A Brief History Of Why America's Healthcare System Sucks
Isn't it kind of weird that your boss can decide whether you die of cancer? That's effectively the logic behind employer-based health insurance. If you have it, you can get chemotherapy; if you don't, then go ahead and be independently wealthy. If you can't even manage that, then just die already.
Americans do not apply this logic to other necessary services. It's not like if your house is on fire, the fireman says, "Sorry, you don't have coverage for this, so if you want me to save your house, I'm going to need $250,000. That's just to start. Steve's really the door specialist, though, and that's gonna be a whole other set of charges ..." So why aren't doctors provided as a public service like firemen, police officers, teachers, or lawyers? As with many terrible things in life, from the Cowboys to presidential assassinations, you can thank Dallas.
Even into the 20th century, hospitals were not places you went to heal. You went there to die, and that was pretty much it. Healthcare was barely regulated, riddled with snake oil, and extremely cheap. In 1900, healthcare cost the average American around 5 bucks a year (about $100 adjusted for inflation).
But healthcare rapidly improved with antibiotics, rigorous training, and scientific evidence. By the 1920s, clean and educated doctors could save your life, rather than just saw off a leg or throw cocaine at you until you died. But this came at a cost that most people couldn't afford. Hospitals needed money to run. So that's when administrators at Baylor University Hospital in Dallas hatched a plan. They offered healthcare to teachers on a rolling basis for 50 cents a month. By the time of the Great Depression, hospitals around the country copied the program by offering cheap plans to workers' groups. Today you know that program as Blue Cross.
This program was hospitals negotiating directly with workers, though. How, then, did it become the standard for employers to offer private plans? It's another oddity of the American system. Why would companies willingly shoulder the majority of an enormous cost for its employees? To understand that aspect of the American healthcare system, you have to mix in a pinch of Hitler.
World War II was the organizing event for American healthcare. The war lifted the country out of the Great Depression and ushered in a hiring boom. For the first time in over a decade, employers had to compete for employees, rather than the other way around. The obvious incentive companies offered was higher wages. Now, normally the government would not step in to stop companies from doing that, but the wartime economy was not normal. Economists feared that if companies kept raising wages, it would cause uncontrollable inflation -- something the country could not bear while fighting the war.
To prevent the country from spiraling back into a depression, in 1942 FDR created the Office of Economic Stabilization and froze wages. But businesses still needed to compete for workers, so they developed generous benefits packages. If workers couldn't obtain higher wages, at least they could secure cheap, comprehensive medical care. And then the IRS did something in 1943 that all but guaranteed the system would last: They made employer-based health insurance exempt from taxation.
At the end of the war, President Truman tried to follow the trend of other nations that were building universal healthcare systems, but businesses and the Chamber of Commerce defeated him. A universal system had popular support, but the American economy boomed so hard that employer-based healthcare covered about two-thirds of the country. Now it's the system we have, and it's basically the only system any American alive knows. But it is still a quirk of a wartime industry from over 75 years ago. So anyway, sorry you're dying of a treatable illness. Have you considered starting a war?
For more, check out What Your Doctor Wants To Tell You, But Can't (From A Medical Physician):
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