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Chapter 2 From Progress to Loss of Control |
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A striking example of changes in medicine is the history of the Mayo doctors. Their lives covered a century of tremendous transformation. |
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Dr. William Mayo, an immigrant, was a frontier doctor in Minnesota in the 1850s. His attitudes and actions were typical of his times. In the early 1860s, when the Minnesota Sioux took the warpath, Dr. Mayo distributed pitchforks among citizens reticent to do battle. When asked about the purpose, he answered "run your pitchforks through them, of course". |
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In 1863 Dr. Mayo went to Rochester, Minn., as an army surgeon in charge of examining new recruits. He established himself in the growing city, became a reputed physician, pioneered in surgery, and guided his sons.Will and Charlie, into medicine. They in turn presided on the conversion of a family practice and a small community hospital into an international medical center. Their lives encompassed the changes that led to the emergence of large medical centers. As we will see later, big medical centers became part of our current struggles. |
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The years of the Mayo brothers also saw the scientific transformation of medicine, which became able to use basic sciences to rapidly advance the medical and surgical care of most patients. |
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The financial aspects of changes in the medical world became increasingly obvious only after 1950. In that year, the average cost for patient-day in a hospital was about $16, government programs and private insurance paid 49%. By 1975, even before steep increases, the per patient-day had jumped to about $152, while government programs and private insurance paid 88%. |
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What are the factors that influenced this change? |
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Though advances in science and technology continue to influence the care each patient receives, only a minority will use the most expensive technology, and only for short periods. |
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Since 1943, employers have received tax benefits for sponsoring health care insurance. This is an excellent break for the employer, who can pocket the tax benefits, and pass the expenses on to the employee in the form of flat fees, and to the consumers in the form of more expensive products. This situation places the insurance company as broker of health care. |
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The employers were joined by the public sector two decades later. Since the 1960s Medicare and Medicaid programs brought the federal and state governments more into the medical field. Their guidelines may make medicine more costly. That's the case of restrictive measures in psychiatric care that prevent timely and effective treatment. |
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The emergence of new technologies in increasingly larger medical centers that received reimbursements from insurance companies and government programs promoted a transfer of power from the patients to the insurance companies, and by extension, to their allies, the employers. |
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This transfer of power was coached in benevolent words such as "coverage", "benefits", "protection" and similar terms that suggested support and care. In reality, the transfer meant that the intermediary's concern for his own financial gains replaced the individual's concern for his own health. The interaction between the sick individual and his doctor was substituted by the financial calculations of the insurance industry. |
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The Health Maintenance Organizations (HMOs) became highly efficient control tools in the creation of a "health industry" dominated by the employers and the insurance companies. |
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main | table | intro| 1 | 2 | 3| 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | * |
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©2000 Munoz and Eist, The People v. Managed Care |
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