Correspondence

Unemployment after Health Care Reform?

N Engl J Med 1994; 330:222January 20, 1994

Article

To the Editor:

A change in the financing of our health care system is clearly needed -- and imminent. When I was in practice I was astounded by the amount of paperwork the private sector generated in paying for health care and dismayed by the amount of time my staff and I devoted to the paperwork, rather than to the patient. Should simplification of paperwork indeed result from a national health care plan, this would free a considerable amount of time for the provision of health care. But the law of unintended consequences could operate here. What will all the people do who used to process the paperwork?

When the United States began scaling back on the defense budget, the nation suddenly realized that a lot of people were going to lose their jobs; after all, someone was building all those tanks and planes. This led to such anomalies as candidate Bill Clinton's call for the continued construction of nuclear submarines for the primary purpose of maintaining jobs in Connecticut, while Cold Warrior George Bush planned to shut this program down.

The health care industry is a massive, labor-intensive field, facing the same difficulty. If we rapidly become more efficient administratively, we will not need all the clerks, claims examiners, administrators, and other office help that the average medical practice has had to hire in the past decade. Unemployment may burgeon. Yet none of the ideas floating on Capitol Hill focus on this issue.

Francis X. Brickfield, M.D.
U.S. Embassy, Addis Ababa, Ethiopia