But when my siblings and I were in the midst of "getting it over with," the pediatrician, as part of his normal duties, showed up at our front door. I vividly remember him--a stranger to me, really--coming into the bedroom I shared with my similarly-stricken sister, his leather black "doctor's bag" in hand; his cold stethoscope on my chest. They used to call those visits "house calls." They didn't cost extra.
Until the 60s, when governments and unions used coverage for bargaining and as perks for employees.
Then, in 1965, President Lyndon Johnson, in a fit of liberal largesse, sought to provide retirees with government-sponsored health coverage. At that time, most people retired at age 65 and looked forward to rapid decline, surviving at most another decade, as US life expectancy was only 70 years. Medical care was just starting to get technical; pharmaceuticals were becoming more sophisticated and proprietary.
Without universal retirement plans, a new class of oldsters who weren't being taken care of by newly mobile children got attention in Johnson's "War on Poverty" after exposes about their subsisting on dog food. Medicare filled in where Social Security left off, followed by Medicaid, the national program for non-elderly poor. But the key there is that it's not federally-managed--each state controls its administration locally.
Really, it's only been in the last 20 years that HMOs and employer-subsidized health plans became de rigueur, severing all direct connections to local doctors and inserting middlemen at faraway desks, insulated from customers by powerless phone personnel. Ask a kid what a doctor's bag looks like--he'll shrug.
Do we customers like dealing with huge corporations who determine our premiums, our co-pays, our deductibles? Do health care providers like that their fees are negotiated and set by the same corporations? Ever get an "EOB" (explanation of benefits) from a health insurance company that lists a doctor's charge, and then the "adjustment" he makes because the insurance company decided his fee was more than they've decided to pay? What is this game?
It's the stuff of consumer backlash. Because if taxpayers know one thing, it's that adding layer upon layer of government bureaucracy onto a system that's already rife enough with regulations, strategies and middlemen isn't going to streamline anything. Instead, it will complicate and worse, cost much more.
The US spends 16% of its GDP on health care; more than any other modern country. It's not going to drop--either with feds controlling potential profit or with the status quo, because free enterprise is already so tamped down by government regulations and laws that shape the structure of the insurance industry. What's the answer? I'm not in a position to speculate, but getting back to catastrophic insurance coverage, with individual management of relationships with doctors would be much better than the interminable phone waits and impersonal rulings on payments that we all now face--which would be much, much worse controlled by the biggest bureaucracy of all, the federal government.