An Interview with Quentin D. Young M.D.

PRINT PAGE
EN ESPAÑOL

An Interview with Quentin D. Young M.D.
Director, Health and Medicine Policy Research Group
By Karen Ide and Clinton Stockwell, PRAGmatics
PRAGmatics
Spring 2004
————————————————————————————————————
PRAGmatics—Will you please share with us a highlight from your long and successful career as a physician and as a human rights/health care activist?

Dr. Young—I guess my answer would be the civil rights movement medical arm. When the southern movement started activating, the medical community for human rights would show up spontaneously. We all know the climax with major changes in the legal status of Blacks in the South and the de facto status segregation in the North. The medical community was a do-good expression of liberal nurses and doctors who wanted to be part of the action. At first, we just thought we would be there like Red Cross workers and take care of people who had heat stroke or got beat up or bitten by a dog or whatever. We had people on staff down there for the long term but we also got volunteers who would come down from another part of the country, some for a week, or a month, or two. The function was to bear witness to the struggles of the people who are fighting for their rights and our presence was testimony to their legitimacy and our willingness to share their burdens. It sounds a little highfalutin, but that’s what it’s supposed to be. The doctors did turn out to have several functions. I’ll give you one example. The public demonstrations were like a Japanese opera. There would be a demonstration called to protest the exclusion of eating places or school segregation or hospital segregation. The people would turn out, mostly young people, and demonstrate. The police would tell them to disperse. They wouldn’t disperse and different things would happen—houses would get torn up—people would get arrested and taken to the hospital and taken to jail and very soon our task was evident. After the protesters were booked, we would go to the jail. A doctor with a tie and white coat, even though he was considered a “nigger lover” was treated with respect and deference by the police. We could go around and very ostentatiously say, “You’re looking really good,” and the whole point was to have a doctor see these people before they got out of jail because the specialty of the house was very often to brutalize the protestors. But a doctor there having seen them was pretty close to expert testimony, so bruises that were there the next day would clearly and unarguably be due to something that happened overnight. So that was one of the functions that was interesting to note. The whole effort was probably a high point of my career in terms of mixing my activism with medicine.

PRAGmatics—Today, March 4, has been designated “Health Care Action Day” by many activist groups across the country. Do you feel this movement is picking up steam? Do you see any prospects for its realization in this country in some form in the near future?

Dr. Young—Well, it’s definitely picking up steam. And the reason turns out to be not the good one: that do-good solitary social justice consciousness in the country, but rather, I’m sorry to say—it’s because the system is so disorganized, so chaotic, so costly, and so harmful, that it is garnering enemies. But maybe that is the obvious way that most social change takes place. Human slavery was abolished after a bloody civil war and because it was incompatible with our nation’s continuing existence. So the abolitionists and many wonderful people who had strong ideological and moral objections took great risks, gave their lives. But the vast majority who participated in the rejection of slavery did it for elementary, mundane, materialistic reasons and I think that is what is happening now, and it’s happening very fast. Today is “Universal Health Care Day.” Our group, Physicians for a National Health Program, is dedicated to that single issue—even though there is not a lot of enthusiasm for the concept of
universal health care out there. But, we know that everybody should have it. The most evil elements in the health system are the Hospital Insurance Association and the Group Health Association. These are the holding companies for the big corporate interests that are taking over. They really don’t care whether it is universal health care just as long as they control it and get the money. We are much more explicit and worry about the universal aspect because other forces are precluding explicit solutions like ours, which is single payer national health insurance, government-run, based on the tax system. We feel universal health care is no longer the best answer; it’s the only answer. There was a time when there were alternatives that might have worked, but that day is passed. We’ve had too much of a transfer of power from patients and physicians, for that matter, to giant corporate interests that are dedicated to the goal of maximizing profits, which accounts for much of the distress in the American health system.

PRAGmatics—In the U.S. as elsewhere, there is a debate as to whether quality health care is a right or a commodity. Is it possible to reconcile these opposing values, and is the goal of quality health care as a right for all people attainable?

Dr. Young—I certainly believe it’s attainable. It has been attained in certain countries that aren’t very different from us. I totally come down on the side of health care being a human right. It’s very hard for me to see a coherent, let alone a moral or decent argument against it, because illness doesn’t distribute itself according to the ability to care for yourself and be cared for. It strikes children. It strikes the poor. It strikes the most needy and most ill-protected disproportionately. That’s the correlation. Cardinal Bernardin said it best. He said, “Health care is so important to human life and dignity that it is the responsibility of society to offer access to decent health care to every person.” I was pleased that he didn’t say “every citizen” but “every person.” So the answer is that it should be considered a right guaranteed by society, which means it must be a responsibility of the government.

We’ve had a failed experiment in marketplace medicine over the last fifteen years. People forget that 20 years ago, there was no such thing as a for-profit hospital. One of the greater achievements in this country in the Tocquevillian sense of nongovernmental organizations and the American penchant for organizing to solve problems was our hospitals. They were invariably nonprofit, secular or religious entities, based on community; and, the hospital board of directors was always the elite leaders in the community.

Our argument is that the record of America’s hospitals under that circumstance was impeccable. But a lot of it wasn’t. There was a lot of legal segregation in the south and de facto segregation in the northern hospitals. However, at the end of the day, they were community-responsive and responsible, and they got great support for that great subsidy. They got low taxes. They got free services from the city. In many circumstances, Chicago for example, big urban developments surrounded them that made their environment more attractive and more functional, and it was a deal. They would in return meet community needs; around the clock emergency services, obstetrical services, specialized services for kids with mental illness or venereal disease. The government played a huge role but it was essentially a volunteer communitarian kind of thing. That has been put on the back burner during the growth of for-profit hospitals. One of the most serious consequences of the for-profit health system is that there is a significant and dangerous decline of nurses, from what was once two million. Very few people are going into nursing and many are leaving. And this is not just a luxury item.
They are the caring in the health care system. So we have to reject ommodification. We think it’s an abomination and should not be tolerated. It should be eliminated from the health care transaction. We’ve had the experiment. It’s failed. And we must stop the damage it’s doing.

PRAGmatics—What is your assessment of the recently passed Medicare legislation? Since it is not due to go into effect until January 2006, can something else be drafted to amend or replace the Medicare bill before it is enacted?

Dr. Young—It’s an abomination. It’s a terrible, terrible bill and we’re in favor of its repeal. I’m happy to see that the best leaders in Congress, starting with Jan Schakowsky, have adopted that strategy. We regrouped after it was forced across the line. Many organizations are calling for the law to be rescinded because they now have a better understanding of what the bill contains. It is a scam.

PRAGmatics—What is your opinion about the costs of prescription drugs? What should be done about that?

Dr. Young—First, we must insist that doctors do not give unnecessary drugs. An example is the use of antibiotics for the common cold—a huge multi-billion dollar event. It shouldn’t happen. This is the wasting of drugs and the creation of resistant organisms. Second, we must use many more generic drugs. The amount that we spend on brand name “aspirin-like” drugs alone is ridiculous and unnecessary. That money could be spent on drugs for far more beneficial purposes. And it will take more patient education. It takes peer review. For health reasons, I would also restrict the kind of advertising allowed for medications.

And of course, it’s obvious I want to negotiate the lowest price and I would be for price controls if they were recalcitrant. I want the multi-billion dollar trading and profiting of companies from federal tax revenue-supported research ended. This health system has what I call three running sores. One is the absence of a generous, comprehensive drug benefit. That’s a terrible thing and there’s all kinds of ways that it hurts patients, including killing them. The second one, of course, is mental health. The system operates with an idiotic limitation on mental health services on almost every contract you have—six visits a year—as if someone is going to get sick on that basis. And then you have the exclusions. And the third one and possibly the most serious one, is the failure to plan for long term care. We have a time-line in our system in terms of the seniority of the baby boomers and there’s a major central issue in terms of the nature of our society. Are we going to stockpile all of our old disabled people in institutions at great cost or are we going to find ways to have community and family surround them and make life more decent and foster communitarian reality? Those are the things that are just totally neglected among marketplace solutions for profit making. So I think the reason we say that single payer is the only solution is because there is no other way to find the many billions you need to solve these problems, and we could do it because the money is there. We would get the money by ending the 15 to 30 percent administrative costs. And if 1 percent of the total costs for administration equals $17 Billion savings, that is quite impressive. It can be saved. Other countries do it. We have done it with the Medicare system.

Quentin Young graduated from Northwestern Medical School and did his residency at Cook County Hospital in Chicago. From 1972-1981, he served as Chairman of the Department of Medicine at Cook County. From 1943-1945, he served in the U.S. Army and later in the U.S. Public Health Service.

PRAGmatics—A few years ago, Community Renewal Society was an advocate of a theme called “building healthy communities.” What needs to be done so that economically depressed and marginalized communities in urban centers, such as Chicago, can have a more acceptable standard of health?

Dr. Young—Up until now I’ve been talking exclusively about a technical solution, mainly the financing of health care. My heart is in the last question. Rudolph Virchow, the remarkable mid-19th Century physician, who is considered the founder of modern public health, modern psychology and modern pathology, understood the centrality of social conditions to health status and preached it, and his preachments have stood the test of time. What I think CRS was addressing, was a solution to the causes of ill health and that it was not only with doctors but in resolving a variety of afflictions of social problems in the oppressed or depressed poverty community. In this country this is often synonymous with situations facing racial minorities and it’s everything you can think of—clean air, decent housing, good nutrition, social stability, good education—all the good things that we know are necessary. Those are the correlates to good health. When we solve those problems, then how good a heart and lung apparatus you have or how skilled you are at operating on different organs fades because it’s the environmental stresses that are the big of health. We’re very, very enthusiastic about this. Within our physicians group, we see the importance of social justice issues in enhancing the health status of people. We see the present system with heavy emphasis on treatment and profit-making as absolutely anathema or at war with the issues we mentioned. We see many diseases that can only be susceptible to control or elimination by a public health model. We see a frightening and not as yet understood surge of life-threatening asthma in the inner city. We see new diseases all the time that don’t respond to or antibiotics and are then heightened by the bioterrorist brouhaha. We’re talking about Mad Cow, SARS and HIV/AIDS. All these things are there and more keep coming and we have to increasingly say, “What are the strategies? What are the long term strategies that can allow us to rid these threats as they come and then control them?” So I’m interpreting that this is what CRS advocated and we identify with that very closely.

PRAGmatics—Chicago recently built a new facility—Stroger Hospital. Our question is, as you look at this city with respect to others in the country, where is Chicago in terms of its symbolic and real place in delivering health care and how real is the symbol of the new public hospital with respect to health care?

Dr. Young—The answer is a good news-bad news answer. I and many others, ultimately the elite in the business community, were convinced that with the old hospital being nonfunctional for many reasons—most of them structural—what the pathway was we would take. It was very sharply divided with harsh debate, at least initially, and the hospital council, or private hospitals were saying to just give them the money and they would absorb the count. I was on several committees that examined the problem and ultimately made the case successfully that by far the best way to go was to build a new hospital. Unfortunately, the maximum bonding available would only allow the building of one with about 450 beds. You should have 3400 beds. That was the same kind of hospital you have today, but at the time they made that decision, the hospital was running with about 1200. The bad news is, although it is a marvelous state-of-the-art hospital, it is going to be overwhelmed by sheer numbers with the status quo. But it’s a great achievement. There hasn’t been a new public hospital in this country, I would say, for the last 30 years, and so to get a major one is significant. Charity in New Orleans, Philadelphia General, and other public hospitals were closed.

However, the greatest achievement is the establishment of 32 high grade solid buildings as excellent facilities in many communities and the suburbs, and that is the real safety net and certainly is a cushion against the growing need for public services. So that gives you some comfort but people still pay inordinate rates for getting prescriptions filled. So the system constantly gets overwhelmed by the limitations of the private sector. Where is Chicago relative to other cities? It’s probably better than most, but it isn’t that much better. We have this really sharp cleavage between people who are poor without insurance but are not ready for Medicare, and then Medicaid, which is designed for them, being the wild card in the budget crunched economy. Most of the states have serious budget deficits and the biggest budget item is Medicaid. It always looks tempting to the pols, and the hungrier they get the more they slash. But it doesn’t have to be this way. We have the money. We have the workforce, a health workforce that is the envy of the world in terms of scientists, doctors, technicians, nurses, and basic health workers. We have physical plants, hospitals, and all the high-tech equipment. So the system is all there. In countries like Canada or England, the problem isn’t the system, it’s the money! In the U.S., it isn’t the money, it’s the system!

In addition to his distinguished career as a physician, Dr. Young has been a leader in public health policy and medical and social justice issues for more than fifty years. In 1951 he was a founder of the Committee to End Discrimination in Chicago medical institutions. In the 1960s he served as National Chairman of the Medical Committee for Human Rights.

PNHP was founded in 1987 and has physician spokespersons across the country who advocate for a single-payer national health program see www.hmprg.org & www.pnhp.org