Lundberg George D
Medscape, Inc., New York, NY 10001-4905, USA.
Yale J Biol Med. 2002 Jan-Feb;75(1):23-7.
John Peters and his committee had a few basic goals. One was that local, state, and federal governments needed to provide money to construct facilities, support medical research and education, and care for the poor. And they wanted experts to call the shots. Over time, Peters and the committee got what they wanted for the most part: Hill-Burton money for building the hospitals, the rise of the National Institutes of Health, Medicare, Medicaid, a Veterans Administration system, and new and expanded medical schools. The experts calling the shots included David Kessler at the Food and Drug Administration and Surgeon General C. Everett Koop. In the halcyon days of American health system reform, back in 1993, Yale's Paul Beeson wrote about the Committee of 430 Physicians and its goals in the Pharos of Alpha Omega Alpha. Beeson was optimistic and he quoted from my 1991 JAMA health system reform editorial as a sharp contrast to what Fishbein had written - although coincidentally, we both quote Lincoln. My editorial began, "'with malice toward none, with charity for all...' so spoke Abraham Lincoln in his second inaugural address recognizing that he had no political consensus regarding either the constitutionality of states seceding or the morality of slavery being abolished. Nonetheless, he knew what was right and was able, through persuasive, often inspiring rhetoric, to conclude a bloody and decisive Civil War and constitute the foundation for this great republic.... Yet access to basic medical care for all of our inhabitants is still not a reality in this country. There are many reasons for this, not the least of which is a long-standing, systematic, institutionalized racial discrimination.... An aura of inevitablitiy is upon us. It is not acceptable morally, ethically, or economically for so many of our people to be medically uninsured or seriously underinsured. We can solve this problem. We have the knowledge and the resources, the skills, the time, and the moral prescience. We need only clear-cut objectives and proper organization of existing resources. Have we now the national will and leadership?" Beeson's answer to that question in 1993 was, "Yes, but not by one comprehensive act." He quoted Peters from his 1938 Annals of Internal Medicine article: "a sweeping program suddenly imposed in this country as a whole out of the head of any Jove would undoubtedly create confusion if not chaos. Thoughtful investigation and experiment promises more than grandiose projects born of emotional preconceptions. The programs must be built of an evolutionary manner, step by step." Very wise, very valid. But how long must our people wait?
约翰·彼得斯和他的委员会有几个基本目标。其一，地方、州和联邦政府需要提供资金来建设设施、支持医学研究与教育以及照顾贫困人口。而且他们希望由专家来掌控局面。随着时间的推移，彼得斯和委员会在很大程度上实现了他们的愿望：希尔-伯顿法案的资金用于建设医院，国立卫生研究院的崛起，医疗保险、医疗补助、退伍军人管理系统以及新的和扩大的医学院校。掌控局面的专家包括食品药品监督管理局的大卫·凯斯勒和卫生局局长C. 埃弗雷特·库普。在美国医疗体系改革的美好时光里，回溯到1993年，耶鲁大学的保罗·比森在《阿尔法欧米伽阿尔法医学生联谊会期刊》上撰文讲述了430位医生委员会及其目标。比森很乐观，他引用了我1991年发表在《美国医学会杂志》上的关于医疗体系改革的社论内容，以此与菲什拜因所写的形成鲜明对比——尽管巧合的是，我们都引用了林肯的话。我的社论开篇是：“‘勿以恶小而为之，勿以善小而不为……’亚伯拉罕·林肯在他的第二次就职演说中如此说道，他认识到在州脱离联邦的合宪性以及废除奴隶制的道德性方面，他没有达成政治共识。然而，他知道什么是正确的，并且能够通过有说服力的、常常鼓舞人心的言辞，结束一场血腥而决定性的内战，并为这个伟大的共和国奠定基础……然而，让我们所有居民都能获得基本医疗保健在这个国家仍然不是现实。原因有很多，其中一个重要原因是长期存在的、系统的、制度化的种族歧视……一种必然性的氛围笼罩着我们。从道德、伦理或经济角度来看，我们这么多民众没有医疗保险或严重保险不足是不可接受的。我们能够解决这个问题。我们拥有知识、资源、技能、时间和道德先见。我们只需要明确的目标和对现有资源的合理组织。我们现在有国家意志和领导力吗？”比森在1993年对这个问题的回答是：“有，但不是通过一项全面的法案。”他引用了彼得斯1938年发表在《内科学年鉴》上的文章内容：“在这个国家整体上突然从某个朱庇特的脑袋里蹦出一个全面的计划，无疑会造成混乱，甚至是混乱不堪。深思熟虑的调查和实验带来的成果比基于情感先入之见而生的宏伟项目更多。这些计划必须以渐进的方式逐步构建。”非常明智，非常正确。但我们的人民要等多久呢？
