National Diagnosis

Write those letters now. Call your friends, and tell them to write. If you don’t, this program, I promise you, will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade very area of freedom as we have known it in this country. Until, one day . . . we will awake to find that we have socialism. And if you don’t do this and if I don’t do it, one of these days, you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.

Ronald Reagan, lobbying against Medicare

Medicare and Medicaid were signed into American law on July 30, 1965, both health care plans key components of President Lyndon B. Johnson’s “Great Society” vision. Given Johnson’s landslide victory in the 1964 election and Democratic control of both the Senate and House, Reagan’s warning of lost freedoms and slippery-slope socialism had no legislative impact. In fact, given that it was tied to Johnson’s civil rights agenda, Medicare greatly enhanced freedom for black Americans, because it required hospitals to desegregate their waiting rooms. As described in David Barton Smith’s The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System, the decision by the Johnson administration to tie Medicare to civil rights was empowering and revolutionary:

The most common responses to racial and economic disparities in opportunities in our nation’s history have been: “it’s just the way things are” or “it just takes time.” However, for the civil rights activists involved in the implementation of the Medicare program of 1966, the response was, “Now!” In four months they transformed the nation’s hospitals from our most racially and economically segregated institutions to our most integrated. In four years they changed patterns of use of health services that had persisted for half a century.

After a half century of Medicare, argues Elizabeth Rosenthal in An American Sickness, we need a new revolution to overthrow a Big Health system so “fantastically expensive, inefficient, bewildering and inequitable” that “we are all potential victims of medical extortion”:

Imagine if you paid for an airplane ticket and then got separate and inscrutable bills from the airline, the pilot, the copilot, and the flight attendants. That’s how the healthcare market works. In no other industry do prices for a product vary by a factor of ten depending on where it is purchased, as is the case for bills I’ve seen for echocardiograms, MRI scans, and blood tests . . . The price of a Prius at a dealership in Princeton, New Jersey, is not five times higher than what you would pay for a Prius in Hackensack and a Prius in New Jersey is not twice as expensive as one in New Mexico. The price of that car at the very same dealer doesn’t depend on your employer, or if you’re self-employed or unemployed. Why does it matter for healthcare?

Rosenthal argues that “the type of healthcare we get these days is exactly what the market’s financial incentives demand,” and that Americans must force their politicians “to change the rules of the game, with different incentives and new types of regulation.” In The Patient Will See You Now, a follow-up to his earlier The Creative Destruction of Medicine, Eric Topol argues that patient empowerment is not only needed but at hand, made possible by a new revolution in health care “powered by unplugged digitization, with the smartphone as the hub”:

We are embarking on a time when each individual will have all their own medical data and the computing power to process it in the context of their own world. There will be comprehensive medical information about a person that is eminently accessible, analyzable, and transferable. This will set up a tectonic (or “tech-tonic”) power shift, putting the individual at center stage. No longer will MD stand for medical deity.

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