Professor C.E.A. Winslow Chairman of the Executive Committee of the Committee on the Costs of Medical Care and Professor of Public Health at Yale University summarizes the results of five years of foundation funded effort on what to do about the broken U.S. health care system in the January 27, 1933 issue of Science:

1. Use the equivalent of HMOs run by hospitals for accountable, integrated, care: “Medical service, both preventive and therapeutic, should be furnished largely by organized groups of physicians, dentists, nurses, pharmacists and other associated personnel. Such groups should be organized, preferably around a hospital, for rendering complete home, office, and hospital care.”
2. Use capitated payment to accumulate collective reserves to pay for services: “the costs of medical care [should] be placed on a group payment basis, through the use of insurance, through the use of taxation; or through the use of both these methods.”

The “method of accumulating the collective reserves to pay for services would differ with local conditions.” The indigent would be supported by tax payments, rural areas would have a tax levied on them, and in industrial areas that employer “might properly contribute his share.” In the final analysis, the professor thought that “[i]t seems highly desirable, however, for the development of a due sense of personal responsibility that as large a proportion as possible of the costs of medical care should be borne by those who are to receive that care—in other words, by payment from individual families through the medium of an insurance plan.”

The Committee would have applauded ObamaCare. Its majority was not prepared to recommend “compulsory sickness insurance” in 1933 for fear that it would fortify the existing system of “individualistic” medical practice. What it recommended was “a period of experimentation with voluntary group purchase going hand in hand with the development of group practice so that when compulsion comes the public can contract with well-organized and well-established medical center and their cooperating agencies. We can begin with industrial groups, church groups, neighborhood groups and other voluntary aggregations, while we are gaining experience in medical organization and in actuarial practice.”

The good professor states that the Committee is just trying to save Americans: “We believe that the policy we have proposed is the only way of forestalling a type of state action which has become almost universal in Europe and which will be inevitable here if such forms of voluntary group planning as we have suggested cannot be successfully evolved.”

He closes with a quote from the Committee that says that if “state action is necessary there are forty-eight laboratories.” As his summary makes clear, he sees nothing wrong with experimenting on the whole American population. “Experimental social planning along sound theoretical lines, but based on existing American institutions—this is the objective set before us for the solution of the economic problem of medical care.”

In other words, you have to pass the bill so that you can find out what is in it.

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