HCR -- The Changing Scene In American Medicine: 1955 to 2010

By John Ballard

I don't often say this but this link is totally essential reading.
It's quick, easy reading and very likely won't tell you much you don't already know. But as you read you may start shaking your head sadly as Dr. Meador tells how the practice of medicine has changed over the years of his career.

Here are some of the juicy parts.
Do take the time to read the rest. This guy's excellent.

When I entered private practice in 1962 (after graduating from medical school in 1955, completing a medical residency, serving two years in the Army Medical Corps, and completing a NIH Fellowship in Endocrinology), there was no Medicare, no Medicaid, and very little medical insurance of any kind. Patients paid cash, vegetables, meat, or nothing.

We turned no one away for lack of insurance or inability to pay. I had no idea when I saw a patient if they did or did not have insurance or were able to pay. The medical insurance of those times paid only if the patient was admitted to a hospital with a known diagnosis. For those patients with insurance, we admitted all we could in order to get tests and imaging studies paid. This led to an abuse of hospitalizations and many bogus diagnoses. Almost any diagnosis would justify the admission, including pseudo-diagnoses such as achlorhydria, hiatus hernia, or even retroverted uterus. This wrong use of admissions to get insurance coverage was common. There was no insurance for outpatient care. That did not change until late in the 1960s.

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[...]  The AMA�s restraint on physician advertising was set down by federal court orders in 1975. The flood gates were opened and the public began to be saturated with appealing ads for hospitals, drugs, tests, and procedures, whether needed or not. Each major television channel soon had medical experts extolling the latest device or drug. Drug companies began to monger new drugs to treat new and thinly defined ailments. For the first time, drug ads were aimed directly at the public. The flood of patients now became a tsunami and the cost for health care soared to 17% of the gross national product.

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Some of this rush to medical care is fueled by a large misunderstanding by the public about the difference between life expectancy and human life span. The rise in life expectancy from birth has been widely and incorrectly attributed to advances in curative medicine. People believe that the human species is being made to live longer mainly by medical care. This is not the case. The rise in life expectancy from birth is attributable to reductions in deaths in childhood, mostly before the age of one year. Most of the reductions in childhood and infancy came from public health measures, clean water, clean milk and from immunizations. More people are living to older ages because they did not die in childhood. Humans as a species are not living longer life spans. The life span of humans is fixed at 85 years plus or minus 5 years. It has not changed in recorded history.