Why is America so concerned about health care reform? I find statements like “Don’t touch my Medicare” and “everyone should be able to access state-of-the-art health care regardless of cost” uninformed. They are visceral responses that show a lack of understanding of America’s health care system’s past, future and current resources as well as the funding challenges America will face in the future. We all wonder why the health system is at what some call a crisis point. Let’s take the emotion out of this debate by briefly looking at how the country’s health care system evolved and how it has shaped our culture and thinking about health care. Let’s start with the basics. What are the pros and cons to the Obama administration’s health care reform proposals? And what about the ideas put forward by the Republicans?
We all agree that access to high-quality health care services would be a positive thing for our country. Being diagnosed with a serious illness can be a major challenge in life. It is also extremely frightening to have to deal with it alone. We will see that it is not easy to achieve this goal without your individual contributions.
These are the main themes I will discuss to help you understand the current state of American health care.
- The recent American history of American healthcare – What has caused the high costs?
- The Obama health care plan contains key elements
- The Republican view on health care: Free market competition
- Universal access to high-quality health care is a noble goal, but it’s not easy to attain.
- What can we do to help?
Let’s first look at the history of American health care. Although this is not meant to be an exhaustive look at the history, it will help us understand how the system developed and what our expectations are. What caused rising costs?
Let’s start with the American civil war. Ghastly results were caused by dated tactics and the destruction inflicted on the victims by the modern weapons of the time. It is not well known that many of the war deaths were not due to actual combat, but rather from what occurred after a battlefield injury was sustained. The evacuation of wounded soldiers was slow and caused delays in the treatment of the injured. Second, wounds often required wound care, surgery, and/or amputations. This can lead to massive infections. You might survive a wound from battle, but then you would die due to the actions of medical professionals who, although they were well-intentioned and often very lethal. A lot of deaths can be attributed to common illnesses and diseases that were not treated with antibiotics. All causes accounted for 600,000 deaths, which is more than 2% of the U.S. Population at that time.
For a better understanding and a more current perspective, let’s jump to the first 50 years of the 20th Century. There were steady improvements in American medicine after the civil war in the understanding and treatment certain diseases, in surgical techniques, and in doctor education and training. The best doctors could offer patients was a “wait-and-see” approach. While medicine could manage bone fractures, and more often attempt dangerous surgeries (which are now largely performed in sterile surgical environments), there was no way to treat serious illnesses. Most deaths were due to untreatable conditions like tuberculosis and pneumonia, scarlet fever, measles, and/or other complications. Although doctors were becoming more aware of the existence of heart and other vascular conditions and cancer, they didn’t have much to treat them.
A very basic overview of American medical history will help us understand how we were able to treat minor or serious ailments until relatively recently, around the 1950’s. This is the crucial point that we must understand: “Nothing to treat” means that doctor visits, if any, are limited to emergency situations. In such cases costs can be reduced. It was clear that doctors had very little to offer, and thus there was virtually no incentive to spend on health care. The second reason that costs were kept low was the fact that most medical treatment were paid out-of-pocket. This means that patients had to pay for their own healthcare. There was no health insurance, and certainly no health insurance that was paid for by employers. Health care costs were the responsibility, except for those who were very poor and were able to get into a charity hospital.
What does health insurance have to do about health care costs? Its impact on the cost of health care has been and continues to be enormous. As a way for companies to avoid wage freezes, and to retain and attract employees after World War II ended, health insurance became a huge pool of money that could be used to pay for healthcare. The availability of billions of dollar from health insurance pools encouraged America to invest in medical research. Americans were able to get insured through both private, employer-sponsored health insurance and increased government funding which created Medicare (1965) and Medicaid (1966). Additionally, funding was made available to expand veterans’ health care benefits. It has become extremely lucrative to find a cure for any condition. This is the main reason we have so many treatments today.
I don’t want to suggest that medical innovation is a bad thing. Consider the millions of lives that have been saved and improved, as well as the many other benefits. With a funding source that is now so large (hundreds upon billions of dollars per year), it is inevitable that health care costs will rise. Most of us want and accept the best health care technology available, including pharmaceuticals, medical equipment, and diagnostic tools. The result is that we have more health care options to choose from. Until recently, most people were covered and the cost of the treatment was paid by the government or employers. The “perfect storm” of unmet public demand for access to treatment and care means that health care costs will continue to rise. The storm is growing.
Let’s now turn our attention to the important questions that will help us understand the current health care reform proposals. Is the current U.S. spending on health care sustainable? Is America able to maintain its global competitiveness with 16% of our gross national products being spent on healthcare? How much are other industrialized nations spending on health care? Is it even close? Information to answer these questions becomes critical when politics is added to the mix. It is important to understand health care and how it affects our thinking. If we are properly educated, we can make more informed decisions about whether certain health care plans might help or hinder some of these issues. What can we do to address these challenges? What can we do as individuals to help solve the problems?
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