The Good Old Days of Medical Care: A Clear-Eyed Look at the Past (and Present)
We are consumers. Not patients. We buy goods and services. Some things we get free through charitable concerns. Things priced so high that few could afford to buy them. Disease-modifying drugs, for example. The co-pays alone are enough to make Warren Buffett wince. It makes some people yearn for the good old days before managed care.
Wistful for the past
The high cost of being alive in these times makes us wistful for an era when a loaf of bread cost a dime. An era when our family doctor treated us for everything in each stage of life. Even I remember this. Dr. Fredericks delivered all four of my mother’s children, set my sister’s broken arm, treated my measles when I was a kid, and later gave me my first PAP/pelvic exam and script for birth control. He made house calls, too. The only reason we stopped seeing him was because he left internal medicine and became an anesthesiologist. After that, we saw his partner, Dr. Sutherland, who happened to live in my neighborhood, a diverse little subdivision where my neighbors’ dads were salesmen, insurance agents, foreign car repair shop owners, architects, physicians— and my dad, who was a hairdresser and jazz musician. There was more familiarity in the old days with our doctors as well as our neighbors.
But the old days are dead. There is no consumer Christ that will bid them rise from the grave. Nor should there be.
Less expensive times
We attach humanity to less expensive times past. But are they truly related? During those eras, being a doctor meant going into a profession that did not promise wealth. One became a doctor to pursue a meaningful profession. Depending on a doctor’s specialty, they could only hope to become upper middle class at the most. A country doctor sometimes took canned vegetables as payment for services. Anyone whose aim was solely to make money wasn’t going to do it by spending 12 years in school and then long hours in clinic. Greed is not served by taking an oath to do no harm. Think Bernie Madoff. Or going way back, J. P. Morgan.
Things have not changed much. Many doctors still aren’t within spitting distance of being upper class. My neurologist provided a glimpse into her financial world last month. I complained about how difficult it’s been to procure co-pay assistance, and lamented how much I pay the IRS each year as a self-employed semi-retired person because there are so few deductions available for my circumstances. “I can’t write off deductibles,” she countered. Meaning she sometimes waives a patient’s bill if it’s large because they haven’t met their yearly deductible. But she can’t write it off as a charitable contribution. This strikes me as unfair. Medicare already underpays her.
The old days were not better
The good old, dead old days were not better if you consider how few options people had compared to today. Take 1932. Kidney disease was a death sentence. No transplants, no drug therapy. And no hip replacements were available, only a wheelchair and endless pain. People went blind from cataracts. Even if cataract surgery and hip surgery had been available, nobody could have paid for it anyway. Health insurance didn’t really take off until the 1950s and 60s.
As expensive as it is to be sick in our time, we have it much better than people did long ago. Drugs that required a doctor’s appointment and prescription are now available over-the-counter. For multiple sclerosis patients, being consumers gives us some power to pressure drug companies and the FDA to fast-track MS therapies and let us bear more of the burden of risk.
Our legacy as consumer-patients
Maybe that will be our legacy as consumer-patients. Our sense of urgency, our willingness to become test subjects in our daily lives has undoubtedly laid the groundwork for bigger changes down the road. Since we are taking charge of our health care more and more, maybe someday the powers that be will construct a universal model of access that works along with market forces, bonding socialism and capitalism in a shaky but well-attended wedding.
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