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September 23, 2009 > Healthcare- A stormy debate

Healthcare- A stormy debate

A TCV series by William Marshak

Congress is currently considering HR 3200, otherwise known as "America's Affordable Health Choices Act of 2009." The debate is loud and boisterous promising utopian reforms at one extreme and Communistic disaster at the other. As with many such highly visible, personal and far-reaching national decisions, arguments sometimes diverge from reality in order to wrest public attention from other day-to-day concerns.

This discussion extends from the halls of Congress to local hospitals, clinics and physicians. Everyone has a personal stake in this argument and most are aware of its significance. Health professions and the delivery of health services and products has been a two-edged sword. Wonderful advances have vanquished diseases, eased suffering and saved lives while costs and access present significant obstacles for many.

Entwined within the debate is the disparity of available services in communities across the nation, even in geographically contingent areas such as the Bay Area. The number of medical practitioners and specialties vary dramatically. Treatment, facilities and financial rewards are equally disparate. Economic differences of those in need of healthcare add to the mix. Close inspection of our healthcare system, its strengths and weaknesses and how those within it are compensated can help dispel simplistic and shallow slogans and arguments. In a series of articles, Tri-City Voice will examine how healthcare evolved in the United States, types of delivery systems, healthcare compensation and why this subject has become the topic of hot debate.

Response to inflammatory rhetoric, newspaper articles, blogs and talk shows is often based on incomplete information and political agendas. Conclusions drawn by any of these sources may, at times, be verified or dispelled by an in-depth examination of the facts. It is often a case of which "facts" are to be believed but in their absence, a clear understanding is difficult if not impossible. Armed with credible data, perspectives can change and solid conclusions may be reached with some confidence.

Local healthcare does not operate in a vacuum. Many of the same issues discussed on a national scale apply to local professionals and healthcare facilities. Terminology in all corners of healthcare is often confusing and can therefore be used to illuminate or obscure how this system operates. Even use of a singular term "system" is inaccurate since healthcare has evolved into many disciplines and schools of thought.

The bottom line that drives much of medical treatment in the United States is the powerful organization and business it has become. From early medical treatments that bordered on quackery to the sophisticated technology available today, medicine has evolved into a business... a big one!

According to pbs.org, in 1901, the American Medical Association organized into a national organization with a rapidly increasing membership that grew from 8,000 members to 70,000 in 1910. This represented half of the physicians in the country. Organized medicine was emerging and with it, the concept of profit took root. As medical practice became more reliable and the use of surgery to cure ills expanded, gaps appeared in reimbursement expected for medical care and the ability of many to pay for it. Reform efforts were set aside as the United States entered World War I in 1917.

Prestige and income separate many physicians from other workers in the following decade; General Motors signed a massive insurance contract with Metropolitan Life for 180,000 workers. The Great Depression changed the emphasis in the 1930s toward unemployment benefits and old age insurance so Social Security benefits were passed without health benefits. At this time, nonprofit insurers called "Blues" (Blue Cross) were primarily interested in hospital costs and began to serve community organizations. Tax breaks kept premiums reasonably low until private insurers entered the market. Wartime wage and price controls during World War II led to increased competition for workers and health benefits were used to attract employees. Health benefits were exempt from company income tax and the race was on!

The political power of organized health care and insurers is evident in any congressional approach to addressing health care. In the 1940s President Truman suggested a national health program which was violently opposed by the American Medical Association and called a "Communist Plot." As competition has increased in the private health insurance market and technology advances, prices have skyrocketed and a system developed over decades to close the gap between costs and benefits is now at the center of a healthcare storm of debate.



The next article of this series will discuss "modern" medical costs, reimbursement and insurance. An interview with Washington Hospital Healthcare System CEO Nancy Farber will explore the challenges of hospital operations in the present economic and political climate.

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