Brickman J P
Department of Humanities, U.S. Merchant Marine Academy, Kings Point, New York 11024, USA.
J Public Health Policy. 1999;20(3):282-309.
The late 1930s challenged laissez-faire medicine. Recognition of serious inadequacies in the distribution of medical services stirred activists who questioned fee-for-service delivery and posited a national health program, including health insurance. The AMA and its components--state and county medical societies--counterattacked, mobilizing money and their powerful political arsenal to fight government intrusion in private medicine. The Physicians Forum, initially under the leadership of Ernst P. Boas, emerged as a formidable element within the New York County Medical Society (the largest component of the AMA). The Forum provoked discussion of medical indigence and economics, upsetting the Society leadership with independent candidate slates and telling the public that doctors spoke with more than one voice. For 25 years, the Physicians Forum altered the dynamics of the Medical Society of the County of New York. While the Forum effort to institutionalize minority opinion in the councils of medicine failed, the interchange between County regulars and Forum insurgents broadened the medical reform agenda and moved the County Society in directions that historically it had avoided. Although medical economics formed an unbridgeable chasm between County regulars and rebels, Forum members demonstrated that medicine was not monolithic, that "majority opinion [was not] ... unanimous opinion," and that doctors must speak to issues of medical and social policy.
20世纪30年代后期对自由放任的医学提出了挑战。对医疗服务分配中严重不足的认识激发了一些积极分子，他们质疑按服务收费的提供方式，并提出了一项包括健康保险在内的国家健康计划。美国医学协会（AMA）及其分支机构——州和县医学协会——进行了反击，筹集资金并动用其强大的政治武器库来抵制政府对私人医疗的干预。医师论坛最初在恩斯特·P·博阿斯的领导下，成为纽约县医学协会（AMA最大的分支机构）内部一股强大的力量。该论坛引发了关于医疗贫困和经济学的讨论，通过独立候选人名单扰乱了协会领导层，并向公众表明医生并非只有一种声音。25年来，医师论坛改变了纽约县医学协会的动态。虽然该论坛在医学委员会中将少数派意见制度化的努力失败了，但县医学协会的常客与论坛叛乱者之间的交流拓宽了医疗改革议程，并使县医学协会朝着其历史上一直回避的方向发展。尽管医疗经济学在县医学协会的常客和叛乱者之间形成了一道无法逾越的鸿沟，但论坛成员表明医学并非铁板一块，“多数意见并非……一致意见”，并且医生必须谈论医疗和社会政策问题。
