A Golden Age of Health Care?
July 1, 2002
I was in a used bookstore in Ann Arbor when something on National Public Radio (are used bookstores required by federal law to play NPR?) caught my attention. A commentator was lamenting the high cost of health care in the United States, which he blamed on the fact that medicine had gone from being a "calling" to a business. Today cold, calculated profit-seeking has replaced genuine care for the well-being of patients, hard-hearted insurance companies and HMOs interfere with the relationship between caregivers and those who seek their services, giant pharmaceutical companies bombard us with advertisements for new drugs that do not really represent an improvement over medicines already on the market. What he called for was nothing less than a "rethinking of the social contract" so that it recognizes that all Americans have a basic "right" to health care.
All of this got me wondering just when Americans were expelled from that Eden when doctors and patients lived in harmony, before we needed insurance firms and HMOs to help with the cost of health care, and drugs were developed by kindly chemists who had nothing more than the welfare of the public in mind. Did such a paradise ever exist?
Certainly, if it did, it was well before the 1960s, when Medicare and Medicaid led to an explosion in consumer demand that jacked up the cost of health care. Indeed, it would have to be earlier than the late 1940s, when Harry Truman sparked a war against the American Medical Association by proposing compulsory national health insurance. It would even have to predate World War II, when health insurance first emerged as a popular fringe benefit—a way of increasing employees’ pay without falling afoul of Franklin Roosevelt’s draconian wage and price controls. Probably we would have to date it even earlier than the enactment of the Pure Food and Drug Act of 1906, which assisted the growth of gigantic pharmaceutical corporations by driving smaller firms out of business.
My guess is that we’d have to go back to the late nineteenth century to find an image of the health care profession that the NPR commentator would support. Remember the kindly doctor on television’s "Little House on the Prairie"? The one who would gladly make house calls in any sort of weather? The one who would accept a basket of eggs or a jug of milk in lieu of a cash payment? It’s certainly an appealing image, and one that stands in marked contrast to the health care professionals we know today—indeed, it stands in contrast to the entire world we know today.
Could we recreate such a health care system today? Perhaps. There is no law that says doctors and hospitals have to charge what they do for their services, or that doctors can’t make house calls. Or that insurance firms or HMOs have to exist at all. Why not scrap all these modern contrivances and return to the "good old days"?
Sound good? Okay, here’s the catch—we would have to toss aside virtually every other health care innovation of the twentieth century. Want to get rid of high costs? Then get rid of the big-budget extras. Goodbye, magnetic resonance imaging. Goodbye, laser surgery. Goodbye, chemotherapy. Goodbye, every anesthetic since ether. Goodbye, every lifesaving drug that pharmaceutical companies have developed this century. And, we should add, hello (or perhaps welcome back) to polio and a host of other maladies which have long since been practically forgotten.
Now I hear the objections. "Wait a minute, you can’t dismiss these things as ’big-budget extras’! These are absolute necessities! How dare you suggest that we do without them?" In short, not only do we think we have a right to health care, but to the best, most advanced, and most expensive health care options that are out there. And you can be darned sure that if our HMO balks at coughing up the dough we’ll see them in court!
In 1932 the Spanish scholar Jose Ortega y Gasset criticized what he called the "primitive man" who, while he is enthusiastic about the latest products of civilization has no interest at all in the principles that brought them into being. Hence he "wants his motor-car, and enjoys it, but he believes that it is the spontaneous fruit of an Edenic tree."
Ortega y Gasset’s words came to me as I stood in that used bookstore in Ann Arbor. The NPR commentator wants to return to some golden age of medicine, but surely would never dream of giving up the sort of medical advances that have dramatically increased our average life spans and measurably enhanced our quality of life. And at no point does he suspect that these advances have taken place precisely because the medical field is operated as a business, and not a government entitlement. In short, he wants to chop down the tree, but still enjoy the fruit.
If this is what he means by "rethinking the social contract," don’t count on me to sign on the dotted line.
Dr. Moser is an assistant professor of history at Ashland University and an Adjunct Fellow of the Ashbrook Center.