John Fischer in The Morning News:
Broadly speaking, I’m a healthy person. I kickbox, I don’t drink much, and I only have a cigarette once in a while. I was never subject to childhood inhalers or Ritalin or even a hospital visit. My blood pressure is great, my eyesight is okay, and I seldom get cavities. So like a dodo bird, ignorant of predators, I saw no cause for concern. Shortly after my physical I booked an appointment with a urologist I found on the internet. He was a cue ball–bald man in his early 50s who asked me a battery of diagnostic questions and then instructed me to pee into a funnel-like machine that measured my “voiding” velocity. With a sound like an old printer, the device spat out a graph of my bodily function reduced to numbers, which my new urologist spent several minutes examining. He nodded as though a suspicion had been confirmed.
To require medical treatment in the 21st century is to enter into a system that has never been truly functional. The mechanics of who provides and who pays for medicine in this country have been under debate since at least the late 1800s, fundamentally inseparable from the larger question of our government’s basic responsibility to its citizens. So unlike, say, sewers or interstate highways, the shape of our medical system has been informed far more by ideological stalemate than by consensus. It’s a fight we revisit every few decades (Franklin Roosevelt and the American Medical Association in the ‘30s, Lyndon Johnson and Medicare in the ‘60s, Hillary Clinton and the Gingrich Republicans in the ‘90s) without ever really concluding. Though its most recent incarnation—President Barack Obama and a bill called the Affordable Care Act—has provoked its own particular mania, it is essentially the same debate, re-tooled for the Internet era. But if our thinking about the who and how of American medicine hasn’t changed much in a century, the system itself most certainly has. Catalyzed by money, technology, and a growing population, it has mushroomed to such size and complexity as to be almost incomprehensible to the person entering into it. According to the Centers for Medicare and Medicaid Services, U.S. medical expenditures will account for about 20 percent of our gross domestic product by 2020. That’s about four times what we currently spend on defense, or social security. Add to it the fact that, according to Health Affairs magazine, as many as 31 million people may remain uninsured even after full deployment of the Affordable Care Act—roughly one out of every 10 people. And then there are the labyrinthine financial calculations that dictate which procedures are covered by insurance and what pharmaceuticals make it to market and how many channels a hospital TV should display. Furthermore, we can add medical devices, research grants, colonoscopies as expensive as cars, drug reps paying for golf junkets, and so on. Like poverty or climate change, medicine in this country has grown well beyond our abilities to fully understand it, much less manage it.