Wednesday, October 08, 2008

Reagan: Medicine is the doorway to creeping socialism

That’s what he warned of in a 1961 address which predated his political career. He was speaking against the King bill (aka the King-Anderson bill), a precursor to Medicare. The bill, vehemently opposed by the AMA, was narrowly defeated. It resurfaced two years later in the Johnson administration, given new life by Johnson’s political influence and substantial democratic majorities in the House and Senate. It passed in the form of the Social Security Act of 1965 which gave us Medicare.

The address was recorded on a vinyl record distributed by the AMA. This was a time when the AMA staunchly supported what it believed to be the interests of doctors. It was a less cynical time when the interests of doctors were not believed to be invariably conflicted with the interests of patients.

I found the link over at Movin’ Meat, where Shadowfax gives a more favorable spin on Medicare (it’s efficient and wildly popular, he says) than I would. Efficient? If it’s efficient now (and that’s debatable) it clearly wasn’t during much of its history. In the early days of the program you could admit Uncle Freddie to the hospital for a barium enema. If Mom was a little stressed and overworked you could admit her for a rest and a check up. And if there was no one to watch Grandma while the family went on vacation, well…

The gravy train went on for 20 years. Medicare’s effort to improve efficiency and quality in the 1970s, via implementation of Professional Standards Review Organizations (PSROs), was a failure. It was dismantled in 1982. Then, in a panic over spiraling costs, Medicare abruptly (ironically, during the Reagan administration) switched from a gravy train to a mandate for the delivery of unreimbursed care in the form of its prospective payment system based on DRGs. Overnight Medicare became more intrusive, new crimes were invented and hospitals scrambled to discharge patients “quicker and sicker” and develop new forms of creative charting.

It makes you wonder. What if the bill hadn’t passed in 1965? Could the free market, perhaps alongside a means based government health care program for the elderly, have done better?

1 comment:

Anonymous said...

"Could the free market, perhaps alongside a means based government health care program for the elderly, have done better?"

Yes. Unfortunately, since there is no free market anymore, this will never be put to the test. At least not in this country.