It Seems Like Yesterday

Now that the Affordable Care Act has been upheld by the Supreme Court, the elderly and disabled can look forward to a more holistic and affordable approach to medical needs. The dreaded "donut hole" will be fazed out and eventually closed. Visits to the doctor to check out your overall condition before you get sick are now covered under the new law.

Most of us seniors know someone who has been affected limited income, stretching Social Security checks, trying to pay for prescriptions and doctor deductibles while leaving room for food. The cost of medical care has gotten so high that serious illness can lead to modifying treatment or even bankruptcy. Many doctors told me of their dismay with a system that was broken and needed to be fixed. Now that this law is going into effect, hospital stocks are up in spite of the rest of the market's skepticism about European developments. Traders felt that "Obamacare" is good for the hospitals and good for business. Who knew?

As I was going through some old family papers today, I compared some of the newspaper clippings with current events. How did medical costs, the basic cost of surviving a medical emergency in our hazard-filled high tech-environment, get to be so extremely expensive?

In an article written in the Blairstown Press on July 19, 1899, the editor writes: "Vernon, the 11 year old son of Allen Frutchey of Upper Mt. Bethel was killed when driving a reaping machine on his father's farm.  For some reason, the horses ran away and he was thrown off the reaper.  His little sister who was sitting on the seat with him was unhurt." This was before automobiles and ambulance service so the poor chap succumbed.

Another entry reads: "The mother of Mrs. Ervin Beck, Mrs. Lavina Emery, died at the former's home in Walnut Valley at the age of 79.  Her husband died several years ago meeting a horrible death by falling from a haymow onto the tines of a pitchfork.  The deceased was the mother of...."  This was before antibiotics and emergency care that could have saved him. She died at home of old age... 

In a later column dated July 19, 1922, the Press editor records: " Merrell Landes fell thirty feet from the haymow on the Charles Lewis farm and was hurt, but not seriously."  In those days, if one was able to walk, thrifty hardscrabble farmers likely did not seek medical assistance because of what it might cost.

 During this period of time, one local physican customarily charged $1.00 for visits and $1.50 if he had to set an arm or fix eyeglasses. During prohibition, one doctor prescribed whiskey for his patient and charged $1.50 for a pint to treat "digestive disturbances".

In a Blairstown Press article dated July 15, 1937, the editor states: "Two boys, Harold Aber, 18 and Junior Nolan 17, of Union City, were hurt when they fell from a rumble seat along the Hope Road.  They had been to Blairstown and were hitch-hiking back to Hope where they were visiting.  Edwin Schneider gave them a lift and they were having a fine time enjoying the "fun" of standing up in the rumble seat.  After a while Schneider missed them and turning back found them along the road. Aber  (was) unable to walk and Nolan unconscious.  They were taken to Newton Hospital."  Here ends the record but one wonders how they got there. Now there was a medical facility in Newton, Sussex County, but it was a good 12 to 15 miles from the scene of the incident. Perhaps Schneider drove them there himself.

The Press also states in the July 15, 1937 article that "Irvin Phillips, 83 died at the home of his son Edward of Yellow Frame."  Elderly people were cared for by family members and many died at home. There is a shift under the Obama administration philosophy to caring for persons in their own homes instead of the current reverse graduation process of hospital-rehab-nursing home that we see so often today.

The Press also notes in the July 15, 1937 article that "Mrs. Otto Haldiman was painfully injured when the horses ran away.  She received a sprained ankle and bruises...Mrs. Orphia Hall has returned from Easton Hospital after surgery....Miss Grace Raynolds returned from Easton Hospital after an appendicitis operation..." Easton Hospital was about 30 miles away, in Pennsylvania and across the Delaware River.

By 1951, rural area residents were sometimes served by going all the way to Orange Hospital in Orange, New Jersey. Urban areas could support medical facilities to perform complex surgeries.

Costs had increased from the 1930's but were still low. One financial record in l972 shows doctors visits were up to $11 to $15 per visit, Newton Hospital's radiologist charged $4 to read xrays and all patient bills were sent to the insurer, Prudential Insurance of America, Medicare B Division, for reimbursement.  It appears that Medicare paid the hospital bill of about $100 per day or less.

As employers competed for a depleted work force following WWII, they found that offering medical insurance was an incentive for hiring men. That optional offering morphed into the entitlement situation that currently exists. When an employee is cut out of his job, he loses his health benefits which affects his entire family. This evolved into one of the deciding factors for the present state of the Affordable Care Act, justifying many insuring entities instead of more efficient centralization.

Employer coverage is not taken lightly by someone in the job force.  The threat of losing medical coverage supplied by an employer's pooled coverage is mainly because of the difference in cost. A company writes more favorable terms for a client with many employees who do not make claims for coverage. The employer, in turn, looks for young and healthy employees so the insurer will give him the lowest rates.

 Independent coverage can also have terms dictated by the insurer which often meant that coverage could be denied for preexisting conditions, making it prohibitively expensive to be a single policy.

Regardless of the political posturing, having a central government-run healthcare entity is the most efficient. Canada, England, France, Germany, Italy, and most of the rest of the world has taken steps to assure that their citizens are covered by basic health services. Having a centralized offering worked for them but the United States has been reluctant to change.

This bring us to Obamacare.

Yep.

 It looks like we may be taking a huge step forward by taking some small steps backward. Or is it the other way around? We are taking the first step forward to get back to what we had before...before medical overheads and drug costs became so enormous that they could lead to bankruptcy, or before employers figured insurance consequences were part of a resume...

My opinion is that we have nothing to lose by giving it a chance. We could be worse off if insurers continued to dictate vital terms of service and medical emergency rooms continued to cope with costs from uninsured patients.

America rocks.