Health manpower: challenge for the Eighties.

It was Edmund Burke who, after the French Revolution, wrote, "But the age of chivalry is gone. That of sophisters, economists, and calculators has succeeded, and the glory of Europe is extinguished forever." I suppose that the presence of an economist on this program-in fact of two economists-might lead some to contend that the glory of medicine is similarly extinguished. There are in fact those who suggest that the recent flowering of medical economics has helped push medicine from its pedestal down into the grubby marketplace and has altered-for the worse-the way laymen and even the way physicians think about health care. I acknowledge that concern. I, too, am distressed with the new language. I am troubled when I hear about marketing committees in hospitals and when physicians speak of satisfied customers instead of patients. I do not believe it is entirely healthy to substitute the word "producer" for the word "physician" or "consumer" for "patient." Words, language do affect attitudes and attitudes do affect behavior. Nevertheless, I do not agree that the glory of medicine is extinguished or, indeed, that if it were, the proximate cause would be the flowering of medical economics. The intrusion of economic concerns into medicine, after all, did not begin-as some would have us believe-in 1965 with the enactment of Medicare and Medicaid. The Code of Hammurabi almost four thousand years ago discusses fees, fee structures, and price discrimination. Furthermore, if economics is about the allocation of resources (and it is), economics has been with us and with medicine from the earliest days. It is not the study of economics or the growth of medical economics that has created a nexus between economics and medicine. The interplay was always there. That interplay is more evident today as we find ourselves in a world in which medicine can do more; in which many of the things it can do require substantial resources; and in which diminishing rates of economic growth, that is, a slowing down in the expansion of resources, force us to choose in areas in which we believed choices were not necessary. The problem, unfortunately, does not derive from health economists and cannot be solved by our elimination. Health economists examine the interplay between economics and medicine, its dimensions, forms, and arrangements. It is that interplay I should like to discuss with