine tried. The American physician has been grossly irresponsible in nearly all matters relating to the cost of medical care. One can trace this irresponsibility quite directly to the American Medical Association."

5. "Other countries are doing better, and most of them have some form of socialized medicine. The United States is extraordinarily backward in this respect. However, many American observers have looked at European socialized systems and have come away shaking their heads; and there is a widespread doubt whether any European system can be adapted to this country. Very likely, America will have to work out its own system. The combination of group insurance with a group-practice system seems a feasible, economical, and practical, method, acceptable both to doctors and patients."

The first half of the article is as clear an explanation as you will find anywhere of the stunning challenges and successes of modern medicine. And the second half remains, after all these years, a valuable critique of the organization and leadership of American medicine, from the AMA, to hospitals, to individual practitioners. I think it's fair to ask: aside from the costs stated in 1970 dollars, what has fundamentally changed in the 38 years since this article appeared?
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