June 18, 2022

There are truths regarding health care in America that need broadcasting.  Some truths are intimidating and discouraging, with no need for us to be reminded, such as the crazy costs of hospitalization, testing, procedures, and pharmaceuticals.  Another such truth is that along with ridiculously expensive medical care has come incredible success in the battle against the morbidity and mortality of disease.  But the truth about how we got here is worth reviewing.  It is the result of a unique, accidental confluence of circumstance.  Unfortunately, it is unsustainable in its current form.

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Many of the residents of our country act as if cost should not be a factor in the delivery of health care.  They feel as if medical care is a right and not having a socialized, government-sponsored system of delivery is akin to slavery.  On the other hand, corporations successfully weave among the patient, the doctor, the current government-sponsored health care systems, and their fellow capitalist insurance companies, managing to make a good profit while driving up cost. 

How did we get to the point where it was conceivable to produce pharmaceutical agents that cost six figures a dose?  When did we conclude that it is cost-appropriate to pay doctors and facilities to transplant a pair of lungs, a kidney, a liver, or a heart?  Most telling for the future, what would we be willing to sacrifice to make things sensible?

Our way-out-in-left-field costs have their origins in a simple-to-understand source.  After World War II, the federal government froze wages in its concern for runaway wage inflation, knowing that businesses desired to employ the best of the huge returning workforce and pay them accordingly.  With no means to attract new workers through better wages, companies created benefits packages along with employment that included costs shared in health care.  (A harbor company in San Diego with the now familiar name of “Kaiser” was among the first.)

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Health care insurance companies created from this new market accumulated monies with each employee paycheck.  Health care at the time was rudimentary and did not have much to offer sick patients.  As a result, prospective patients did not have the same desire to go to the doctor that we have today.  As money built up in the system, doctors and hospitals began to realize better, more predictable finances, and the costs of treatment options were barely considered, because insurance companies were more than willing to pay.

Practically no one could personally afford what resulted from this cost-is-no-object-in-care approach.  With these new treatments, massive wealth was created.  Research and development in pharmaceuticals radically expanded.  New devices for radiologic evaluation were invented.  New surgical instrumentation allowed doctors to do previously unimaginable procedures.  Transplantation of organs was no longer a fantasy.  The best and the brightest were funneling into medical schools with the prospect of leading the way in both the advancement of patient care and their own personal wealth as a result.

Following the money, the legal system dove headlong into health care, too.

For a while, the insured and employed in America generated enough money for health care providers to extend care to the uninsured.  The local, state, and federal governments created programs for the uninsured to further bridge the gap, as did charitable entities, many of whom already existed.  Contrary to today’s unspoken narrative that scores of the uninsured were dying on the streets, care was extended to most.

The head start that the insurance companies had to accumulate wealth before distributing payment began to fail to keep up with the demand for dollars in the 1980s.  This is the reason that their lobbyists permitted the introduction of managed care contracts in the early 1990s. Companies had the option of managed care when deciding on more affordable (to them) plans for their employees. 

With the launching of managed care came a couple of “stowaways.”  One was a means to make medical bills so opaque as to be unreadable.  Another created the need for doctors and hospitals to dramatically increase their staff to pursue payment for services from the new bureaucracy.