The Anatomy of Our Melancholy

Abstract Events in health care since Medicare and Medicaid, and a public determination to control quality, cost and distribution of medical services, are moving the medical profession from a loose, implicit contract with the public to a structured, formal one. The responses of organized medicine to this trend are deficient in certain respects, particularly in the lack of systematic and positive planning. Medical societies have neither recognized the need nor prepared for negotiation with government. Because of the structure of medical societies, and because of medicine's socioeconomic objectives, medical societies do not appear to be appropriate bodies for health-care planning or negotiation. More effective would be statewide institutes that would complement local health-care delivery organizations, would develop uniform data-collecting systems, would analyze and interpret such data and would act as intermediaries between physicians and third parties in negotiations at super-regional levels.