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What's Wrong With American Healthcare?By Gene Santoro | American History | Single Page | 18 comments | Print This Post | Email This Post Health is not a free market commodity, like a car. People will spend everything they have and whatever they can borrow for health. An Interview With Medical Historian James Mohr Subscribe Today
Q. Is government involvement in health care un-American? A. There is a long American tradition of public responsibility for health. In the 19th century, for instance, states devoted as much as 30 percent of their budgets to public mental health care. And when it became clear that vaccination actually worked against smallpox, state after state created labs to provide vaccines free of charge to citizens. So to say it's un-American is profoundly wrongheaded. Is the current system broken? It can't be sustained as it is right now if we care about the public's overall health. We can't afford it. The World Health Organization ranks the U.S. 38th in health-care quality, below Dominica and Costa Rica and above Slovenia and Cuba. Meanwhile, per capita we're spending half again as much as our nearest competitor. What's the key problem? Nowhere else are doctors paid the way they are here, or allowed to have such absolute autonomy. Decisions made in the 19th century created an occupation that almost guarantees a handsome income and high status, but offered few incentives to be rigorous about internal discipline: It's still almost impossible to lose a medical license. As a result, medical mistake rates are stupefying: Hundreds of thousands of Americans die annually from medical errors. You sound like an anti-doctor muckraker. I'm not. I believe most physicians are caring professionals. But because of the way our health-care system evolved, bad doctors are rarely held accountable for their mistakes. Under 5 percent of doctors account for roughly a third of malpractice suits, yet the system lets them keep their licenses. How are doctors regulated? Historically there has been very little regulation. By the 1880s, the doctors who graduated from a medical school were pushing to upgrade the profession. They wanted licensing laws at the state level and tighter educational requirements, and got them. But unlike elsewhere, American licenses came with no strings attached. What was the result? The heightened educational standards began reducing the number of medical school graduates, thereby reducing the number of license-able physicians. And so their power and prestige in society increased—along with their incomes, which was the bottom line. Meanwhile, the situation priced many Americans out of health care. What about early efforts to provide national insurance? In 1915 and 1916, bills were introduced into Congress that would have produced a structure similar to those in place today throughout Western Europe. Initially the AMA—the American Medical Association—was all for it. After all, doctors had been accustomed to collecting only 50 percent of their bills, so 100 percent looked like a good deal. National insurance seemed inevitable. But the AMA soon began to shift its position. Why? The leadership was afraid: If the government became the principal payer, doctors might lose their autonomy and become government employees at fixed salaries. So they hunkered down behind the concept of fee-for-service: direct payment by the patient. They actively opposed doctors who hired out to group practices, and ostracized doctors who signed contracts with labor unions on a per-head basis, similar to modern HMOs. World War I brought new arguments: National insurance was Prussian, socialist, un-American. What resulted? Doctors' incomes and medical costs continued to rise steadily in the 1920s. In 1932 the Committee on the Costs of Medical Care, a national blue ribbon panel that included the AMA, again recommended a national insurance program. But a committee minority said that would destroy the medical profession. The AMA claimed this minority represented the majority of physicians—although no one could ever calculate whether that was true—and killed that initiative too. Pages: 1 2Help HistoryNet by bookmarking to
            Tags: American History, interview, Politics
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18 Comments to “What's Wrong With American Healthcare?”
I feel that the medical industry right now knows that their time at the trough is just about done, so they are taking everything they can now, much as the financial industry did at the end of the Bush Presidency.
By Tony Tramonte on Oct 15, 2009 at 6:27 pm
Sounds like the professor has a predisposed opinion of health care and a liberal agenda.
By Biscuit on Oct 16, 2009 at 2:09 pm
Sounds like someone hasn't done all his research on the countries that have had soicalized healthcare….I agree that we have a problem ….but is letting the government take over the best idea ???? I think one only need look at the system now that says that medicare is broke…..you want them to determine who can have what and when,,,,,,this is different medicine than what the our elected senators and etc. have….I like how the Va. treats my husband… and I am for letting our service men have healthcare……but letting everyone have health care is asking for a REAL NIGHTMARE !!!!!!
By Kathy on Oct 16, 2009 at 2:25 pm
how much did obama pay this guy for this poppycock?
By mr.spock on Oct 17, 2009 at 10:47 pm
Much more discussion of this article here;
http://www.armchairgeneral.com/forums/showthread.php?t=84259
By HistoryNet Staff on Oct 20, 2009 at 10:19 am
When I read an article that is highlighted at ACG, I expect something that has been researched or well thought out by the author.
What a dissapointment. I am opposed to further intrusion into private industry, medical and otherwise by the the federal government, but I could have made a better arguement supporting government intervention than this writer.
Come on, ACG. Don't waste out time with something as sophmoric as this type of analysis.
By Justin R. Riggins on Oct 22, 2009 at 9:43 pm
How can something written from a historical perspective make people so angry? Why is providing for a citizens a nightmare? Health is right. We all pay for everyone's illnesses now. To me it makes more sense to shift to paying for health. There's been so much rhetoric about things being "un-American." It feels un-American to me to let people die because they can't afford healthcare.
By Breanna Ferriby on Oct 24, 2009 at 1:15 pm
Actually US health care is just about the best in the world – IF YOU'RE HAVE HUGE AMOUNTS OF MONEY that is.
Otherwise it's well down in world rankings. Government-assisted health care works very well in Canada, the UK, Australia and Europe so what's so special about the US?
Isn't it weird how the US government will spend unlimited money on protecting its citizens from military enemies like terrorists and communists, etc but can't be bothered to protect them against microbial enemies, disease and acccidents?
It's a funny old world.
By Dave Dee on Oct 26, 2009 at 3:55 am
The Govt does not PAY for anything. The Govt TAKES the money of its citizens and decides that it knows best where to "use" that money. If anyone really thinks the govt will be able to run health care at the quality of care available now to us, just view any of the other hundreds of govt programs for your answer.
The problem is NOT the health care system. We have the FINEST health care in the world. What the problem comes from is that govt has ALREADY become involved in heath care and created this mess. Your health care will be decided by a govt manager who will base decisions solely on cost. You think its bad now, just stand by.
Because its "free" will result in people clogging up every clinic, hospital and ER will every complaint of sniffles and ache and pain. Just look to your favorite socialist country as to what the WAIT is now for their health care for simply procedures. Why do you think people from these countries come to ours for treatment. The willingness to relinquish so much of our freedom in this country for "promises" of utopia reflects the danger we face from within.
By JD on Oct 27, 2009 at 2:27 pm
This article was from American History magazine, not Armchair General magazine. Just a clarification.
By HistoryNet Staff on Oct 28, 2009 at 2:42 pm
Notice the author of this article did not mention tort reform. Aside from any financial 'incentives' to run these myriad tests, doctors want to make sure they've covered everything so, if something were to happen, their patients can't sue them for NOT running a certain test.
By Sean on Nov 1, 2009 at 10:39 pm
a much larger waste of money is the amount being paid to government employees such as mr. mohr. i suggest a new pay scale for all public servants such as he. by dramatically cutting government employee salaries and benefits we would have enough to finance public health care. of course public servants will pitch a fit over anything disturbing their tax payer financed way of life.
By joe on Nov 2, 2009 at 9:14 pm
Sounds more like a political site instead of a history site…
By JoeBlotnik on Nov 14, 2009 at 12:22 pm
There's a lot of misinformation being touted in these comments. This was a fair and balanced, historically informed interview, one that in fact doesn't go nearly far enough — health care is a human right, not a privilege or commodity. We don't question that when it comes to personal and national security, K-12 education, fire fighting, etc. Medicare has its problems, but it is far more cost-effective than private insurance — 3% overhead vs. up to 30% — and its rate of inflation has in fact been lower than private insurance. It's not immune to inflationary medical costs because it doesn't cover everybody. If it did, there would be a savings of $400 billion a year, easily enough to cover everyone. Single payer is not "socialized medicine" — it's a publicly financed, PRIVATELY delivered system of health care. Patients in Canada can see any doctor anywhere in the country. In the US, you're severely limited to your "in-network" provider, that is if you even have insurance. Unfortunately the health reform passed by the House isn't going to solve the problem of out-of-control costs — it's a bonanza to the private health insurance and pharmaceutical industries. But that's the US "free enterprise" system for you — socialization of risks and costs, privatization of profits. When it comes to health care, that becomes a life and death matter for millions.
By Loup on Nov 16, 2009 at 2:44 pm
Any attempt to reason with a liberal is a waste of time and breath. The only hope that we have is to pray for our country, live what we profess, and get to the polls in 2010.
By Susan Johnson on Nov 18, 2009 at 1:39 pm
Where in the US Constitution does it allow for Congress to mandate that every person in the country pay for health care? No where. Where in the US Constitution does it say that health care is a RIGHT of the people? No where. If, as Obama repeatedly claims, that the vast majority of the country is behind him and believes in Govt run health care, then all he has to do is have his tame Congress pass a Constitutional amendment proposal and send it out to the states to have the people vote on it, but he won't do it, because he KNOWS that he would never get it passed by the 3/4 of the people.
Why would anyone think that the Government is capable of running anything as important as our health care? The Government, at all levels, are supposed to be limited to doing those things that we as individuals CAN NOT do for ourselves(police, fire, national defense, etc), they are not supposed to be taking our taxes and wasting them on spending projects that make politicians money or increase their ability to be reelected.
Furthermore, how can anyone trust anything that Obama says? He does nothing but lie continuously, especially about his health care spending. "My health care bill won't raise the national deficit as much as one dime" is what he and Pelosi and Reid keep telling the media. Unfortunately, the media is either in bed with Obama(likely) or just too stupid(more likely) to realize that the federal budget DEFICIT is the yearly amount by which spending exceeds revenue and the accumulation of the yearly DEFICITS – the few examples of yearly surpluses + interest on the debt = the national DEBT.
Politicians crow about how they have lowered the DEFICIT, but that is just political talk to fool the uninformed, they are just adding a smaller amount to the national debt, not actually lowering it.
Obama "claiming" that he won't add a dime to the deficit in the year 2020 is nothing but sophistry as the 2020 budget has not, and will not, be written until 2019 at the earliest. It is all a BIG LIE! One quick and easy way that they could ELIMINATE the budget deficit entirely, is by simply passing items off-budget and not counting them as part of the yearly budget, as the Congress recently did with Dr's medicare payouts.
whale
By Whale on Jan 28, 2010 at 2:05 am
Wow. A lot of whoppers from health care reform opponents here, but that's not too surprising I guess. Sad to see so much intellectual dishonesty on a devoted to the academic rigor of studying history.
Funny how the folks who don't want the federal government to be in charge of anything use its services everyday and rarely complain about most of them. They have no problem with the military or the interstate system, but for some reason the government can't be trusted to run health care…no one ever elaborates on why. No one ever provides ANY empirical evidence that health care is terrible in nations with a government run health system.
Don't forget, being shrill is not necessarily being factual or having a sound argument.
By Mike on Feb 7, 2010 at 1:26 am