The advance of medical science in recent decades has accustomed the public to expect expert medical attention, while at the same time it has antiquated the traditional structure of medical practice.

Complex technology has pushed doctors into medical specialties. The doctor no longer practices with his black bag alone. Increasingly, he calls on the services of large general hospitals with their mass of supporting personnel, and these establishments, along with new equipment the doctor must have in his office, add a high fixed overhead to the cost of medical care.

Furthermore, with the conquest of infectious diseases, the incidence of acute illness has declined relative to that of chronic illnesses which require prolonged care and often cause permanent disability. In addition, doctors are more aware than ever of the relations between physiological and mental illness. Illness involving psychological maladies is not susceptible to quick cures; instead, it entails high and continued expense.

Blue Cross

For a time the problem presented by rising demands on increasingly expensive medical care was met by private insurance.

In 1929 a school teacher in Dallas, Texas, broke her leg and was nearly ruined financially by the cost of medical care. Outraged by this situation, she organized local teachers into a group insurance plan with Baylor University Hospital. The plan, under the name Blue Cross, quickly spread to other parts of the country. During the Depression hospital administrators pushed Blue Cross to keep their institutions solvent when private charity declined with the stock market.

Blue Cross, which pays hospital bills, and Blue Shield, its counterpart for covering doctors' bills, both employ the traditional insurance concept of protecting the individual by spreading the risk of financial loss among many people.

Some groups, however, are not attractive risks for private insurance plans. To provide for these people, service plans were devised which emphasize obtaining complete care rather than minimizing financial risk. For a fixed sum, service plans will provide an individual or family with complete medical care.

Mr. Goldstein's case is his own, and does not represent the views of the CRIMSON.

In 1946 the United Mine Workers led by John L. Lewis demanded the establishment of a welfare and retirement fund. After bitter strikes and the opposition of local medical societies, the Fund was put into operation in 1950.

The Fund hires some doctors directly; on a contractual basis, it pays other doctors a fee for each service rendered. By constructing hospitals the Fund attracted young doctors and raised the standards of medical care in the coal fields of Kentucky, Pennsylvania, and West Virginia--areas long marked by high mortality rates and low doctor-patient ratios.

In recent years unemployment in the coal mines has caused the Fund to run large deficits. To remain financially sound, it has closed some of the hospitals and terminated coverage of the unemployed. This experience demonstrates that even large private funds cannot cover groups in financial difficulty.

New York's HIP

The high quality of care which can be provided under pre-paid doctors' service plans is illustrated by the Health Insurance Plan of Greater New York. HIP covers 550,000 people and employs more than 1,000 physicians practicing in 32 groups. Subscribers pay $31.80 per year for office and house calls, vaccinations, and laboratory tests. Doctors practice singly or in partnerships which may add members as the need arises.

HIP's success in providing effective preventive medicine is indicated by statistics. Compared with New York Blue Cross-Blue Shield subscribers, HIP members have lower hospitalization rates and lower rates of infant mortality.