The Medical-Industrial Complex

Dwight Eisenhower addressed the nation for the last time as president on January 17, 1961. It got me thinking about what he might say if he were leaving office today, at a time when healthcare is one of the greatest concerns rather than the Cold War. What follows is his original speech, mostly verbatim, to which I have made a few additions and changes in order to shift the focus to healthcare.

"This conjunction of an immense medical establishment and a large healthcare industry is new in the American experience. The total influence - economic, political, even spiritual - is felt in every city, every state house, every office of the federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society.

In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the medical/industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.

We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of medicine with the huge machinery of the healthcare industry so that the well-being of the populace can be assured.

Akin to, and largely responsible for the sweeping changes in our medical-industrial posture, has been the technological revolution during recent decades. In this revolution, research has become central; it also becomes more formalized, complex, and costly. A steadily increasing share is conducted for, by, or at the direction of, the Federal government.

Today, the solitary inventor, tinkering in his shop, has been overshadowed by task forces of scientists in laboratories and testing fields. In the same fashion, the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity. For every old blackboard there are now hundreds of new electronic computers.

The prospect of domination of the nation's scholars by federal employment, project allocations, and the power of money is ever present and is gravely to be regarded. Yet, in holding scientific research and discovery in respect, as we should, we must also be aware of the fact that public policy has become the captive of the healthcare industry.

It is the task of statesmanship to mold, to balance, and to integrate these and other forces, new and old, within the principles of our democratic system - ever aiming toward the supreme goals of our free society, not to merely rubber-stamp every profit-making scheme concocted by the healthcare industry."

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