The high point of efforts to improve access to health care by "documentation." - Committee on the Costs of Medical Care - National Health Policy

Physician Executive, Nov-Dec, 1992 by Norbert Golfield

Cost shifting from employers and employees, preemployment testing, and rigorous eligibility screening, also known today as "coordination of benefits" or COB, are time-honored tools to decrease health care costs.

CCMC reports contain a veritable fountain of interesting health care experiments, many of which emphasized the value of prepaid and/or preventive services--virtually all of which occurred without support by foundations! In many situations, health care institutions were willing to place themselves at financial risk to prove their confidence in the value of preventive services such as prenatal care: "It was our thought that if we could say to the people of the community that we are so confident of the lessened risk to the mother who has seen her doctor early in pregnancy, that we are willing to guarantee that the amount of the hospital bill will be low, it would demonstrate our belief in the efficacy in the belief of proper prenatal care. We are supplementing this work at the hospital by the establishment of prenatal clinics in the outlying sections of the county."[16]

Concluding Remarks

As late as 1932, it appeared that the final report might be unamimous. In a letter dated April 27, 1932, the CCMC chairman, C.E.A. Winslow declared: "I anticipated wide differences of opinion regarding the historical and philosophical section. It was misplaced as a part of the actual report of the committee."[17] By September 1932, the inevitable split between physicians and the rest of the committee occurred. CCMC emphasis on group practice represented the ostensible lightning rod: "The important point is just this--that the majority advocates the organization of the entire medical profession into groups to furnish care under some type of contract practice, the funds to be furnished by insurance, preferably of the voluntary type. It seems to us that they have taken this position and then have rationalized it throughout the report....We believe that the safe way for the future is by the development of the individual practice of medicine, making use of organizations where possible to eliminate waste and improve the service. It is, of course, impossible for two conceptions so widely at variance to be reconciled (emphasis added).[18]

The final CCMC report, with its majority and minority recommendations, was issued shortly thereafter. There were virulent editorials in the Journal of the American Medical Association. When news articles did appear on the CCMC final report, headlines emphasized the rancorous finale.

In the short term, the recommendations of the CCMC fell on deaf ears for those who mattered most--the young officials who made up the new administration of Franklin Delano Roosevelt. While they may have been young, Roosevelt and his assistant were not politically foolish. They carefully tackled only those domestic issues that could be successfully addressed legislatively. The Roosevelt administration did not believe that the modest CCMC recommendations could be enacted. The reasons for the noticeable absence of national health reform from the Roosevelt agenda of massive governmental involvement in almost every other domestic issue will be fully explored in the next article in this series.