Page 199 - The Drucker Lectures

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was a young economist, the first job he got after he received his
Ph.D. was on a commission on the cost of medical care, which
President Hoover started. And to my knowledge, the commis-
sion never published its report because it was totally unaccept-
able to Mr. Hoover, who wanted to introduce a German-style
health-care system in this country. He had lived in Europe many
years of his life, as you know, and was a great admirer of the
German system. But Congress had turned him down, and he
wanted to show that paying for health care was an important so-
cial issue. But that commission of distinguished medical people
and sociologists and economists could not find any cost for med-
ical care. It was less than one-half of 1 percent of gross national
product in 1929. Now, since then, that number has increased at
least 50-fold—from one-half of 1 percent to 14 percent. And no
structure can stand that kind of growth, almost all of which has
come after World War II, by the way. Eventually, you reach a
point where you can’t patch anymore. And we have reached that
point everyplace.
And so I think what we are doing in this country frightens
me because, first, we are patching. And secondly, we pretend
that this is an American problem. It isn’t. It is a problem of the
success of health care. Our assumptions are no longer valid. We
have to redesign the system. And I’m not talking about how to
pay for it; that’s the wrong way to start. The right way to start is
to ask what we’re going to pay for.
Probably half of the demands on the system consist of things
that are treated pretty much the way the physicians in Alexander
the Great’s army treated them. Between you and me, we X-ray
the ankle more to satisfy the patient than for any great medi-
cal reason. But it takes the same three months to heal. And, all
right, you can put a shot of a steroid into it for the pain, but it
still takes three months. And the same is true of the baby diar-
rhea and the croup. Treating these sorts of ailments probably