Health Care Crisis and Reform: Everything Old is New Again

By Clive Riddle, October 1, 2009

As the Summer Town Hall agitation of health care reform has now wound its way into autumn, it seems darn perplexing trying to prognosticate what exactly will happen next with health reform and what exactly is the national mood at this moment.

So I thought it might be instructive to listen to the ghosts of health reform and health crisis past. I took a stroll down memory lane, sifting through Time Magazine’s archives for the past 70+ years. Along the way I found many a headline that surely must have surfaced from discussion from this summer’s town hall meetings. But it seems, both health care and Yogi Berra are experiencing déjà vu all over again.

Here’s a timeline of recycled topics from the 30’s through the 60’s:

Presidential Commission Recommends Complete Reorganization of American Medicine

December 5, 1932: “The Committee on the Costs of Medical Care finally published its recommendations for the re-organization of the practice of medicine in the U. S.” The Committee report notes that a massive number of Americans have no access to care (“38.2% of the population were getting no medical care whatsoever”) and that if the “U. S. annual sick bill were equitably spent, every inhabitant of the nation would get adequate medical attention, every person connected with the practice of medicine would earn an adequate living.” The Committee advocates large group practices, based around hospitals.

A Book on What is Wrong With Health Care and a Call for National Health Insurance

May 15, 1939: Professor Bertram Bernheim, MD of Johns Hopkins pens “a startling book, Medicine At the Crossroads.” He “sees national health insurance coming” and says that eventually “all doctors will band together and practice in clinics, and this streamlined system of medical care will in itself bring greater specialization and raise the quality of service. Once this great step is taken, he believes it will make little difference in a doctor's professional life whether the patient or the government pays the doctor's bill.”

Study on Nation’s Health Finds U.S Plagued by High Rate of Chronic Disease

January 15, 1945:  the Senate subcommittee on Wartime Health and Education after a two-year study of the state of the nation's health found that “about one U.S. citizen in six has a chronic disease or physical impairment.”

Physician’s Rebel Against Discounted Insurance Payments and Second Guessing Over Tests Ordered

December 1, 1947:” San Francisco rumbled last week with a battle over compulsory health insurance. Under fire was a medical system covering San Francisco's 12,000 municipal employees. The only governmental compulsory health insurance system in the U.S., it provides medical care in return for a small monthly fee deducted from members' pay….Because members' payments were set too low, doctors have often been paid less than the scheduled fees. Last fortnight, aroused by rebuffs of their demands for a 15% raise in fees, and by Medical Director Alexander S. Keenan's suggestion that they had needlessly pyramided costs by calling for too many laboratory tests and X rays, the doctors finally rebelled.”

Heated Debate Over Competing Proposals of Public Option vs. Private System

December 29, 1952:  “Attention has been concentrated on two rival methods…compulsory national health insurance (favored by President Truman and Federal Security Administrator Oscar Ewing, "socialized medicine," to its opponents) and the present system of private payment…..ast week the U.S. was offered a middle way. The President's Commission on the Health Needs of the Nation recommended that the U.S.: 1) put the Truman-Ewing plan on ice, 2) go all out to extend voluntary insurance plans to tens of millions not now covered, 3) let federal and state governments pay the premiums for those who cannot afford to pay them, 4) dot the nation with up-to-date medical centers where doctors would practice in groups.”

U.S. Health Care is Touted as Best in the World, But Really Isn’t

November 16, 1953: A noted physician, Boston's Dr. James Howard Means, pens a book, Doctors, People, and Government in which he states "The impulse to reform in medical public affairs comes usually from without, and resistance to it from within the majority fold of organized medicine ... It is only under the lash of public opinion that organized medicine makes any social progress” The article notes “though U.S. medicine is often touted as the best in the world, he asks, ‘Best for whom? Doctors, patients, or everybody? Certainly it is not best for everybody, else the public affairs of medicine would not have been in turmoil for the past two decades.’”

Medical Costs Rising Much Faster Then Any Other Segment of the Economy

August 27, 1956: “Medical costs have been rising faster than any other item on the cost-of-living index, according to the Bureau of Labor Statistics. A patient must now pay 25% more for treatment than in 1950, as compared to an 8% rise in the overall price index. At the same time, benefit payments from health-insurance programs are running a fifth higher this year than last.”

Physicians Having to Hire Staff Just to Deal With Insurance Paperwork and Hassles

September 8, 1957: “Health insurance, a boon to no million people in the U.S., is regarded by more and more doctors as a paper-spewing ogre. Reason: the torrent of technical information requested by insurance forms is cutting into doctors' valuable time for treating patients, leading directly to higher costs for medical care. With even minor treatment requiring detailed reports, many busy doctors find they can no longer get along with just a receptionist or nurse, are hiring a new kind of medical officeworker—the ‘insurance secretary.’”

Covering Millions of More American Will Cause a Log Jam Trying to Access Health Care

October 22, 1965: In the Article Medicare: Will It Work? fears are cited that “no one in the Administration or in the American Medical Association can be really certain as to how many aged eligibles will jam into hospitals for long-delayed, noncritical "elective" operations or other "nonessential" treatment.”

Health Insurance Industry Fights Government Insurance Proposals Only To Embrace Them After Passage

October 22, 1965: Before the health insurance lobby opposed today’s Public Option, they opposed the HMO Act of 1973, only to embrace them later. Before that, “the insurance industry was second only to the medical profession in battling the advent of medicare. For years, insurance lobbyists in Washington opposed any Government-sponsored health-insurance program. Last week the insurance industry's representatives were still active, but this time it was at the huge social-security complex on the outskirts of Baltimore, where they are negotiating with the Government to get their share of medicare. Most insurance companies now realize that medicare, far from being the disaster they once predicted, may prove to be a welcome pep pill for their industry.”

American Health Care Is Un-Organized, Inefficient, Costly and Not Always High Quality

December 1, 1967: The article Crisis of Organization states “costs for its services are rising twice as fast as the general cost of living, and are expected to keep on soaring, hospital costs to the tune of 250% by 1975, physicians' services by 160% and dental care by 100%. Yet the industry is ill-organized and inefficient, and much of the care given in hospitals is of poor quality. That is what the National Advisory Commission on Health Manpower reported to President Johnson last week.”