A brief history of Healthcare

Once upon a time, a sick person would go to the local quack, and said quack would prescribe a course of leeches. This went on for quite a while. Many people died as a result of quackery.

Over time, “Leechcraft” became known as “The Healing Arts”, quacks became known as “Doctors”, and hospitals were invented by the church. The process of training Doctors became formalized, and moved from the hospitals to the universities.

And Healthcare got expensive.

Since a stay in the hospital was expensive, the first Health Insurance — “Major Medical”, which insured against the huge expense of an extended stay in hospital — was invented.

And Healthcare got more expensive.

“The Healing Arts” became “The Healthcare Industry”. HMOs were invented, ostensibly “to control the spiraling costs of healthcare” (did it work? You decide). The cost control in HMOs was achieved by giving your Doctor the power to decided whether further treatment was necessary and punishing them for making too many referrals. For those patients who did not want such restrictions, they invented the more flexible (and expensive) PPOs, in which the patient decided what treatment was needed, were invented. Those who could afford it got PPOs, those who couldn’t — also known variously as “The Plebeian Classes” or “The Great Unwashed” — got the leavings.

And Healthcare got more expensive.

We hit hard economic times, and one of the government’s well-meaning but inept responses was to freeze wages. Enterprising employers, looking for ways to incentivize employees without paying them more, introduced Employer-provided Health Insurance, where the employer footed part or all of the cost of health insurance. It soon became so popular that employers who did not offer “Health Benefits” found it difficult to attract staff. Within ten years, Health Benefits were such an integral part of the landscape that it was difficult to imagine a world without it, and it was only a matter of time before otherwise-intelligent people started to believe that Health Insurance was a basic human right.

Even for the uninsured, the vision of employer-provided health insurance was a compelling one; folks with jobs got insurance that paid their healthcare bills, while those without jobs — or those who could not afford insurance — would get free care with the money that was left on the table. A worthy and excellent vision.#And Healthcare got more expensive.

And then came merger-mania. The health Insurance industry was composed of hundreds of companies, some for-profit, some non-profit. As inevitably happens when these two types of businesses compete, the non-profit health insurance firms got acquired by the publicly-owned for-profit ones that were flush with shareholder cash. Over time, the playing field shrunk until there were only a handful of major players left standing.

At the same time, the Health Insurance companies looked at the the money left on the table and decided to grab it for themselves. And so they designed a system where all roads lead to Health Insurance. They introduced a system of Co-pays, Co-insurance and deductibles that passed on the costs to their customers, and created “Networks” of health professionals who were contractually obliged to accept lower payments than they would have liked. As a result, the healers, now doing more work for less money, no longer had the time or resources to give free treatment to the indigent.

And Healthcare got more expensive.#As is often the case when a significant proportion of the population are dispossessed, disenfranchised and disenchanted, the uninsured started looking around for someone with deep pockets to pay their part of the bill. Naturally they turned to the Government, who, having done such a stand-up job with Social Security, Welfare,  and the Post Office, could clearly be trusted to look after the Nation’s health.

And they were not alone: Women pushed for free birth control (presumably so they could slut around at somebody else’s expense) and free abortions (presumably to deal with the “unintended consequences” of said slutting around), and they called it “Reproductive Freedom”.

And there was much rejoicing.

With so many votes on the table, the politicians looked around for a solution. And after several abortive attempts over three decades, they finally came up with a compromise, which one wag described as follows:

…a healthcare plan we are forced to purchase and fined if we don’t, which reportedly covers at least ten million more people without adding a single new doctor, but provides for sixteen thousand new IRS agents, written by a committee whose chairman says he doesn’t understand it, passed by a Congress that didn’t read it but exempted themselves from it, and signed by a president who smokes, with funding administered by a treasury chief who didn’t pay his taxes, for which we will be taxed for four years before any benefits take effect, by a government which has already bankrupted Social Security and Medicare, all to be overseen by a surgeon general who is obese – and financed by a country that’s broke.”

This great compromise, had the following effects and unintended consequences:

  • It required employers to offer health insurance to all full-time employees. As a result, many employers who could not afford this had to reduce full-time employees to part-time, and in some cases, to dismiss employees outright.
  • To bring more money into the system, it required anyone who had access to Health Insurance whether they wanted it or not. In a landmark case, the Supreme Court actually took unbelievable stance of declaring a Health Insurance premium paid to a private business to be a tax. Those who refuse it will pay fines, and may eventually serve jail time. Time will tell.
  • It required Insurers to abolish lifetime caps, mandated free-of-charge preventative care, required coverage of children through college and into adulthood, and made it illegal for insurers to refuse coverage based upon pre-existing conditions. While these are all good things, they add to the costs of insurance, and it came as no surprise that heath insurance costs shot up. What did come as a surprise was that nobody was able to make the connection between the great compromise and the increased insurance costs.
  • It required all insurers to provide birth control and abortifactants (aka the “morning-after” pill) to women at no cost. This puts businesses that are ideologically opposed to abortion in a very difficult position, and at least one major employer may have to close down as a result.

In the end, everyone got what they wanted — Health Insurance, Pharmaceutical and Medical Industries got the profits they wanted, women got the free birth control and abortion pills they wanted, and large portions of the Great Unwashed got the free stuff they wanted.

And they all lived happily ever after. Except for the working insured and future generations of taxpayers, who will be presented with the bill.

Fairytale or History lesson? You decide.

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