Word: plan
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Dates: during 1960-1969
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...major health problem of poor people, Pollack says, is that they are "under-utilizers of maintenance and prevention, and over-utilizers of emergency treatment." By luring needy patients in for more prevention--and by using the health plan's emphasis on out-patient treatment -- the Harvard center in Mission Hill will offer the poor a kind of medical assistance much different from the mere doles that Medicaid and Medicare pass...
...despite these efforts at curbing Roxbury's swollen sickness rate, no one is pretending that the Harvard health plan is solely--or even primarily--designed to help the poor. The 6000 poor patients who will join the program will make up only 20 per cent of the plan's membership. The other 80 per cent--24,000 people --will be people who now have Blue Cross or other kinds of private insurance...
...angry liberals pressed them hard enough, the plan's administrators could come up with reasonable excuses for including so many affluent patients at a time when the poor are sicker and more desperate. Other health plans, Pollack might say, are famous for their "social conscience," and only 10 per cent of their patients are poor. So if the Harvard plan takes 20 per cent of its patients form Roxbury it must be twice as socially concerned...
...that kind of simplistic rationalization never comes up. The reason for the plan's economically-mixed clientele is far more subtle. All plans aimed entirely at the poor have a basic weakness: since all their money comes from the government, any cut off in the government fiscal supply will instantly kill the plan. Pollack adds that poor-only programs may become over-specialized. If they only treat sick poor people, they may lose touch with the real world of American medicine; their techniques will be fine for the ghetto, but they won't apply to the majority of the country...
...fundamentally this fear of drifting away from the medical mainstream that directs most of the plan's decisions -- including drawing the "poor line" at 20 per cent. In each of their moves, the plan's directors are conscious of a national audience. What they are trying to build is not just a plan for treating 30,000 people in Boston. Instead, they are piecing together a model that they hope can reshape medical systems all across the country...