[Skip to Content]
[Skip to Content Landing]
July 13, 1984

A Modest Policy Proposal: The National Health Selective Disservice

Author Affiliations

Dr Crawshaw is in private practice, Portland, Ore.

JAMA. 1984;252(2):261-262. doi:10.1001/jama.1984.03350020063028

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


EARLY on a raw February morning, I discovered how close this year of 1984 has come to fulfilling George Orwell's prophecy. A bright colleague, thought by some to be a loudmouth, by others a renegade, opened my sleepy eyes to strange possibilities when he sat down beside me at breakfast exclaiming, "I've got it all worked out. To hell with HMOs and PPOs; it is NHSD, the National Health Selective Disservice all the way!"

It was 6:45 AM and we were at the counter of the Central Cafe, a hole-in-the-wall beanery, a block and a half from the local hospital. It's the kind of place that tries to live down its honest working man's heritage of red plastic upholstered chrome-plated stools and formica counter top by piping in classical music and labeling hash-brown potatoes "cottage fries" on the menu. My friend, or more precisely, my acquaintance, was still in his