Wednesday, March 26, 2008

Project Health: highlighting the age-old dilemma of universal health care

An eight-page oversize pamphlet (maddeningly printed crookedly on some pages) entitled Project Health gives a consumer-oriented overview of a health care delivery system overhaul proposed by Multnomah County in 1973. A longer document on the plan, also from 1973, and an update from 1981 are also available in the PNW Archives collection.

The consumer version of the plan is filled with color and graphics, to help elucidate the complex problem of universal coverage to the average man on the street. One chart even uses smiley faces and frowny faces to show the reactions of various stakeholders to different courses of action (or inaction):

The first goal of the Project--to "develop an alternative to the present system of providing hospitalization for the poor at Multnomah County Hospital"--was resolved a few short years later, when the County Hospital was sold to the State and University for $1.00. The solution to the second goal--to "develop a plan which would give comprehensive health care to the poor"--has proven far more elusive.

An inadvertent foreshadowing of the "mystery" of how to solve the health care crisis comes in another graphic, where doctors reviewing the services are portrayed as the Sherlock Holmes's of the health care equation:

It is a mystery that continues to beguile health care systems and practitioners: how to manage costs, providing the greatest benefit to the largest number of people. Are expensive life-saving interventions always necessary, or even desirable? What are the ethics of managed care which denies expensive treatment to some in order to provide preventive treatments to potentially thousands of others?

In her 1993 book The Healer's Tale: Transforming Medicine and Culture, Sharon Kaufman talks about medicine's current focus on means over ends, and finds that the fascination with technological advances has created new cultural tensions over age-old questions like "What is motherhood?", "What is death?", and "When does life begin?" Her book focuses on the life stories of seven physicians, in an effort to get at the heart of the crisis.

We haven't solved it yet, so our group of Dr. Holmes's have their work cut out for them.

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