NEWS

WASHINGTON PERSPECTIVE ting waste in the system.

Add in, too, the inherent political
Health reform weakness of Clinton, elected with
no longer a hot issue 43% of the vote and barely workable
The country seems to be taking the Innumerable political autopsies majorities in Congress. Even with
those handicaps, the Clinton Health
collapse of health-care reform withi tend to agree on the factors that
indifference. Congressmen returning doomed the best shot yet at provid- Security Act seemed to be off to a
from the summer recess almost uni- ing this country with universal health promising start at its launching last
autumn. But, distracted by other
formly report scant interest in the care. Perhaps of primary importance,
issue. The Clintons have shied away most of the public and health-care governmental issues and his personal
the President then devoted
from the subject in recent weeks, thus industry are content with things as woes,
intermittent attention to health
signalling that they know a dead they are, though they feel strains and onlycare. The lobbies for the major
horse when they see one. And now anxieties. The Clinton camp broad-
economic interests in the health
there is serious talk that in the home- cast many true and heartrending .’.
stretch to adjournment for the Nov 8 reports about the uninsured 15% of fearsome
industry produced a cacophony of
elections, Congress may avoid even the population and the many others warnings of danger to
if their self-serving prefer-
modest health-related measures. : who are inadequately covered. But patients
ences were not enshrined in health-
Going home for pre-election bond- most Americans are safely insured for
reform law.
ing with their constituents, legislators health care and not receptive to taxa-
expected to encounter strong senti- tion for the benefit of the downtrod- Lacking a majority coalition on
what to do, Congress is inclined to
ments, on one side or the other, con- den. Arguments that health care for
do little, if anything, about health
cerning Washington’s number-one the uninsured is really financed by
reform in the remaining weeks of the
domestic topic for most of the past higher prices for those who are cov- session. The soothing argument of
year. But by general account the out- ered did not seem to register with the ’.
the moment says avoid haste, wait till
spoken members of the electorate are public. Cost shifting, as it isknown, ; next year, and then proceed carefully
concerned with crime, welfare does not visibly affect the well-
in dealing with the difficulties of
reform, immigration, jobs-not with insured. ; health care for all. But
health-care reform. Typical among Many corporations that insure attaining knows that is a
the legislators, a midwestern Democ- their workers came out against a gov- everyone specious
that the Con-
ernment-decreed employer mandate . argument, given
next
ratic Congressman who strongly Sup-
will almost surely be less
ported the Clinton health plan told for insurance, arguing that it would gress inclined to reform. The most impor-
me that he had gone home prepared . cramp their options if later on they
tant factor seems to be that the voters
to do a lot of explaining about the had to cut costs. Doubt and con-
are not fired up about health-care
fizzled effort. He found little interest ’. tention swirled around the White
reform. In fact, they seem bored by it.
in the subject. ; House’s claims that, over the long
There are signs that major seg- run, universal coverage could be
ments of the public are weary of the achieved at no additional cost by cut- Daniel S Greenberg
debate and perhaps not so dissatisfied
with the present economics and CALCUTTA PERSPECTIVE
organisation of the health-care Sys-
tem, despite its well-publicised fail- Mother Theresa’s care for the dying
ings. The leading exemplar of reform
as a winning political issue is Democ- On Sept 8 the Calcutta Telegraph : work (my wife and I fed some of the
ratic Senator Harris Wofford of ’. reported that an unidentified man residents and scoured the metal
Pennsylvania, who won an upset aged about 65 had been found dead plates and drinking vessels with wood
election two years ago in a victory : near the Kalighat Temple. The ash). There are two large rooms, for
credited to his belabouring of the remarkable thing is that this incident men and women, each with three
Bush administration for neglect of was newsworthy. A walk through that rows of concrete benches with green
health care. Wofford faces the voters squalid part of the city will show you plastic mattresses. In a central lobby
again in November because he is fill- disease and degradation on a grand two sisters of Mother Theresa’s
ing the remaining portion of the late scale. The fact that people seldom order, the Missionaries of Charity,
Senator John Heinz’s term. This .’. die on the street is largely thanks to were coordinating the efforts of five
time, however, health-care seems to the work of Mother Theresa and her volunteers (young people from Bel-
have lost its political lustre, and Wof- mission. The citizens have been sen- gium, Germany, and Japan). Along
ford is in a difficult campaign. Some sitised by her work over the past with two novices from the order, they
retrospectives on his surprise election 40 years; and, where formerly they ‘°. were distributing rice, vegetables,
now question whether his champi- tended to avert their eyes, now they . and water to about 90 men and
oning of health-care reform really
was are likely to call an ambulance. And, women.
the decisive factor. Whatever the case, if the hospitals refuse admission, I was surprised to see many of the
reform of the health system is closely Mother Theresa’s Home for the v inmates eating heartily and doing
associated with a President low in the Dying will provide. ; well. These days, it seems, more than
popularity ratings. Many Democratic The home is a former pilgrim’s two-thirds leave the home on their
candidates are keeping a safe distance hostel close to the temple. Visitors feet. Their common feature is not
from Clinton.: are welcome, especially if willing to that they were originally perceived to

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 be dying but that they had failed to : the sisters must remain on equal Apologies for Nazi crimes
gain admission elsewhere. What sort terms with the poor. So the most
of medical care do they get? It is hap- : important features of the regimen are For decades the German medical commu-
hazard. There are doctors who call in : cleanliness, the tending of wounds nity abstained from discussing crimes
from time to time but usually the sis- j and sores, and loving kindness. (One committed by Nazi doctors. But two
medical societies have now broken the
ters and volunteers (some of whom requirement is that all prescriptions
have medical knowledge) make deci- be written in pencil, and subse- silence by making the issue a major topic
at their annual conferences. In Munich
sions as best they can. I saw a young : quently rubbed out, to allow re-use
the German Society for Gynaecology and
man who had been admitted in poor of the paper.) If you give money to
Obstetrics and in Darmstadt the German
shape with high fever, and the drugs Mother Theresa’s home, don’t
Society for Psychiatry, Psychotherapy,
prescribed had been tetracycline and expect it to be spent on some little and Neurology publicly accepted respon-
paracetamol. Later, visiting
a doctor luxury. Finally, how competent are sibility for dealing with the horrors com-
diagnosed probable malaria and sub- ! the sisters at managing pain? On a mitted by their medical colleagues in the
stituted chloroquine. Could not ! short visit I could not judge the v past.
someone have looked at a blood film? The president of the gynaecologists’
power of their spiritual approach, but
Investigations, I was told, are seldom I was disturbed to learn that the organisation, Prof Hermann Hepp from
Munich, offered his apology to the women
permissible. How about simple algo- formulary includes no strong anal- who were sterilised or forced to have abor-
rithms that might help the sisters and gesics. Along with the neglect of tions. He admitted that after World War
volunteers distinguish the curable ; diagnosis, the lack of good analgesia II gynaecologists had failed by not talking
from the incurable? Again no. Such marks Mother Theresa’s approach as about the physical and psychological harm
systematic approaches are alien to clearly separate from the hospice . done to women and by not giving them
the ethos of the home. Mother movement. I know which I prefer. ; special help. It is impossible to go on talk-
Theresa prefers providence to plan- ing about ethics if the past is not faced,
ning ; her rules are designed to pre- Hepp said.
A recent poll has shown that about two-
vent any drift towards materialism; Robin Fox
thirds of the directors of university gynae-
think that the Nazi past
derived foodstuffs imported from the UK. cological hospitals
Preventing spread of BSE The number of cases, however, is compar- ’,
was never properly discussed. However,
there are few ideas on how to deal with
Experts on bovine spongiform atively small: 98 in Switzerland, 92 in this
Ireland, 10 in Portugal, and 8 in France. problem or how to help the remaining
: victims.
encephalopathy (BSE) called for compul- About 300000 men and women
sory reporting of BSE and worldwide sur-
: Another conclusion was that progress of
were sterilised, of whom 5000 died as a
veillance of the disorder when they were research into prion-transmitted diseases is
slow despite annual funding of a million consequence of the surgery. 75 000 handi-
brought together at a meeting in Paris capped people were killed by doctors, and
earlier this month by the International ECUs per year by the European Union.
at least 100 000 lost their lives in medical
Office of Epizootics and WHO. The main Prof D C Gajdusek, who chaired the
experiments. Of all the professions, doc-
aims were to assess the worldwide extent meeting, hoped that a partial solution to tors had the greatest involvement with the
of BSE and the risks it poses to trade, and the difficulties would be through the study Nazi party, 45% being members.
to reach a consensus on the connection of chimeric mice with human genes. The
When the war ended, victims did not
between BSE and Creutzfeldt-Jakob dis- group also requested that until more data receive
are available "infected countries take all
compensation, and many Nazi
ease. :
doctors were able to continue with their
The group concluded that BSE contin- possible precautions to avoid any spread careers. This unfairness was also true for
ues to affect largely the UK (133 766 cows of BSE, however remote the probability of
it occurring to human beings ... Even annual
psychiatrists and their patients. At their
dead since 1986), although the number of
conference, psychiatrists likewise
suspected cases has fallen by 32% over the though prions are likely to be dangerous . discussed the responsibility that their dis-
past year. Veterinary advice to stop giving only when ingested in large amounts, all cipline holds for the Nazi crimes. But the
animal-derived foodstuff to cows since organs of infected cows that might con- injustice persists today; there are survivors
1988 has been estimated to have saved the tain prions must be destroyed, and no of the Holocaust who are still
waiting to
lives of 50 000 animals to date. Four other suspect material used in the manufacture be rehabilitated.
European countries have reported cases of pharmaceuticals". :
after the import of infected cows or
through feeding cows infected animal- Jean-Yves Nau Annette Tuffs

German health introduction will lead "doctor shop-

on plastic ping".
to tact. it admits that tnere is a
: patients
tendency tor
consult specialists without first
to
The allegations, made by doctors and seeing their general practitioner, but says
By January, 1995, members of the some of their societies, have been strongly that the trend is not new. However, a
obligatory health-insurance system in . denied by the federal health ministry. The recent survey by the Central Institute for
Germany (which covers about 95% of ministry argues that the card will lead to Health Care and the Scientific Institute of
the population) will carry yet another less abuse, since it could be lent to only Local Health Insurers has concluded
plastic card in their pockets. It will replace one person at a time, during which the otherwise-ie, that the card has encour-
the vouchers that the health-insurance rightful owner would have no access to aged patients to go direct to specialists.
companies issue, and will contain the
.
medical care, whereas the vouchers could There has been no accompanying increase
basic personal and membership data be more widely distributed. In either case in health-care costs so far. Whether the
to be read by a practice’s computer. The .
the identity of the carrier is usually not quality of medical care has been affected
card has been tried out in a few states, checked by the doctor. : remains to be seen.
such as Bavaria and Hessia, and a contro- The ministry also insists that fears of
versy has arisen over claims that the cards doctor shopping when the card replaces
are open to abuse and that their general vouchers are based more on myth than on Annette Tuffs

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