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76

FRIDAY, JULY 6, 1990

keep aware of political
realities. It all depends if Con-
gress really is concerned
about the uninsured. Maybe
they think a national in-
surance system will save
them money, but use a pious
`help the uninsured' attitude
to put it over. One must look
at it with some sophistica-
tion."
However, Adelman feels
safe in predicting that we will
probably see a lot of major
changes in insurance within
two to three years. Even if
there's a national will to
change the system, there's
probably not a national
pocketbook. So we'll see
piecemeal solutions.
Of course, when politicians
take on a health-care agenda,
Adelman is ready. At the
state level, the MSMS
"rather narrowly defeated a
Lansing bill to insist on man-
datory assignment for
Medicare." As she explains
the conflict, "Medicare pays
for certain services, a certain
amount. Traditionally, some
patients over 65 are fairly af-
fluent; some are perfectly
able to pay more out of
pocket, to get more of the
personal attention that
money can buy." If that's the
case, "the doctor can accept
Medicare assignment (a set of
direct payments from the
government based on a fee
schedule) for others on
modest or fixed incomes, and
charge more for people who
have more money."
Over time, the majority of
physicians, have chosen to ac-
cept assignment in deference
to the needs of their patients,
and to avoid paperwork. "In
Michigan, almot 94 percent of
claims are on voluntary
assignment. However, that
[Lansing] bill would have
made it mandatory to always
accept assignment." Not only
would that deprive doctors
the opportunity for discretion,
Adelman says, it would have
created much bad will.
Perhaps the hassle of deal-
ing with insurance, as well as
a high rate of liability cases
coming to court, are reasons
why the nation is dropping in
the number of students apply-
ing to med school each year.
The ratio today is about 1.6
applicants for every one posi-
tion, as compared to a three-
to-one rate just a few years
ago.
Another issue important to
the MSMS concerns the en-
vironment — in particular, a
National Center for Disease
Control study that ranked
Michigan first in chronic mor-
tality in four types of cancer
possibly related to en-
vironmental factors. In a local

effort, a proposal from the
Michigan Department of
Public Health offers a myriad
of policy recommendations
and proposals covering health
questions like the toxic con-
tent of game fish. But,
Adelman says, the commit-
tee's extensive board contains
only one doctor. "With very
minimal professional medical
input," she says, "how do they
establish priorities? How did
they make these [medical]
determinations?"
Adelman wants to involve
more doctors not only in the
environment, but also in the
war against drug abuse.
Especially among the area's
poor and uninsured drug
abusers, there is a "whole in-
terrelated set of diseases."
Among the more affluent,
"it's still a very serious
health problem."
But too many doctors,
Adelman feels, are too much
in the dark about substance
abuse. The MSMS has
"started to identify priorities.
We need an initial assess-
ment among physicians to
make sure the average one
can come to an understanding
of how to take a proper his-
tory of chemical dependence.
We need to boost the back-
ground of doctors who don't
get into these issues rou-

Adelman wants to
involve more
doctors not only in
the environment,
but also in the war
against drug
abuse.

tinely." Adelman cites a pro-
gram at Hutzel for pregnant
addicted women and their
children, the only program of
its kind in the state:
Whatever questions need to
be tackled, Adelman is still
proud of the work of the
state's physicians. She finds
many of them willing to take
a stand. For instance, the
AMA position opposing the
sale of assault weapons —
that really originated in
Michigan. Students and
residents proposed that
position.
Adelman's new post with
the MSMS will send her to
Lansing at least one day a
week. She finds juggling time
one of her biggest personal
challenges. It's Certainly not
the schedule Adelman would
keep if she'd followed her first
career path, geology. Adel-
man had, in fact, taken her
undergraduate degree in
geology, from Wayne State in
1962. Between that first
degree and her entrance into
Wayne's medical school,