There's a lot of talk about health care reform these days and it sure can be confusing. One thing everyone seems to agree on is that health care costs too much. How the hell did we get into this mess? Another thing everyone agrees on is that health care should be a human right here in the USA. I know some don't feel that way, and personally, I find those people scary. Those folks will be the topic of a future blog post I'm sure, but for now, I'd like to retrace our medical footsteps in an attempt to unravel the mystery of how we got to such a place...a country with health care costs totaling upwards of 17% of our GDP. Maybe we need to think about how something as basic as protecting one's health got so expensive for so many people. That's why I've decided to condense the past thirty to forty years of modern medicine into a concise blog post. Sometimes the most recent history is the history least familiar to us, like not seeing the forest because of the trees or something like that.
There was a time, not too long ago, when people had health insurance to guard against medical disasters. You know, horrible diseases or terrible accidents. Nobody expected to go to the doctor for an office visit and not pay anything. The way most health insurance was set up was that you did pay when you went to the doctor, and when your expenses got to a certain level for any given year, then your insurance would "kick in" and start to reimburse you for your expenses. This system worked quite well for most relatively healthy people, and even for people who had some health issues because the system was designed around not expecting people to be responsible for medical costs above a certain level. Once you reached your "deductable", insurance covered your medical costs. Most policies had caps of about $2 million, in other words, use more than $2 million worth of procedures and you were screwed. Back then $2 million worth of medical work meant you were better off dead.
Now that was a time ago when medicine was practiced more like the art it is rather than the high-tech medical mystery tour as practiced today. Don't get me wrong, diagnostic tools are great, but nothing beats a well trained diagnostician with a lot of clinical expertise. We just don't trust their instincts that much anymore and feel the need to "back it up" with the findings of a machine. Of course, the use of these machines is expensive and as more and more docs started using machines to back up a diagnosis, trips to the doctor started to get expensive. Who wants to pay all that money up front for a test you need to confirm what your doctor thinks is wrong with you in the first place? Thus a new form of insurance was born. Why, that old fashioned form of health insurance was only suited for old fashioned medicine anyway.
As medicine became more "sophisticated", the need for a new type of insurance appeared. I call this the Golden Age of the Co-Pay. Initially, co-pays were the dominion of the pharmacy. People had "prescription cards" that allowed them to purchase medicines for a fraction of what they cost. Back in the late 70's, hardly anyone had a prescription card. I worked in a pharmacy, and most of the folks that had prescription cards worked for a union; it was a union benefit. Considering the fact that prescription drug use was nothing like it was today, the prescription card was not that hot a commodity. Things sure have changed. Not only are prescription drugs more expensive today, they are a whole lot more plentiful. Over the years they have sure figured out a lot of ways for people to use prescription drugs. I am also sure, before too long, we will have a drug regulating every possible human biological pathway, and then soon after that we will have more that are "new and improved".
Of course, everyone wanted to take advantage of these powerful new drugs. Sometimes they were needed, in which case they were truly life savers. We sure love our prescription drugs and have really come to depend on them. A lot of times we think we need them because someone on TV has told us that we are suffering from something we never even knew we could suffer from. Have you noticed the proliferation of illness in the past thirty years? I wouldn't worry about it too much though, because before you even realize you got something there will be a treatment for it.
So let's recap for a minute. As diagnostic medicine came to the forefront, a better means of paying for it became necessary and the idea of a co-pay went from a measly prescription drug card to a system of paying for office visits and the accompanying tests. As modern pharmacology developed people wanted to avail themselves of these new drugs, expensive as they were at times, so the prescription card now became a hot commodity. This coupling of more sophisticated diagnostic "tools" and the accompanying rise of modern pharmacology created an environment of financial opportunity for health insurance companies to provide products to help the medical consumer finance their need to participate in this new modern era of medicine.
These past thirty to forty years have resulted in what I call The Age of Medical Paranoia. At first, this new era seemed harmless enough. What's the harm of getting a diagnostic second opinion with the help of some machine? Sure it costs more, but the patient has a moderately priced insurance premium to cover the costs. And heck, most of the time his employer pays the premium, so might as well take advantage. As the tools became more sophisticated, the more people looked to them to ensure the notion that there was nothing wrong with them. Feeling okay, that's not enough, better have some machine determine nothing is going haywire. Now this may sound diabolical, but it was around this same time that the proliferation of pharmaceutics began. All of this preoccupation with "health" created another opportunity to provide the patient with something to make them feel like they were doing everything in their power to safeguard their health. Could it be that manufacturers saw a market to peddle wares among a growing population of medical paranoiacs? And why worry about the cost, you have co-pays and insurance.
As time went on, the American population grew more and more fixated on health issues. Now keep in mind, for most people this did NOT mean watching what one ate or realizing the importance of exercise or a healthy lifestyle. Why waste all that time taking care of yourself when you can just not pay that much attention about what you are doing to your body and take a prescription to fix what you fouled up? Who cares what it cost...you got your co-pay. High cholesterol, no problem. Overweight, no problem. Stressed out, no problem. Only there were problems and the "cure" for the problems weren't cures and worse yet, they caused more problems.
Diabetes was becoming more of a problem and so was heart disease. Cancers started appearing more frequently causing a whole lot of problems. People all of a sudden were suffering from respiratory problems. Aches and pains of every type began to appear, in the bones and muscles. Kids were sicker too, and all of a sudden they became "hyper" and needed to be calmed down. All these medical problems began taking a toll on the population because all of a sudden alot more people became sad, really sad, enough to have to take medicine everyday just to cheer them up. It even got to the point where it affected people's sex lives and they needed drugs to help them perform sexually. As cancer rates went up, so too the arsenal against it. And then it seemed like everyone had some sort of allergy or respiratory dysfunction. Arthritis was crippling more and more people. So much so that people were having to literally replace joints that were so disease ridden that they were unsaveable. Then one day it seemed like everybody over a certain age was just incapable of holding their urine for any length of time, and to make matters worse, some poor fellas couldn't pee fast enough when nature called. And just when people thought things couldn't get any worse, people started losing their memories to the point where they didn't even remember....anything.
As people got sicker and started using more medical services they were encouraged to buy more insurance "just in case". Just in case you may need a prescription or just in case you might get a cancer diagnosis. You might have a heart attack so just in case, you'd better have coverage. You may need to replace that knee or shoulder, better have the insurance just in case. All this "just in casing" helped create a financial empire. As the people's dependency grew, so did the power of this empire. As long as people remained afraid and were constantly reminded of all the medical disasters that could befall them, the more the industry grew. At the same time, the pharmaceutical companies became the "white knights" of health care, ever ready to supply you with a a medical arsenal. It was like your own little defense department against disease. And we all know how out of hand defense departments can become.
Now there are many who want you to believe that the answer to the spiraling costs of health care lie in changing the way we all access care and the way doctors practice medicine. Granted, that part of the reform solution cannot be ignored. This brief history of modern medicine illuminates that principle. But what it also illuminates is an opportunity for an industry to play off the medical fears of a nation at the expense of that nation and its people. What was once a system to insure people against medical disaster ( health insurance) is now a system that helps create medical disasters by denying people access to care. What was once a system to provide protection from the financial effects of getting sick, is now a system that creates financial hardship with the high cost of premiums or the denial of health claims or coverage at all.
You really can't blame the insurance companies and drug makers, after all, this is capitalism working at it's best. There is a need and a market to fill it. The question for all of us is this, if access to health care is a human right, is the free marketplace the best place to protect it? If people's health is "up for grabs" who makes sure those doing the grabbing are playing fair?When people are sick, aren't they placed at an unfair advantage? When does providing a service become profiteering off the misery of others? These are all questions to be pondered over the next weeks as our government begins to tell us how we got here and who is best likely to help us solve the problem. We all need to see who benefits the most from the present system in order to arrive at the solutions that will benefit us all.
