“Quality affordable healthcare for every American.” We once had it. Here’s a review of the journey that stole it.

Gee, Wally, medical care has come so far since the early ’60’s. It was just too gosh-darn simple then. People got sick, went to the doctor, got a checkup. The doc harrumphed, made a diagnosis, wrote a prescription. For the price of cat food you got your meds and went home. Later that evening the doctor might stop by to check on you. His black bag could not have held colonoscopy equipment but contained everything needed for a house call. 

Usually you got well. On rare occasions when you didn’t, well, doctors were humans, too, and they were forgiven for mistakes since they were also your friends. Life happens. Lawyers stayed busy writing wills and prosecuting hubcap thieves.

But alas! Every now and then, someone got so sick for so long they couldn’t pay their medical bills. Sometimes they even went bankrupt! Something had to be done! And President Lyndon Johnson decided the government should do it. Johnson signed some legislation in 1965, and abracadabra!–we had the miracle of Medicare. America’s walk across the cow patties (“meadow muffins” in Texas lingo)  had begun, arm in arm with our new friend in healthcare, the government.

Medicare required an agency to administer it. And, of course, “compliance” surveyors, the Barney Fife’s who became increasingly meddlesome in policing which services and medications were reimbursable. They gained more control over doctors, who now had two groups to satisfy–patients and Medicare. The phrase “Medicare doesn’t cover it” became a staple in American conversation. Medical costs rose, as did Medicare premiums, as did taxes to fund the Medicare bureaucracy.

Enter the insurance companies. Like casino owners, they knew how to calculate the odds of you getting sick, place their bets (or not) on your health, charge you premiums, and create deductibles. Enter managed care, where insurance companies seized even more control of both the medical professionals and the patients. Enter a new corporate behemoth called the healthcare industry and the redefinition of patients as consumers. Enter malpractice suits and battalions of lawyers placing full ads on the back covers of phone directories to lead the assault against the healthcare industry. Enter expensive marathons of tests with expensive equipment which, along with the jacked up costs of doctor/hospital visits, were needed to protect the industry from malpractice suits.

EXIT the doctor/patient relationship. Exit clinical judgment, replaced by the verdicts of the testing machines. Exit affordability.

Exit quality healthcare.

So where are we in 2009? The insurance industry and Medicare have hijacked “healthcare.” Doctors have banded together in corporations to survive financially. Medicare eats up more and more money and coughs it up with greater and greater reluctance. Insurance companies concoct rackets to hoard premiums and deny payments to consumers. Doctors charge as much as Medicare will allow. Hospitals, among other little stunts, charge patients five dollars or more for sample packets of tissues that they get for free. Corporations have found themselves a new cash cow. And we have the muffins to prove it.

House calls? Only grandparents remember those. You’re lucky if you know who your doctor will be, since your insurance company has more say in that than you do. People with insurance go to the doctor for every hickey and sniffle because “insurance will pay for it.” They think healthcare is free! Insurance companies respond by raising rates. Patients who can still afford it ravage the system, making it impossible for the uninsured to afford it at all. Endless rounds of testing and gun-shy doctors make the sick get sicker and experience “adverse outcomes.” Without insurance, people who go to the E.R. have their bills handed over to banks in other states for collection, and–patients are going bankrupt. Just like 1965.

Except now, because insurance rates are higher than car payments, medical care is not only unaffordable, it sucks. That long walk we took has been in a circle around the barn. Now we have really stepped in it, and we’re belly deep.

Change? Let’s rethink everything. Maybe non-profit healthcare options. Credit union style health accounts. Citizen watchdogs with fangs. Higher taxes for ambulance chasers. A second tier medical system with legally protected physicians who make diagnoses without expensive testing, or even insurance reimbursement. Government coordination and inducements for the non-profit sector to fill the gap between the have’s and the have-not’s. SOMETHING. 

Health insurance is not healthcare. Since most people have come to think of the two as synonymous, let’s hit that point again: Health insurance is not healthcare.

Health insurance is not the answer. It is the problem. It could be that we’ve waited so long to address this problem that massive government intervention is our only option. Or maybe it’s time to start another 44 year walk around the barn, in the other direction, to see if we can recover some of what we had before 1965. 

                                                                                                 

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