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Sickness & struggle, part 8

The impact of technology on health delivery and access

Published Dec 23, 2009 3:41 PM

The past decade has seen a flurry of promising breakthroughs in medicine. The HPV vaccine, targeted cancer therapy, human genome mapping, natural orifice surgery, and drug-eluting stents are among the biggest breakthroughs of the 21st century. Many of these developments hold the potential to prolong and improve life.

An examination of Center for Disease Control statistics reveals a steady increase in life expectancy for the U.S. population since the start of the 20th century. In 1900, the average life expectancy at birth was a mere 47 years. By 1950, this had dramatically increased to just over 68 years. As of 2005, life expectancy had increased to almost 78 years.

Prior advances in medical science and technology are responsible for this 30-year increase in life expectancy. The discovery and use of penicillin to cure life- threatening infections, the development of a polio vaccine and the first successful organ transplant all lent themselves to a drastic improvement in life expectancy throughout the 20th century.

Technology and health care access

Another trend has emerged alongside this rapid increase in life expectancy. The 20th century advances in medical science and technology have corresponded to the rise of insurance companies as an intermediary between the doctor and the patient.

Prior to 1920 the rudimentary state of medical technology meant that most patients were treated in their homes and medical expenditures were often negligible. According to Melissa Thomasson, associate professor of economics at Miami University, lost wages due to sickness were four times greater than the costs associated with treating the illness. As a result, households preferred to purchase “sickness” insurance similar to today’s disability insurance to provide income in the event of an illness.

The U.S. population shifted from rural areas to urban centers at the same time that advances in medical technology and standardized requirements for medical licensure contributed to the growing acceptance of medicine as a science. This in turn led to the development of hospitals as treatment centers and encouraged the sick to seek out physicians and hospitals regularly. By the end of the 1920s, the cost of medical care began to increase in response to this demand for greater amounts of treatment.

In 1929, a group of Dallas teachers contracted with Baylor University Hospital to provide 21 days of hospitalization for a fixed rate of $6.00. Hospital plans such as these spread and eventually combined at the encouragement of the American Hospital Association under the name Blue Cross.

Blue Shield insurance for physician services developed a little later than Blue Cross and was in part a response by physicians worried that hospitals would encroach on their autonomy by providing insurance for physician services. Blue Shield was also developed by physicians to stave off demands for national health insurance.

It is worth noting that neither Blue Cross nor Blue Shield was developed with the intention of expanding access to health care. Both were initially designed as rudimentary forms of insurance for hospitals and physicians to recoup the full costs for the services they provide — profits and all.

Unions fight for expanded insurance coverage

Health insurance is actually a barrier to health care access when left to the machinations of the “free” market without the intervention of workers. Health insurance is a means of regulating access to doctors and medicine. Labor unions have struggled at the bargaining table for expanded employer-paid insurance coverage despite the inherent tendency of private health insurance to ration health care.

Organized labor had been a vigorous supporter of President Harry Truman’s proposal for a system of national health insurance starting in 1945 when the plan was first announced to Congress. By the end of the 1940s, due to opposition by a ferocious right wing, which included the American Medical Association, the plan was dead despite strong support from a coalition of farmers and workers led in part by the American Federation of Labor and the National Farmers Union.

After the defeat of universal health care legislation, the labor movement turned its attention to expanding the system of workplace-based private insurance coverage. In 1949, the National Labor Relations Board ruled in the dispute between Inland Steel Co. and the United Steelworkers Union that the term “wages” included insurance benefits. Labor unions were able to utilize this ruling in their fight to win insurance coverage for their members.

Commercial insurance companies entered the market following the success of Blue Cross and Blue Shield. By 1952, commercial companies surpassed the combined market share of the ostensibly non-profit “Blues.” Due to the success of union campaigns, tens of millions of workers and their family members gained access to private health insurance.

However, the employer-based system of private health insurance was always insufficient. Millions of workers and oppressed people inside the U.S. have always lacked health insurance and as a result, they have been denied adequate medical care.

The impact of the scientific-technological revolution and the corresponding erosion of the U.S. manufacturing base have contributed to a growing crisis in the trade unions that began in the late 1970s.

In 1948, at the start of the full push by unions to negotiate private insurance coverage as a standard work benefit, more than 31 percent of the workforce was unionized. The Bureau of Labor Statistics reports that there were 16.1 million union workers in 2008. This amounts to 12.4 percent of the employed workforce.

These factors have eroded much of the extensive employer-based system of private health insurance won by unions. The result has been a crisis in health care that is only exacerbated by the current economic crisis. This health care crisis is marked by the 50 million individuals living inside the U.S. who lack health insurance and the 25 million who are underinsured.

Next: The fight for real, quality health reform (last in series)