What Is Free Choice?

San Francisco was unwontedly hot (89DEG) as 12,063 physicians streamed into the city last week for their biggest get-together of the year: the annual convention of the American Medical Association.

At the beginning, tempers were running as high as temperatures: hotel space was all mixed up, a fight was brewing over prepaid medical care plans, an uncomfortably hot issue had been added to the program at the last moment (see below). It took the best bedside manner of some of the nation's canniest practitioners to keep things under control.

New York members of the house of delegates launched a frontal attack on prepayment group practice,* with a resolution designed to: 1) forbid solicitation of patients by groups of physicians and institutions and 2) condemn the restricting of a patient's choice of doctor to the members of a group or panel as a violation of "the right of free choice." Talking tough, New York City's Dr. Renato J.

Azzari announced that committee action on the resolution would be taken in executive session, with even delegates barred. A California delegate fumed: "I'd advise that you didn't kick anyone out." Dr.

Azzari backed down, booted no doctors.

The Kaiser Foundation's Dr. Clifford Keene promptly asked for an amendment to recognize that "freedom of choice" is satisfied where the subscriber elects, of his own volition, to be treated by a group or a single doctor within a group. That was the heart of the matter. Suave and diplomatic ex-President Louis H. Bauer saw the trouble that would be caused by the issue and suggested that the A.M.A.'s judicial council takes a year to think it over. The delegates jumped at the idea.

All it meant was that the inevitable fight between group practitioners and the old school, which insists on an individual doctor-patient relationship, was postponed.

Almost overlooked in the heat of these arguments was a farsighted proposal by Outgoing President Edward J. McCormick. Doctors, he advised, should stop charging what the traffic will bear and set up schedules of average fees in each area or region. "The time has passed," he said, "when the medical profession can predicate a fee on a patient's salary, or whether he is in a private room or a ward, or lives 'on the hill' or in more modest residential surroundings."

* Best exemplified by the Health Insurance Plan of Greater New York, with 400,000 subscribers who pick a "family physician" from a panel of about a dozen in each of 30 groups, and California's Kaiser Foundation Health Plan also with 400,000 members (TIME, June 27, 1953).

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