A Short History of Health Care: Let Doctors Be Doctors

I just ran across this on another website.  It’s a column I wrote for Indiana Policy Review a couple of years ago that seems more appropriate than ever now.

A Short History of Health Care: Let Doctors Be Doctors
By Andrew Horning

Healthcare is an odd business in that it has always been both expensive and unpleasant. Until the 1920s, the average doctor couldn’t even help with the average ailment. While medicine then included a range of arts like phrenology, acupuncture, homeopathy and allopathy it really was a coin-toss whether you’d be saved or killed by a doctor’s work.

Then the 20’s brought insulin, sulfa, other “miracle” drugs and sterile fields that meant, for the first time, that healthcare actually worked more often than not. From there, doctors, scientists and medical engineers really took off; rapid advancements increased life expectancies and decreased suffering. And because of increasing effectiveness and supply, healthcare was even becoming cheaper in real cost-benefit terms.

However, politicians had nothing at all to do with this, and that was apparently a problem. Teddy Roosevelt proposed a German-style, cradle-to-grave “socialized” healthcare system, but it was assailed as “the Prussian Menace” in those anti-German years before WWI, and Teddy’s scheme died. Even so, politicians wanting to seem compassionate started promoting socialized healthcare. The July 1919 issue of the Insurance Monitor made this prescient assertion: “The opportunities for fraud upset all statistical calculations. . . . Health and sickness are vague terms open to endless construction. Death is clearly defined, but to say what shall constitute such loss of health as will justify insurance compensation is no easy task.”

No matter. Between The Revenue Act of 1939’s health-related tax breaks, and 1943, when the War Labor Board excluded employer-paid health insurance from its wage freeze, American politicians charged into health care on their favorite horse, income tax.

In a nutshell, here’s what happened: Tax breaks for employer-paid health insurance meant that health insurance became a part of employment, and insurance became an integral part of healthcare. This inserted middlemen, which of course made everything more expensive. But who cared? The tax-subsidized, payroll-deducted cost was invisible enough that Americans started using insurance to pay for routine visits, dental checkups, eyeglasses and even plastic surgery. Group insurance offered large corporations better plans than small companies could muster, giving large corporations even greater advantages in hiring and competition than corporate laws already gave them. This also meant that the poor, or worse, the self employed, were even further distanced from the rich and incorporated in a very serious way. Obviously this created problems, but politicians never admit error, do they?

Four days before Tax Day, 1953, President Dwight Eisenhower established the U.S. Department of Health, Education and Welfare, giving government even more direct control over some of humanity’s most precious commodities. More political money and power meant more reasons for businesses to make campaign contributions and lobby. Of course, politicians at every level of government have used healthcare policy to reward their friends and punish their enemies. That’s their stock in trade.

Now tax money and policy is sifted and sorted through political appointees, immortal bureaucracies and defense-contract-style arrangements to feed a dwindling number of profit-starved insurance companies who then deny your claim. Doctors hire legions of workers to manage the regulatory, litigative, and insurance paperwork hassles; or leave private practice to become an employee within a clerically staffed healthcare corporation. So healthcare is still both expensive and unpleasant. But now it’s only because politicians, not doctors, are practicing medicine. Our healthcare injustices and vital statistics have decayed into an embarrassment at just the time when technology should make healthcare cheap, effective and available to all.

It is hard to imagine what politicians could have done to make our healthcare situation any worse. Yet, according to a July 2006 Harris Poll, Americans rate the issue of healthcare well-behind Iraq, the economy, immigration and even gas prices. Even more strangely, most people now think we must, to some degree and by some unspecified method, “socialize” healthcare just as Europe, Canada and other nations are now scrambling back toward free market reforms. What are we thinking?

Let politicians have their way with Iraq, the Colts and toll roads. Let them run lotteries and practice voodoo. But please, let doctors do healthcare at last; they’ve earned the right.



For my Dad

It’s culturally fashionable to think of your parents as friends and equals.  Try as I might, I’ve never been able to do that.  There has always been a sacrosanct wall of privacy, duty and proper role between my parents and me.  My father in particular, as my first and most powerful example of manhood, held a singular stature, an insuperable position in my life to which I could aspire, but would always have to defer to the man who still occupied it. 

Well, heroes die; what happens next is up to the survivors. 

Dad was always enigmatic to me.  He had no patience with his own errors or failing eyesight, but I remember his hands guiding my first attempts to plane wood, and to play Duke Ellington on the piano.  His hand was on my shoulder through Indian Guides, Webelos, Cub Scouts and Boy Scouts.  He never said very much that I ever heard, though he was a member of Toastmasters.  I’d heard hushed stories that he was some sort of war hero, but never from him.

I also remember a man who was frustrated with the 1960’s and 70’s.  The era of Vietnam protesters, Godless churches, LSD and women’s lib was hard for a man who had the same buzz cut and Errol Flynn mustache he had in 1945.  On the other hand, the engineer couldn’t resist gadgets and flashy cars.  He bought one of the first rotary engine-powered sports cars, though it was useless to a six-kid family, and his love of toy trains was perhaps obsessive.

He never missed a day of work and he never missed a campout, or a chance to make the Pinewood Derby car a little faster, a little shinier, a little bit better than the other kids’ cars…

When my dad said, “I’m going to go blow my brains out,” I knew that all the neighborhood kids would be in for a treat.  He’d pull out his clarinet and do amazing, impossible, delightful things with the levers and valves and a spitty reed.  I knew that he’d once made records with famous people, and that he’d had bands throughout the years.  I also knew that he played in places I shouldn’t ever visit.

I knew that a lot of people blamed his generation, and men in extreme particular, for all manner of evil, and that he never said a thing in response.  I didn’t know why he didn’t respond in kind to all the rage and righteous indignation leveled at him. 

As a teenager I had presumed that he was a wonderful father, but a woman old enough to know better once told me, “yes, but you couldn’t know any better, could you, dear?”

I did know that my dad, a man with a great sense of humor, just couldn’t stand the sitcom, “Hogan’s Heroes.”  It was only about 15 years ago that I learned why.

As it turns out, my father, as a young pilot, was shot down and taken to Stalag Luft 13.  The place became notorious.  But there was no ditzy Sargent Schultz, and there were no tunnels.  My dad was there only a few months, but weighed 94 pounds by the time he left.  I can scarcely imagine what he saw, smelled and felt.  He’d killed, he’d seen death, and he almost died.  I can’t blame him for wanting the memories to go away.

But his sense of duty, honor and fearful respect stayed with him until the very end.

He died a couple of years ago.  His last days were embarrassing, terrifying and painful, but all I heard was that he was sorry for causing us so much worry and trouble.  He knew that he was dying, but he feared the medical bills my mother would face.  Some of his last words were about me, my farm, my family.

He fought for his country, he lived for his family and he died with as little fuss as he could manage.  My dad wasn’t perfect, but I’m now considering his footsteps in awe.

If all boys were to grow up to be like Donald M. Horning, we wouldn’t need government.  Our legions of bureaucrats and politicians would find something better to do.  The big, costly and dangerous mechanism we call government would wither like a parched weed, and the guns of war would be disassembled to make toy trains.

Published in: on July 15, 2008 at 11:00 am  Comments (2)  
Tags: , , , , ,