by Jack Curtis
Once, if you or your child were ill, you called a doctor. He would arrive at your home, carrying a black leather bag full of mysterious medicines and shiny instruments, the mere presence of which provided confidence. You expected his visit to be followed by a bill, which you would pay if you could, seldom a problem for middle class households. It was expected that doctors would have some charity patients from those less well off. You also expected that he would do everything possible for your care because that reputation was the reason you wouldn’t call someone else next time. That was reinforced by the priceless value set on human life by the prevailing Judeo-Christian ethos. No, this is not fiction; such was medical practice in Los Angeles in my youth. A simplification certainly, but it conveys the essential: Human ills and injuries were serviced by medical doctors whose state licensing and professional organizations approximated medieval guilds. Though invisible to most, this sort of professional service continues today for those few who can afford or compel it.
Fast forward: Time, expensive technology and politics have produced significant changes and more are coming, accelerated by the conditions governments have imposed in response to the COVID-19 pandemic. Responding to vastly increased capitalization, bureaucratization and socialization, the practice of medicine has evolved into industrialized healthcare regulated by government and financed by insurers. Paralleling earlier developments in nursing, medical doctors are receding from the front lines, evolving into employed specialists and supervisors with many of their erstwhile functions falling to less qualified and so less expensive workers. The latest step in this progression replaces front line providers with internet questionnaires and telephone appointments to conduct medical interviews with patients at home. Some are calling it “telemedicine.” You may decide whether it is progress.
In place of prompt attention from a highly educated professional, most of us now expect rationed services from a an industry intended to provide the most common services to the largest numbers at the lowest cost. Within that, less common and more difficult/costly services are subject to various degrees of rationing, beginning with the waiting period before seeing a doctor. Emergency care is generally available only from hospital emergency providers who are also politically prostituted as providers for uninsured patients. Those services are generally provided on a triage basis; the length of ER waits is legendary. The quality of healthcare services is debated but it is irrefutable that U.S. life expectancy has been dropping in recent years.
America’s healthcare in coming years is anyone’s guess: politicians are promising universal free care just as the employer cost of a family’s care has reached $20,000 annually. Financing the Affordable Care Act required a $716 billion hit on Medicare and Obamacare is still woefully underfinanced. Extending this into the future suggests that a lot more people will be receiving considerably less care if the current trends persist. The system will continue automating the production of care and reducing the resources allocated to prolonging the lives of nonproductive seniors. The most important medical device may become the cell phone. Providing care through an outdated medical establishment under government regulation and insurers’ rules seems unsustainable but replacing the insurers with government bureaucrats appears an unlikely solution if the U.S. Postal Service and the Veteran’s Administration are reasonable examples. Perhaps they are; we redefined human life as no more than a valuable commodity when we adopted convenience abortion and assisted suicide while initiating a reduction in healthcare for seniors. Providing post-Christian healthcare is not that practice of medicine relict of the Christian era; what was a profession has become an industry in which ethics, motivations and attitudes have altered, reflecting changes in the wider society. Again, you may decide whether that represents progress.
Also, the COVID-19 pandemic quarantine has added a double joker to this: First, the degree to which normal private and VA services have shut down all but emergency and COVID services may well provide more deaths than the virus and second, If the expected resulting economic depression occurs, as seems likely, the provision and financing of healthcare will be up for grabs, probably for a long time. Maybe during that time, we will create a parallel, informal folk medicine or once more see some doctors entering people’s homes carrying a black bag, at least for a while. Maybe someone will even rationalize the training of medical doctors. No bets, though.