Do you remember in To Kill A Mockingbird (pause…if you haven’t read that book, stop reading this now, go read that immediately, and come back to me—your life will be better for it, our friendship will be better for it) when Atticus talks about how people who need lawyering at that time (the Great Depression) can’t always afford lawyering? Because Atticus is both a lawyer and an apparent humanist (to be called other, less racially sensitive things throughout the text of the book), he often provides his legal services in exchange for whatever the client has to exchange. Bushel of potatoes from a potato farmer? Sure. New fence from a carpenter or generally handy kind of person? Heck yeah. Some firewood and a couple of steaks from…well…just about anybody? Absolutely. Sounds great. I might just go to law school myself! (No, no I won’t. I’ll be paying off my two undergrad degrees until our world goes all Hunger Games on us.)
I don’t believe these are the exact payment examples from the book, but they are of the same drift. Atticus Finch understood a few things about the world: 1) people are in need of services—sometimes from lawyers, sometimes from doctors—whether they can afford it or not, and 2) the value of an object or price is relative to a person’s financial situation in life. People come to the high-end restaurant I work at and buy a $400 bottle of wine because they can. Why buy a 20-buck one when you can buy a 200-buck one? Why not $400 when it’s available to you and you have the funds? (Note: the $7.99 one does not stop being available, even when you’re wealthy, folks. But I guess, at some point, what else are you going to spend your money on?)
This column is actually not so much about lawyers; I just thought it was a good place to start. Mostly, I want to talk about the price of health insurance.
Here’s the thing: I’m not trying to harp on politically today for you. I think it’s well timed that we talk about this with it being only a few days after the Supreme Court held up (most) of the Obama administration health care reform. I have many feelings and opinions about the way we do healthcare in this country and in other countries. Some of these thoughts even seem to contradict each other. Therefore, I don’t want to talk about whether we agree or not with where we currently are, because I’m not saying I have the answers. I probably don’t have any of the answers. But, I’m a big believer in this: to know where you are, you have to know where you’ve been. So where have we been with healthcare costs?
In the grand scheme of things, “medicine” the way we think about it is a relatively new thing. Immunizations weren’t even starting to come around until the Civil War era—and they were totally not how you think of them today. In the course of human events, that is not all that long ago. Also, at the beginning of the last century, there wasn’t too much a doctor could do. Surgery didn’t happen like we think of it. Doctors came to your house, gave you some fix-it-all meds, set a broken arm, and as TV and movies lead me to believe, often said, “I’m sorry. That’s all we can do. We just have to wait it out.”
Therefore, prior to 1920, the idea of health insurance was totally unnecessary. There was sickness insurance, which paid for the time you couldn’t work, and was great, and is something we still (basically) retain today in other ways. But there weren’t a lot of medical costs, so why bother with paying for insurance? Plus, insurance companies thought it was impossible to determine what someone’s premium for possibly getting sick was (HA!). Existing insurance companies (for other kinds of insurance) made arguments like this: How could you predict how much someone is going to cost in medical problems every year? What if someone lies about their lifestyle habits? (Because that doesn’t happen at all now with health insurance. No, no. And if you believe that, I got a bridge in Brooklyn to sell you.)
Besides companies, people also thought health insurance was unnecessary. So it didn’t happen. The masses had the same kind of “what exactly would we be paying for” attitude. But apparently somebody—and I wish I knew who—kept bringing up that we should have some healthcare somewhere. The thing is, a whole bunch of European nations decided this sounded like a pretty good idea about the same time circa 1920 and devised nationalized healthcare. See, we could have just had the whole thing done with and never known there was another way to do it. Ignorance is bliss, folks. And see: it only takes seventy-five to one hundred years to get the thing down. Fantastic.
Back in America, doctors, pharmacists, and insurance companies didn’t want health insurance either. Just wrap your lil’ mind around that one, Washington. Then let’s continue the debate. Some insurance companies started offering little healthcare packages just to see if it was necessary after all, but people tended just to choose the other option: burial insurance.
As the 1930s approached (and before we were greatly depressed and Scout’s dad is defending people for ears of corn) we started to have to go to an actual hospital for medical needs. This costs more for everybody, naturally. You need gadgets, training on the gadgets, upkeep, staff, cleaning costs—I guess I get it. Also, now we had medical standards to meet. I think (I hope) we can all get on board with wanting medical standards in place. So, by the end of the 20s, people started saying, “Yeah, maybe we should look into this health insurance thing. Stuff happens, ya know. [Insert 20s jargon here like: see! and horse feathers and cat’s meow. All these can apply in the convo, I feel.]”
In 1929 we get the (now) giant Blue Cross. Do we cheer or jeer at this? The idea originally was to consolidate medical prices into a bill you could actually pay, oh and also to reduce price competition. What a revolutionary concept that we are so far from today and should maybe consider bringing back—like lying down to breastfeed (that’s a Retro Recall). There are certain caveats that make it a bit different from today, I’ll admit. We didn’t have the same kind of overzealous drug companies. We also didn’t have quite the same demand on medical practitioners in lots of ways. It’s six of one, half a dozen of the other. But finally, we did have some health insurance.
The thing is—it worked! Low and behold, it worked damnit. People liked health insurance. Providers liked health insurance. Who knew? (Oh right: Europe.) But, my friends, if you think everything is solved right there, than you must be living in a TV-less society where all you get on the internet is Side B (I’m OK with it).
Here’s the problem: everything expanded. Availability, services provided, people who want services. Shit just get crazy (sorry, Mom). Then, we add Medicare and Medicade. I just can’t get into it, I’m too spent.
Hah—spent, health insurance prices, hah. Pun unintended. I’m so mixed up, I’m entering delirium! I think I need a doctor!