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PERSPECTIVE

Voluntarism in Health: A Forgotten Solution

Free clinics allow physicians to help the poor.

NOVEMBER 01, 1993 by JAMES L. PAYNE

In a period of escalating medical and insurance costs, the working poor are faced with inadequate medical care. They are people who exist on the edge of poverty and live without government assistance. They are proud and self-reliant . . . .

The Bradley Free Clinic in Roanoke, Virginia, exists to meet the needs of our community’s less affluent with respect and dignity. Our mission is to provide medical, dental, and pharmaceutical care to the Roanoke Valley’s working poor using volunteer professional staff. We are one of some 140 free clinics across the country offering family practice medical care to indigent patients.

The success of the Bradley Free Clinic lies in voluntarism, a time-honored American tradition that is often left out of discussions on how to remedy our country’ s health care ills. Until the advent of Medicare and Medicaid in the early 1960s, numerous hospitals operated with the primary intention of providing health care for the disenfranchised. The Bradley Free Clinic and others like it have revived this forgotten method of providing health care for those unable to afford it. They have again made it possible for the medical community to care for the poor without the costs imposed by bureaucratic intervention.

Physicians have been extending solace to the poor for decades, usually in a very quiet, low-key fashion; they do not need or wish publicity for these activities. Most physicians, then and now, hold that helping the poor is part of their professional responsibility. Free clinics provide an excellent opportunity for physicians to continue to help the poor in a clean, well-run, clinically contemporary setting. Through the coordination of their services, the physicians of Roanoke have proven this to be true.

—JOHN M. GARVIN, M.D., writing in Philanthropy, published by The Philanthropy Roundtable

 

The Kingdom That Gives Beethoven a C

What’s happening in the world of arts subsidies says a lot about how modern governments are evolving. In the United States, there has been a contest between arts pressure groups and John Q. Public over subsidizing distasteful and pornographic art, and John Q. has lost. Across the Atlantic, in Great Britain, arts administrators are in the process of turning the whole theory of democracy upside down.

In Britain, the agency that doles out the subsidies is the Arts Council. Its music branch has developed quite distinctive tastes in composers, and it has decided to put taxpayer money where its mouth is. The Independent, a leading London newspaper, found that it had adopted a formula to simplify grant-giving, classifying composers into four grades.

At the bottom of the heap are the grade D composers who deserve no subsidy at all, old favorites like Johann Strauss and Edward Elgar. Grade C composers, a category which includes Beethoven, are worth a subsidy of only 450 pounds per concert. Grade B composers, including heavies like Mahler, merit 1,000 pounds.

Hitting the jackpot, at grade A, accorded a subsidy of 2,000 pounds sterling per concert, are Harrison Birtwhistle and Peter Maxwell Davies. These gentlemen are not rugby players or Arctic explorers. They are modern composers whose principal claim to fame is that the British public can’t bear to listen to their music.

This grading system has upset concert organizers who naively supposed that it was their job to put on concerts that people wanted to come to, not stay away from. One promoter, Michael Blackledge, pointed out that he filled all 750 seats in Bedford’s Corn Exchange when the concert featured politically incorrect Elgar and Delius, but that only 25 came when the approved modern composers were performed. He finds the grading system unworkable. “It’s artistic interference with people on the ground who know their audience,” he said.

Years ago, when the idea of massive arts subsidies was first proposed, arts insiders had reason to be worried. They were perfectly aware that what they were doing wasn’t art as far as the general public was concerned. If democracy worked the way it was supposed to, they would be left off the gravy train. Voters would communicate their desire for likeable music to their representatives, and they, in turn, would tell the civil servants to give the public what it wants. Arts administrators, doing their democratic duty, would contrive subsidy programs boosting Viennese waltzes and leaving Birtwhistle and his chums down at the wine bar in the dustbin of history.

Fortunately for the insiders, none of this happens. British arts administrators don’t suppose for a minute that they are servants of the people. Indeed, they have become quite self-righteous about their duty to give the public what it doesn’t want. The music director of the Arts Council, Kenneth Baird, was not apologetic or embarrassed when asked about the policy of emptying concert halls with grade-A dissonance. “We are happy with these categories,” he said. “It is our duty to support the new and most adventurous, given that that is the least likely to appeal to audiences and sponsors.”

Somewhere between John Locke and John Major democracy got left in the dustbin. The modern state does not function, as the theorists hoped it would, to translate popular desires into policy. It has given rise, as the arts subsidy scene clearly proves, to a more or less insulated class of public officials who use the power of the state to implement their own prejudices.

We used to call this arrangement taxation without representation, and it used to make us angry.

—James L. Payne

ASSOCIATED ISSUE

November 1993

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