Wednesday, August 6, 2008


For the past twenty years, the most consistent controversy in American politics has been over health care. Currently, as the economy is struggling, that controversy takes the front page, but even in that case a good deal of the controversy swirls around the fact that when a person loses his job, he typically also loses his health insurance, i.e. his access to "affordable health care". Even among those in our population who currently consider themselves relatively healthy there is great concern about health. Few of them do not have a parent, a sibling, a close relative or friend who do not struggle with a very expensive, chronic disease. And, although our life span is increasing, or at least, if you believe the media reports, it is. It is becoming enormously expensive to keep it increasing. When I was grade school we talked about cancer in health class and, knowing it was a dread disease, I was enormously relieved to read in the text that it was almost (with the exception of leukemia) exclusively and entirely a disease afflicting the very aged and that anyone under 60 need not worry about it. Anyone who has read through the obituaries lately knows that that is no longer the case. Likewise, adult onset diabetes was a relatively rare disease. I personally knew or even knew of on one that had it. Now, among my older friends, there are very few who don't. I remember a statement by Paul Dudley White, famous as President Eisenhower's heart doctor, that in the early days of his practice, the average American doctor had never even seen a case of heart disease. The backdrop for the controversy over health care in America is the terribly poor health of the American people. But why are they in such poor condition?

The first, and possibly most important thing to recognize about American health is that it has never been good. Americans from the earliest days of our country's founding have suffered from poor health. My own feeling is that the reason for this is that Americans have always turned a large measure of the responsibility for their health over to government. This was, of course, a tradition that they inherited from Europe. There medical doctors were trained in government schools and were typically the third and fourth sons of nobility, i.e. those for whom a position had to be provided. The tradition of government control of medical schools passed on almost seamlessly to America even after it won independence from Britain. Benjamen Rush, a prominent founding father and medical doctor, is reported to have called for freedom of medicine during the early debates about our government, but obviously that call was never incorporated into the Constitution. Of course, had an amendment been passed in the Bill of Rights requiring freedom of medical practice, it would have had little effect until after the Civil War, because until then all regulation was at the state level, but it would certainly have an enormous impact today.

Actually, there came a time when we did experience a sort of freedom of medical practice. This occurred in the middle of the nineteenth century, when discontent with the standard medical practice became so widespread that a number of alternatives sprang up. But rather, than give up control of medicine, most state legislatures merely expanded the franchise. Many students who have a favorite alternative health practice such as Hygiene (my own favorite), hydropathy, natureopathy, osteopathy, etc, are surprised to discover as they study its history that many of the early practiciners of that alternative had MD degrees. This was due to the fact that many states would allow schools teaching those alternatives to grant MD degrees. After the Civil War, and particularly, after the formation of the AMA, this franchise was again narrowed down to allopathic schools, and the practiioners in other alternatives had to award different degrees, if, in fact, the practice of that alternative was allowed at all.

The control of medicine remained largely with the state governments until the beginning of the 20th century when, with the creation of the FDA, it passed increasingly to the federal government. Because medicine has always been government controlled in our country, the corollary has been that our people have always believed that health could, to a certain extent, be bought. But that belief was tempered a great deal, even in my youth, to the belief that only in a very limited way could health be bought. It has only been in the past 30 years or so that a many, if not most Americans, have subscribed to the idea that more money translated into more health. In fact, that health requires so much money that for the average person to enjoy maximum health, the cost must somehow be passed onto others. The reason that people were sceptical about that idea when I was young and before, in my opinion, is the common observation, that rich people, those who could afford unlimited health care, were not particularly healthy. They were the ones suffering from the host of chronic diseases. One, osteporosis, was even named Dowager's Hump, meaning rich woman's hump.

Two government policies have, in my opinion, contributed greatly to the demise of American health. Both came as "unintended consequences" of poor economic policies. The first, and most devastating, came with the decision by the Roosevelt Administration to subsidize the most politically powerful farmers, the cattlemen, the dairy farmers and the large grain growers. This in turn led to the promotion by the government of these crops which promotion was canoized as the "Four Food Group" plan. Under this plan, the American people were told that three-fourths of their food (by weight--a further addition to the deception) should come from very calorically dense foods, leaving the American people to get 100% of their nutrition from less than 5% of their calories. Indeed, if the government had not required that these foods be "enriched", Americans would have been dying from Third World deficiency diseases such as beriberi, rickets, and scurvy. As the government has become more involved financially with health, there has been a growing discension within the government itself about this food plan. The first result was the push to reduce the fat content of the items in the meat and dairy groups so that, if Americans chose to use low fat meats and dairy products, they would increase the nutritious portion of their diets to as much as 10%. Later, of course, the four food group plan was scrapped altogether in favor of the "Pyramid" which is a slight, albeit, very slight, improvement.

The other disaster was the implementation by the Truman Administration of wage and price controls after WWII. Since the Democratic party was largely dependent upon labor union support, they had to give concessions to the wage freezes and the concessions they gave were to allow benefits to be increased and not counted as wage increases. The result was the health care system as we know it. Because it was not really designed with health in mind at all, but rather as an under-the-counter wage increase, the result has been to harm, more than help, health. Indeed, any objective observer would not call it a "health-care" system at all. It is, in fact, for the young and early middle aged a system of symptom alleviation, and even, symptom supression, and for the older middle aged and elderly a system of disease management.

The result of all this has been that the American people have been consistently misled as to what constitues real health and many have been convinced that they have the absolute right to live as irresponsibly as the wealthy have generally lived with respect to health. The real controversy should not center around how can we get someone else to pay to get us healthy. The real controversy should be, how can we develop a true "health care" system.


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