Book Two, Chapter Four: End of Mandate

Crisis is a powerful motivator, whether a semantic conception or physical occurrence. As Chapter Four illustrates, the crisis of the 1970s surrounding healthcare led to an incredible amount of political activity, little of which can be argued to have moved us forward towards a better system. This is not to deny that there was an impending crisis, but merely to point out that from all the changes and new policies resulted little improvement.

I would argue that most of the crisis was political. While it was generally accepted that health care was an area government should be involved in, particularly because it doesn't get distributed equitably if only done on an ability to pay basis, by the 1970s, both conservatives and liberals were dissatisfied with the system. Costs were escalating far beyond that of inflation and yet, return on investment was flat. Health care, as we've discussed previously, had a significant case of the law of diminishing returns. In the early part of the 20th century, medicine had shifted from public health to acute individual disease care. Thus, improvements were readily observable. As we shifted to chronic care, however, improvements were less easily to observe because they were many improvements in quality of life. As Starr notes, life expectancy and death from chronic conditions were actually improving even in this time of acute criticism. However, people were so convinced of a low rate of return on investment that improvements were shrugged off.

Although I think the word crisis is often applied too soon, its effect is undeniable. I find it interesting that the plight of the uninsured and the poor persists today, along with the creeping sensation of a system in crisis. What will it take to enact true change? Why are the providers so resistant to lose profits? Does the Hippocratic oath not include cost and the barrier created by it as a source of harm? Why has the government resisted significant regulation on health care costs?