Health Care Reform: We Can’t Afford It

What do Caterpillar, Richard Pryor, and Penecillium chrysogenum have in common? Other than the obvious answer that they all came from Peoria, they all have been instrumental in changing the landscape of the 20th century: physically, culturally, and medically.

The advent of antibiotics, and in this case the much more productive species of Penecillium, was a game changer. Prior to the widespread introduction and use of antibiotics, getting to 50 years old was an iffy proposition. The premise of social security was founded upon the fact that the eligibility at 65 years old was above the median life span of people in the US. (Now, if we were to adopt the same standard, social security income would begin at about 80.)

Prior to this, it was pretty much a crapshoot as to whether you’d survive that pneumonia. Or injury. Or even surgery done by the best technicians in the world. In fact, because of our human, innate desire to help, as often as not physicians may have hastened the demise of their patients (the IOM had nothing on those guys).

In 1948, Truman, still largely in a WWII afterglow, jumped on the bandwagon for universal health care. It was heady times. Top of the free world, rebuilding Europe and Japan, ushering a new era of American prosperity and influence - we could do it all. The political climate in Europe, always more progressive, embraced the opportunity to develop a more intense social network as they too became more financially successful. The initial costs were low.

Not so in the U.S. We were entering the new American expansionism. Intellectually we had the best teachers, the best labs, the best companies. We made more stuff, better stuff, and on a previously unheard of scale than ever before.

We were America and we could do anything.

But just as the war for better health was won, it was lost. It transitioned to a war of attrition. And from a societal perspective that is a financial disaster.

Europe didn’t know it at the time and we didn’t acknowledge it in 1965 when the Great Society, in one of its centerpieces of legislation, passed Medicare. We thought we were just being realistic, that more folks were living longer and they retired and lost their job-based health coverage, and well, how could that be in a country like the U.S.? No one had a clue that the average life expectancy for someone born in 1900 would increase by nearly 20 years. And still continue to climb after that.

The introduction of Medicare and its reimbursement rules became the basis for all of health care reimbursement. It set the stage for the greatest jump in physician income in history. And the people were there: “It’s my right.”

“We have to do something for the structurally poor.” Medicaid, we’ll share that expense; Come on states, chip in. Clinton era: “It’s all about the kids.” The expansion of SCHIP. How could we not? Bush 2? Part D for meds.

And we were successful, both in saving people and assisting them to live longer and better. Implants and transplants. Bypasses and multiple CT passes. Many laws of unintended, and perhaps intended, consequences.

Well, in 2008 we did it. As in 1964, we gave majorities in both houses to one party that had increasingly moved in a single political direction, and a President to match. And they did it.

And we can’t afford it.

So thanks Mary Hunt for finding that mold that had “a pretty golden look.” The genie is out and putting it in that new bottle is gonna be a bitch.

John Lohnes, MD, FACR, is a radiologist at the Wichita Radiological Group and clinical assistant professor at the University of Kansas School of Medicine in Wichita. He serves on several local and state committees and is a self-proclaimed serial entrepreneur.