Health by Contract

Across the land last week sounded the medical world's unceasing word war over ''socialized medicine." In Sacramento, Calif., Secretary John A. Kingsbury of Manhattan's Milbank Memorial Fund cried to the Western Hospital Association: "Our primary problem is not how to furnish financial assistance to the poor, but to enable those who cannot buy medical care as individuals to buy it as groups."

In Manhattan, joined by a dozen other physicians, Chairman Harry Weinstein of the Physicians & Allied Professions Political League charged the Milbank Fund with "underhanded assault" in its propagandizing, declared socialized medicine would mean "the enslavement of the medical profession."

Manhattan's Sydenham Hospital announced that beginning next autumn it would insure white-collar workers three weeks' hospitalization a year for a $10 premium. At Flint the House of Delegates of Michigan's State Medical Association voted to set up a Mutual Health Service which, at a probable cost of about $27 a year per person, will insure full medical care to families earning less than $1,500 a year. People who want a concrete idea of what group medicine can become could look last week to Tacoma, Wash. Tacoma's Dr. Albert Wellington Bridge. 54, had just signed a new 20-year-lease on Ohanapecosh Hot Springs in Mount Rainier National Park. His Ohanapecosh resort is but a sideline with Dr. Bridge. His main business is the health of some 10,000 Washington lumbermen and miners who are under his care by contract. In that business he has become an extraordinary figure, a medical tycoon. Industrial "contract practice" is a form of health insurance which arose in isolated lumber camps and mining towns and is confined largely to lumber, mining and railroad industries. The contracting employer deducts a set sum* from each employe's wages, turns it over to a physician or hospital association. In return the physician or association agrees to furnish within stated limits all medical and surgical service to employes, except for injuries covered by workmen's compensation laws. More than 500,000 workers in 37 States are thus insured against the costs of sickness. Albert Wellington Bridge's friends think he might have become a great industrialist. Orphaned son of a Vermont farmer, he decided early that there was no proper room for his talents in farming or in the sawmill where, when he finished high school, he worked 16 hr. a day for $8 a month. Selling the farm he had inherited from his father, he took a medical course at University of Vermont, two years later went West. Conventional practice in Tacoma seemed no more promising than farm or mill, but in 1909 Dr. Bridge at last found what he was looking for. He bought an industrial contract practice in Eatonville, 30 mi. southwest of Tacoma. By 1923 Dr. Bridge was rich and ready to expand. Leaving his Eatonville hospital and contracts in charge of his first assistant surgeon, he bought the practice of a contract surgeon in Tacoma, set about becoming a medical tycoon in earnest. As new contracts flowed in he hired assistant physicians to tend them, equipping each with residence, office, drugstore, ambulance. Finding good office-assistants scarce, he set up a training school for them in Tacoma. He bought a hospital and an emergency clinic in Seattle. Last year he put up a five-story, $125,000 building in Tacoma which houses his business administration department, his private clinic & hospital. There Dr. Bridge, undisputed leader in Washington contract practice, directs his medical corporation. He now has 15 branches covering most of southwestern Washington, receives daily reports from each one, telephone calls in all emergency cases. Sixty-five doctors, nurses, office-assistants and business managers are on his payroll. Washington knows Dr. Bridge as an able surgeon and a closefisted, hard-driving businessman. He will stand for no nonsense about shirking bills. His two farms not only supply fresh vegetables for his hospitals but also provide a place where his debtors can work out their bills. Once when he was Mayor of Eatonville he led a posse which captured a band of bank robbers. Dr. Bridge lined up the bandits, advised them to find some new line of work. Robbery, he said, was poor business. The American Medical Association, stanch foe of socialized medicine, does not consider contract practice unethical per se. Two years ago its Bureau of Medical Economics reviewed Dr. Bridge's activities in the A. M. A. Journal, admitted that such schemes give some patients better care than they could otherwise get. But, said the Bureau, they also lead to solicitation, underbidding, inferior service. They squeeze out individual practitioners, leave the uninsured with no more choice of physician and fee than the insured have.

* In Washington usually $1 per month.

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