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July 19, 1971

Is "Bigness" the Answer?

JAMA. 1971;217(3):334. doi:10.1001/jama.1971.03190030058014

When a controversial article appears in the New England Journal of Medicine, editorial comment often accompanies. Not so for a recent essay by Halberstam.1 Acknowledging that there are deficiencies in the way medical care is provided to many people, the author notes that suggestions for reform have been made by economists or by physicians fascinated by the application of economics to their profession. Their writings (and others have copied) are generously larded with terms such as "consumers," "providers," "cottage industry," and "health care delivery."

The nub of Halberstam's message rests in the fact that proposals to systematize "health care delivery"—to make it efficient in some large way with automation, computers, and groupings—are completely at odds with pronouncements of today's radical theorists who "reject centralization, fear unchallenged technology, and envision mankind as having bartered its freedom for a few trade goods." To them, the present organization of American medicine exemplifies