patrick.net

Through the first decades of the 20th century, the American Medical Association marshaled its considerable power to shut down and halt the spread of "alternative" health care organizations. Physician leaders believed they threatened their professional autonomy and pay. Worried about interference in "their" sphere of medicine, AMA officials even opposed health insurance because it allowed groups external to the doctor-patient relationship to finance care. They also feared that physician groups would develop into corporations that would commercialize health care and produce "supermarket medicine."

Accordingly, AMA leaders waged war against physicians who contracted with or worked for "third parties," whether mutual aid societies or doctor groups. Since AMA members controlled state licensing boards during this period, they could revoke the medical licenses of transgressing doctors. For example, AMA officials warned physicians that working for Shadid's cooperative would jeopardize their medical licenses. Organized physicians also exercised a great deal of control over hospitals, and they frequently persuaded administrators to rescind the admitting privileges of doctors who ran afoul of AMA preferences. ...

Federal tax guidelines granted employers a hefty tax break for providing workers with fringe benefits beyond monetary compensation. Plus, employer-provided health insurance weakened labor organizing by making businesses, not unions, the stewards of workers' financial security. ...

Between 1945 and 1965, the share of the populace covered by health insurance increased from approximately one-quarter to 80 percent.

Predictably, under the insurance company model, health care costs shot upward in tandem with expanding coverage rates. ...

A 1950s Blue Cross study revealed that approximately 30 percent of hospital admissions were unwarranted. Hospitalization allowed doctors to deliver patients more tests and procedures than were available in a physician's office. During the same decade, the press uncovered a trend of unnecessary surgeries. Pathologists discovered, for example, that in some hospitals more than half the appendectomies performed were unneeded. ...

... the country's health care system, including the so-called "private sector," is not based on the evolution of competitive markets. Instead, the model sprang from the minds of physician leaders seeking to safeguard their professional status and earning power. Ironically, the arrangements they designed have developed in a way that undermines those very goals. ...

Direct Primary Care (DPC) physicians are beginning to reclaim their heritage by approximating the prepaid doctor groups of the early 20th century. Seen as a low-cost alternative to concierge care, DPC groups accept monthly membership fees in lieu of insurance. In return, they provide patients with extended physician visits, lab and diagnostic tests, and—in states where doctor groups are permitted to purchase drugs at wholesale costs—reduced-priced prescription medications. They have had excellent success in terms of cost containment and care advancements, such as increased doctor-patient communication through phone and email conversations.