Health Care: Function: noun. 1940. Efforts made to maintain or restore health, especially by trained and licensed professionals — usually hyphenated when used attributively. Source: Webster’s Third New International Dictionary, Unabridged. Merriam-Webster, 2002.
The Early History of Health-Care Insurance
As an old fellow who grew up in the 1940’s and 1950’s, I remember the way things were back before health-care became a political football. Notice the date in the citation from Webster’s dictionary. The expression “health care” wasn’t even in the lexicon before 1940. What Webster doesn’t say is that “health care,” in those days, had nothing to do with medical insurance. That was an entirely separate issue.
Health insurance isn’t a new thing. It was first proposed in 1694, by Hugh the Elder Chamberlen, a male British midwife from a family of medical men renowned for introducing the obstetrical forceps. Hugh, the grandnephew of Peter Chamberlen the Elder, inventor of the aforesaid forceps, was its chief exploiter. Being an enterprising fellow, he saw great promise in, among other money-making ideas, selling health insurance. Hugh’s entrepreneurial ideas tended, however, more to get him in trouble than to produce tangible income. Thus, the concept languished until 1850, when accident insurance–actually a form of disability coverage–was first offered to the public by Franklin Health Assurance Company of Massachusetts.
That company provided insurance plans that covered injuries related to railway and steamship accidents. Sickness insurance, on the other hand, dates from 1890, but wasn’t intended or expected to cover ordinary sicknesses. Throughout most of the first half of the 20th century, patients expected to have to pay their health care costs out of their own pockets. In what appears today to be a novel approach, doctors and hospitals followed a fee-for-service business plan; you, the patient, paid for the medical services you received, as they were provided to you.
But, was this a good way to do things? Not to the man on the street, who wanted to ease the risk of financial shipwreck that often came in the wake of catastrophic illness–or to the doctors, whose practices often suffered under the weight of the unpaid, or only partially paid, medical bills charged to their financially strapped patients–or to the hospitals, where staffing, laboratory, equipment, and facility overhead expenses were constantly rising, and a steady, reliable income stream was so valuable. All of these entities, each with competing, yet related, interests, began to see wisdom in reducing the financial shock attending the large fees produced by unusual medical calamities. So, tentative steps were taken to deal with those fees in advance, and, in the 1920’s, an auspicious trend got off to a shaky start:
In the early years of that decade, certain hospitals began to offer pre-paid medical services. Of course, such plans failed to meet the needs of patients who–for one reason or another–found themselves being treated in a different hospital than the one that held their pre-paid service plan. So, in 1929, to resolve that issue, a pre-paid hospital plan that wasn’t tied to specific hospitals or clinics was created by one Justin Ford Kimball. Kimball’s plan enrolled 1,300 members in its first year, but–proving its popularity with the man on the street, and the ability of insurance salesmen to explain its benefits–within ten years that plan had enrolled more than 3 million.
Somewhere along the way, Kimball’s program became known as Blue Cross. Today’s Blue Cross, alongside a host of similar health-care insurers, is the glue that holds the modern medical establishment together. Without that glue, the constant march upward that medical science has taken since the 1920’s would have been much less spectacular. As a result, we enjoy what is, by most measures, the most advanced system of medical care the world has ever known.
I was privileged to be directly involved in the inner workings of Blue Cross, back in the early 1970’s. While working for Texas Instruments, I helped set up a computerized claims collection system for Blue Cross of Florida. From its Jacksonville headquarters, using 16 telephone lines, a TI-960 minicomputer, and a series of hospital-based intelligent terminals, that system nightly collected claims data from hospitals throughout the state. In the process, the time from claims submission to issuance of funds was cut in half. That was a big deal, both for Blue Cross and for the hospitals it served. Blue Cross knew the importance of paying claims fast, and chose to support, rather than hinder, the advance of medical science. It took over 18 months to get that program up and running smoothly. When it was complete, I was pleased to have played a small part in improving the state of medical care in Florida.
The first Blue Cross baby was born on 27 December 1933 to Ann Woodward Reid, whose Blue Cross health insurance certificate included maternity benefits. The mother’s 10-day hospital stay totaled $60.00, corresponding to about $996.77 in 2008 dollars. Today, of course, bringing a baby into the world costs several times that amount. However, the medical care provided to the mother and baby, these days, is thousands of times more complicated than it was in the 1930’s. It is safe to say that, any comparison of costs and care between then and now would show that today’s patient gets considerably more benefits for each dollar spent.
Medicare & Medicaid
In 1945, President Harry S. Truman asked Congress to enact legislation establishing a national health insurance plan, modeled on the Blue Cross experience but paid for, at least partially, by funds from the public sector. Spirited debate in both Houses warned of the dangers of “socialized medicine,” and nothing was done. By the end of Truman’s administration he had reconsidered the wisdom of his proposal. However, administrators of the Social Security system had no such misgivings, and began to lobby Congress for a program that, at the very least, would cover Social Security beneficiaries. In 1965, in connection with his administration’s “Great Society,” Lyndon B. Johnson–with Harry Truman in attendance–signed that program into law, under the titles Medicare (for beneficiaries able to pay a small monthly fee for enrollment) and Medicaid (for indigent recipients).
Over the intervening years, these programs expanded to cover the disabled of all ages, the poor, those with end-stage renal disease, chiropractic services, speech and physical therapy, and hospice benefits. These were worthy additions, but little was done to fund them. Regardless, Medicare kept taking on more worthy projects, until, eventually, all Social Security beneficiaries, every member of Congress and most civilian federal employees, and all those over the age of 65, were required to enroll in Medicare or Medicaid as their primary health-care insurance providers. At that point, those who qualified for Medicare or Medicaid discovered those were their only choices, because private insurers could not compete with the government plans.
In 1980 I joined the ranks of the volunteer fire department that served my neighborhood in central Texas. Immediately I enrolled in a course of study that culminated in being certified as an emergency medical technician. That enabled me, as a firefighter/EMT, to provide prehospital medical care to accident victims and persons with medical emergencies. The ensuing 25 years taught me many of the intricacies of on-scene emergency medical care, as well as the protocols of hospital emergency rooms, obstetrics and surgical wards, and the vagaries of health-care insurance. During that time I never once saw a patient denied care because they were uninsured or were unable to pay. But I witnessed, first-hand, the dramatic changes that took place in health-care insurance during the 1980’s, 1990’s, and the first years of the new millennium.
One of these changes was the decision, by Congress, to change the mainstay of their health-care insurance from Medicare to the Federal Employees Health Benefits Program (FEHBP). This program does not set prices for doctors and hospitals the way commercial health-care and Medicare/Medicaid plans do. Furthermore, it pays claims promptly, in recognition of the fact that when doctors and hospitals are paid within a reasonable time frame, they provide services to insured parties with a smile.
Today, the annual costs of the Medicare/Medicaid programs continue to exceed the ability of new inflows of tax revenues to fund them. FEHBP, on the other hand, is fully funded by Congress, without serious debate. Ironically, political concerns make it impossible for Congress to either provide the needed funding for Medicare/Medicaid or shrink the programs into solvency. Instead, various compromising stratagems have been applied as tourniquets to stem the torrential fiscal hemorrhage. One, for example, limits the fees medical providers can charge for each medical procedure. Another delays payments to the medical providers. Both ploys have had predictable results. Many medical doctors–particularly the more successful, bright, capable ones in their fields–now opt not to provide service to Medicare and Medicaid beneficiaries, a reaction that severely reduces the number of physicians, clinics, and hospitals that Medicare and Medicaid recipients can visit.
Notice that the delay in the payment of Medicare/Medicaid claims was the exact opposite of the approach taken by Blue Cross. It is fair, to some extent, to say that Congressional control of Medicare and Medicaid, by adopting such an approach, has succeeded in stunting the growth of medical science. The FEHBP, however, which provides health benefits for federal employees–including every member of Congress–has been a boon to medical science, and a model for universal health-care insurance, precisely because it does not set prices for doctors and hospitals, and pays its claims promptly. But that is another story, and one we shall not delve into for the moment.
Mandatory National Health-Care
Via the circuitous course just described, health-care insurance grew from its modest beginnings of the early 1920’s to the mixed-bag colossus of the present. Today, most Americans believe they cannot survive without health-care insurance. That is probably overblown, inasmuch as only 90 years ago, before it came along, we somehow managed. But, now, all of America is locked in a rancorous debate over how, and if, we should make health-care insurance available to all.
It is not my purpose to intrude upon that debate. The issues are complicated, and bear close analysis, but not here–at least not now. Were we to attempt such an analysis in these pages, especially in 2009 while the dust and smoke still chokes the air, we’d quickly get lost in a quagmire of thorny, political considerations, most having an emotional character bereft of logic, that overshadow–and obscure–the real question that we should be asking. Let’s proceed beyond that, ask the all-important question, and try to find some answers.
What is The Best Possible Health Care Plan?
That question is this: What is truly the best health insurance anyone can have today? Does such insurance even exist, insurance that is available to everyone, and that covers all imaginable forms of sickness and disease, and every condition that reduces our quality of life, or that threatens to cut our life-span short?
The answer to that question is yes. Ironically, however, traditional health-care insurance will not satisfy all, or even most, of those requirements. That statement is true, whether we speak of health-care insurance provided by commercial insurers like Blue Cross, or by government plans like Medicare and Medicaid, or even the blue-ribbon, superlative plans like FEHBP, which insures every member of Congress.
The Consequences of Universal Health-Care Insurance
Just about everybody, today, has health-care insurance of one kind or another. Many will dispute that statement, but–by just about any measure one takes–it happens to be the case. True, some opt not to be officially insured, but just about everyone who wants to be officially insured has a policy. That makes the concept essentially universal, especially when you consider that everyone, regardless of their ability to pay, can ask for and receive treatment at almost any hospital emergency room in the nation, whether they have insurance or not. This universality of health-care insurance, in conjunction with a generally less-than-optimal approach to administration, has a number of sobering–even chilling–consequences. Bear with me on this. You might be surprised at what those consequences are.
But first, answer this: Did you know that the old fee-for-service payment plan isn’t dead? Yes, it remains true that you can still walk into a hospital, or a doctor’s office, and pay cash for the services you receive. And, when you do, a strange thing happens. You end up being charged a lower total fee than if you pay through your health-care insurance plan. Often, in fact, you pay much less. Now, don’t think I am suggesting we should necessarily pay cash when we go to the doctor. It will save the system a lot of money, yes, but we have insurance to cover that, so if all we are doing is helping the insurer, at our expense, it won’t happen. Still, the savings are there to be had, and that fact, alone, should be a wake-up call to every one of us. Follow along, please…
It is really true that most doctors routinely provide a 10% discount to patients who pay in cash. But that’s just the tip of the iceberg. Many people report saving as much as 50% on their doctor bills by being cash customers, especially when they pay cash for big-ticket medical procedures. There are good reasons for this. Physicians incur considerable expense transacting with health-care insurers, just in paperwork alone. Even small medical practices find it necessary to hire one or more specialists devoted to preparing, submitting, and tracking insurance claims. Disputes between the physician and the patient’s insurance company are common. These disputes often involve large sums of money, and can revolve around such arcane issues as the definition and intended meaning of a single word in the patient’s file. Such disputes often cannot be resolved in a reasonable time frame unless the physician is willing to make costly revisions, redactions, and concessions.
The Real Cost: Double, even Quadruple the Fee-for-Service Amount?
You may not realize, right off the bat, what this means, but the consequences are monumental. In summary, the cost of health-care insurance is much greater than it appears. Not only does each insured individual have to pay a monthly premium for the privilege of being insured, but the simple fact that their health-care insurer pays the bill, instead of them, inflates the cost of the medical care they receive. And that inflation isn’t the 10-50% that it seems to be, either. If the real price (what a patient would be charged if paying for it in cash) of a medical procedure is, say, $500, but the insurance claim price for the same procedure is $1,000, the actual inflation is 100%, double what it would be under a fee-for-service program.
Let’s put this into perspective. According to statistics compiled by the National Association of Manufacturers, annual health-care spending in the United States exceeded $2 trillion in 2006, costing Americans, on average, $7,026 per person, or $600 a month, for every man, woman, child and baby. If–assuming such a thing were even possible–we did away with health-care insurance altogether, and people began to pay their medical bills in cash, on a fee-for-service payment plan, those costs would plummet. At minimum, the theoretical annual savings would be $200 billion. It could be as high as $1 trillion, though. Just by paying in cash. In this hypothetical world, the average annual per capita cost would drop to $3,500, or about $300 a month.
Actually, it would almost certainly drop much more than that. It happens that a large share of the medical expenditure total comes from non-essential, elective visits to medical facilities. A huge number of those would disappear if patients had to pay for the visit out of their own pockets. It isn’t outside the realm of possibility that the resulting cuts in medical expenses would drop per capita costs to less than $150 a month.
But health-care insurance has its place. It’s here for good reasons, for political reasons, and for other reasons as well, and–except for a few hopeless ideologues who are out of touch with reality–most recognize that it isn’t going away. Accept that, then, and proceed onward, with me, to higher ground. This paper isn’t a polemic against health-care insurance. What it is, instead, is a collection of ideas and thoughts intended to promote fruitful thinking about the important, real issues surrounding our state of health. Let’s focus on that.
An Apple-A-Day vs. A Magical Silver Bullet
Health-care, as has already been pointed out, has at least two aspects, financial and medical. Let’s get the financial stuff out of the way first, and then ease into the medical part. For us, as individuals with health-care insurance, it does little good to pay cash when we can, just because it will lower the costs of medical care to the system. Unless you are a politician, the notion of putting our wallets on a diet isn’t a good thing. But there is persuasive evidence to show that just limiting our visits to the doctor confers important cost benefits that do affect our wallets in a positive way. Every doctor visit costs us something, even if our insurance foots the doctor’s bill in full. There is gas, or taxi, bus, and subway expense, not to mention the time spent in transit, in the waiting room, and in the examination. One doctor’s visit easily takes half a day, by itself, at minimum. What is half a day worth to you?
We assume, of course, that we save money by going to the doctor before a medical problem grows larger and requires more costly medical interventions, but it isn’t always financially sound to visit the doctor every time we feel under the weather, or just because something unusual seems to be happening to our bodies. Maybe, instead, we should eat the once-a-day apple of popular verse, provided that poem’s pithy wisdom works.
Of course, if it doesn’t work, staying away from the doctor could–as we have been led to believe–let a pernicious or malignant disease spin out of control, and we may end up paying more as a result. In fact, if the disease has serious life-and-death implications, we may pay much, much more. Toss the coin, or roll the dice. That’s what we are told we do when we take chances by staying away from the doctor. And, from time to time, that’s the way it is.
Still, it’s a good bet that many of us go to the doctor more often than necessary. Ordinary colds run their course whether we treat them with medications or not, but running to the doctor every time we get the sniffles, or our blood pressure rises slightly above the norm, often ends up with us on a medication treadmill that is difficult or impossible to stop. Alternatively, those who take the time to study up on the best ways to kick a cold or the flu, or how to keep blood pressure in check, while taking the least amount of medication in the process, are better prepared to reason out some of their more serious health issues later on. Like, for example, how to make changes in diet, lifestyle, and exercise in order to combat and cure all kinds of medical problems. High blood pressure is a good example, because–contrary to popular belief–it is not an inevitable consequence of aging. Good students of their own bodies can stop, even reverse, the upward trend in their blood pressure without taking pills, no matter what their age is. That’s important, because once you start taking blood pressure meds, you become strapped to an insidious treadmill–one that few feel they can safely dismount, throughout the remainder of their lives.
Our bodies change as we age, too, so unusual happenings are normal aspects of life. With a little research we can usually find out what those things are and when to expect them. You don’t need to pay a doctor to learn that–especially now that the Internet puts such information at your fingertips.
The “Gotta go to the doctor” mindset puts the doctor on a pedestal and imbues the medical profession with secret, almost magical knowledge, but is based more on fancy than on fact. Honest doctors admit that they are ordinary people, albeit–perhaps–with extraordinary intellects and hard-won educations. The knowledge they possess and dispense is neither secret nor magical, and sometimes it is downright wrong. When patients treat their doctors with awe, and hang on their every word as though they were the keepers of some secret hoard of magical silver bullets, they set themselves up for disappointment. There aren’t many–if any–silver bullets in life, but you don’t have to search far to find pretenders to that throne. If, on the other hand, you look for more mundane methods for keeping your body healthy, you will discover valuable health enhancers that, because they come in the garb of peasants (they don’t do all the work, like silver bullets are expected to do, but require your active participation in the cure), don’t get the respect they deserve. The bottom line is this: constantly depending on a doctor’s advice isn’t always the best thing for your financial, physical, or even mental health. Many of us would be much healthier, all the way around, if we took direct responsibility for the bodies we live in instead of completely handing that responsibility over to someone else.
Not everybody, though, has the study time, or is emotionally willing and intellectually prepared to take responsibility for their state of health. For them the choice is clear; taking personal charge of their bodies is not an option. But for those who are so prepared, the benefits of taking such personal responsibility on can be life changing, not to mention life-saving.
Taking Responsibility for Your Own State of Health
Many have believed, all their lives, that their bodies are not very well made. We suppose, simply because of all the flaws we were born with–or that have cropped up because of our lifestyle or our exposure to bad things in the environment–we must resign ourselves to being wards of the medical establishment. For a very small number of us, that may even be true. For the overwhelming majority, however, it probably isn’t true at all. Our bodies are, in general, marvels of acceptable, even beguiling, imperfection. Yes, we aren’t perfect, and yet–contrary to what we may think–that’s not all bad.
Think this through. Who would want to be truly perfect? Just as important, who would want to marry a perfect spouse? Yes, admittedly, these ideas do have a certain allure, and who hasn’t bitterly blamed ancestry for the imperfections we have, as though perfection was an inalienable right that our genes cheat us out of? As a practical issue, though, perfection poses major problems for the individual and for marriages. Ever met a perfect person? I have, and–let me tell you–they weren’t fun to be around. Put simply, a perfect person would be unable to relate with the rest of us, and a perfect spouse would be an impossible mate. Imperfection can and should be viewed as–in contrast with perfection–a genuine virtue. And, in this context, it just means that we are different. One thing it doesn’t mean is that we are detrimentally flawed. The truth is, most human bodies are perfect enough. Which is to say they don’t fall apart on a whim, or even after being mistreated shamefully for years.
The ability of the typical human body to heal itself without outside intervention is amazing. Now, that’s ancestry we can be proud of. We just need to give our genetic heritage a chance to work. And even when the natural healing capabilities of our bodies are not quite enough to do it all by themselves, a little informed nudging on our part will often supply the extra support necessary to make the difference. Like, for example, resting when our batteries need charging, so our body’s natural healing capabilities can work at full capacity. Or laying off sweets while fighting an infection. In the pages that follow I will list more ways we can help our bodies attain and maintain the peak of efficiency, while supplementing their natural abilities to heal themselves. Just remember, as you examine that material, that I am just another ordinary, imperfect, human–probably much like you–without any secret or magical knowledge. The key to excellent health resides solely with you and your innate desire to achieve it. I mean that, sincerely.
What are the chances you will suffer a catastrophic illness in your lifetime? You might be surprised at how low your chances are. You can lower your risk much further, too, by taking charge of your body, avoiding certain food items, increasing your intake of other foods, and being–within reasonable limits, of course–your own physician. Sounds impossible, right? Most of us are of the mindset that doctoring is so complicated that ordinary people cannot hope to heal themselves of anything, including ingrown toenails and the common cold. Yet, the best doctors in the world would have you ask yourself this question: who is better able to determine what is good for you, or bad for you, than you, yourself? Who is with you, day in and day out, through thick and thin, better or worse, observing your reactions to things, the changes that take place as you try different foods and medicines? Nobody but you. You are your own best physician, by almost every measure these doctors can think of. The way medicine is changing these days, it seems even more imperative that each of us begin to realize that.
Growing Older: Ponderings for the Young–and the Old–Alike
Consider just one example. As we grow older, eventually we arrive at the august state of life known as “old age.” To those yet in the blush of youth, yon elder state is reached–by those who are older than them–the moment said elders attain the ripe age of 50. For those nearer the age of 50, of course, old age is more like 60-70, because the real definition of “old age” is relative, not absolute. Regardless, once you pass 50 you suddenly become aware of a very unsettling fact: your medical status, and your worth to society, is now viewed differently than before by the rest of your world. You are no longer a problem solver, but a trouble maker. You are, in fact, the problem, because everybody “knows” you belong to the age group that supposedly (and for some, actually) consumes most of the medical care available. You become a burden upon society, at least in the minds of many, if not most, of those not yet of the “elderly” persuasion.
Here’s the deal. “You are falling apart,” whether you realize it or not–and even whether it’s true or not. And a lot of the time it isn’t true at all. It isn’t that unusual, for example, for some of us to reach the age of 100 with all or most of our mental and physical faculties intact. Thus the period from age 50 to 100–i.e., half of such a person’s life span–have the potential to be the best, most productive and useful years of all. Yet, for some reason, the value of the wisdom possessed by the older generation living within that other half of their lives is lost on everybody else.
Maybe it’s because those who are younger don’t want to take any more advice from their elders. That makes sense. A crucial milepost along the path to self-sufficiency is reached when we stop hanging on the advice of others and begin to reason our destinies out. The best way to learn is to make our own mistakes. We gain more that way than we gain from the advice of others.
Maybe, too, it’s just as much our fault. We oldsters don’t always appreciate the wisdom we have, and–to be honest–we don’t always seem, or act, very wise. We treated the elderly generation of our youth with disdain, too, don’t forget. And if the younger generation is critical of the share of medical care we hog in our old age, their criticism is probably on target. We didn’t take very good care of ourselves back then, just as they aren’t taking very good care of themselves today. To use a familiar cliché, we made our bed, just as they are engaged in making much the same bed for themselves right now, and now we are finding out how much fun it is to sleep in the beds we’ve made. See my point?
In any case, as you age you will see clear, unmistakable signs that the younger generation has serious questions about whether your generation is worth the effort and expense involved in keeping you healthy or even alive. And, like I pointed out earlier, they might–even though flavored with a degree hypocrisy–even have a point. The insidious part, though, is that their criticism has a nasty edge to it. They are the ones who will decide what to do with us, once our core competencies begin to fade. Notice, for example, the present interest, mostly by the younger generations, in the “end-of-life decisions” that the elderly should be introduced to as alternatives to robust medical treatment regimes.
Am I overreacting? Probably, but not by much. Over the coming years, as populations continue to increase, these issues will grow even more apparent. But they are bad enough already to give us pause. Just wait until you turn 65, when you have to drop your old health-care plan and sign on to Medicare and a supplemental plan with another insurance company. That’s when you discover that doctors don’t add “elderly” patients to their client rolls as readily as they take on younger ones. And that the cream of the general practitioners in your city refuse to handle any elderly patients, period. Do you plan to travel in your retirement? Great. Go to a new city, try to find a doctor there to serve as your primary physician, and you will find out how true this is. You may have to call 25-50 doctor offices before finding one who will even consent to see you–and then only after you do a little begging. And what happens at the Emergency Room if, for one reason or another, you have a medical emergency? Is the impression you get in such places–that you are expendable, perhaps even in the way–real or imagined?
One of these days, if you live long enough, you will likely find yourself in all those situations. The core object of this article, and the ones that will follow , is to help you live that long. Is it worth the trip? Actually, yes, it is–in my humble opinion, but you needn’t take my word for it. Another object of these articles is to prove that proposition, with hard, cold facts that show not only that it it worth it to you, the traveler, but to the rest of us who benefit from your continued presence. The proof Is rather straight-forward. But you need to know, that when you embark upon that worthwhile trip, you’ll be way ahead if, in your youth, you chose to become your own doctor. Later on you may be the only doctor you can find who will be willing to treat you.
Assembled and edited by Jerry Cates, Editor-in-chief, Bodsinthenews.info. Questions? Corrections? Comments? BUG ME RIGHT NOW! Telephone 512-331-1111. E-mail email@example.com. Or register, log in, and leave a detailed comment in the space provided below.