Monday, August 7, 2017

Our Medical Nightmare, Part I

My Own Anecdotal Medical Insurance History

I joined the work force in the late 1960s, after the usual early flirtations with delivering or hawking papers, stock boy gigs, and summer jobs. My experience, therefore, is of preparing for an adult work-life that was disappearing just as I was arriving. I got there just in time to watch the old-style work relationships taking that last fatal step off the cliff. Within ten years it was all gone. It had been good while it lasted.

The post war period, let’s say 1945 to 1965, was characterized by a pleasant symbiotic relationship between management and labor. There was a high degree of unionization, sure, but even for non-union jobs there was a complex network of laws, tacit agreements, conventions, and covenants to insure that the working relationship of capitalists and workers went smoothly.

The major covenant was the promise from the capitalists that if the workers would be diligent, and work hard to insure a firm’s profits, the firms would take care of their workers and their families. (A covenant is an unwritten social contract of sorts, a set of promises between two groups of individuals. Another example would be the Implied Covenant of Habitability between landlords and renters, which has probably also fallen by the wayside.)

Part of this covenant was the provision of health insurance to virtually all wage earners, be they low skilled or high management. From the president of the company to the fellow who cleaned the toilets. It sounds like a dream by now, but back then were was almost a feeling in America that we were all teammates of a sort, the straight white people anyway.* All of the employees of a company were part of a team, working together to insure that the company prospers, so that they could work there for the long haul and then happily retire on the company’s own pension system. Amazingly, there was even a certain loyalty involved, not only on the part of the workers, but coming from the company as well. I know that this sounds like a stupid idea now, like listening to a scratchy 78 RPM record from the days when jazz bands included banjo players. It was true, though.

For most workers, the medical insurance that was provided was Blue Cross/Blue Shield. Amazingly, up until this post-war period the entire health care system in America in general, and Blue Cross/Blue Shield in particular, were administered as non-profit entities. The insurance that was provided was of the high deductible variety. In my case, I was always strongly disincentivized to make doctor’s visits unless they were really necessary, because the odds were great that I was not going to get up to the deductible amount in any given year, but the insurance was there for big-ticket items in case of emergencies.

This actually worked pretty well. I was a job-hopper, but I was almost always working. My insurance policy changed with every change of jobs, but I was always insured by someone and it was effortless to keep up with it. I never paid for insurance in those days. There were a very limited number of medical insurance companies, so more often than not the changeovers took place in-house.

Here’s an example of the ease of it all. I worked for Random House for a total of six months between June and December, 1969. Upon leaving, I went directly to a new job with no time missed. My first child was born in April, 1970. The Random House policy paid for the birth, because the baby had been conceived while I worked at Random House. Somehow, I didn’t even pay the deductible on that one. Maybe the deductible was only for out-patient and meds.

My wife and I both worked, but early on my wife switched to self-employment. As a result, she had no insurance. She solved this problem by finding a low cost clinic of family medicine for low income people. She made sure that we qualified, so to speak. By now it was the mid-1970s, and it’s time to note that medical costs had not yet begun their wild upward spiral. We were able to obtain all of the medical care that we needed, including dental care, at prices that we could afford to pay out of pocket. And you may believe me when I tell you that we were a young married couple of modest means. We had to be very careful with money. For a treat sometimes we’d all go to Del Taco for dinner. But we could manage it. (To give credit where credit is due, my parents helped us mightily by paying for my boys’ orthodontia. Those were two big jobs, very expensive, and we’d have been hard-pressed to pay for it ourselves. We took care of everything else ourselves.)

This went on through the 1980s. In 1987 one of those almost inevitable catastrophes came along. We were both self-employed in the family Day Care business when I suffered a burst appendix. Again my wife, by the time of this writing my ex-wife, was a big resource. We were still at that clinic of family medicine, and she had pre-arranged for us to be qualified for MediCal, the California based equivalent of Medicaid. I was admitted, over strong objection by the doctors, to Santa Monica Hospital, which is a high quality facility. They were about to send me to Los Angeles County/USC Hospital, but my wife dragged the two doctors out in the hall. They returned five minutes later, looking almost afraid, and said, “okay, we’re going to admit you now.” I was there for seven days after a major operation. My end of the bill was only the charge for the phone next to my bed. I think it cost $15 per day. Those programs, so necessary to the peace of mind of working people, are either on the chopping block or being mercilessly cut back even as we speak.

By the 1990s, health care in America was becoming the hyper-inflated nightmare that we are familiar with today. During the period covered by this installment, the medical business was slowly beginning to change over from a benevolent non-profit system to a vicious price gouging racket. Those changes and the situation today will be the subject of Part II.

This part was more of a personal memoir than anything else, maybe a bit of historical background, too. Coming up is the amazing story of how what we once had was lost. Young couples of modest means in our Brave New World have a much tougher time of it, not only when it comes to medical care, but also as regards employment, education, finances and retirement planning. It’s just fucking sad, when you think about it.  

*This kind of disclaimer must always be included when discussing the pre-civil rights epoch. Many people now act like there was a white America in the pre-Hippie days, and it’s true that white people were a higher percentage of the population. But it’s truer to say that diversity was high even then, and has always existed in America. Immigrants have always been with us, and it is a truism to say that we are all immigrants. Only the Red Indians are “Native Americans.” The big change is not the sudden appearance of diversity, but that the diversity is no longer required to exist only in the deepest, darkest shadows. Black Americans, and Hispanics and Asians, etc, are no longer invisible. Now, of course, people are allowed to be themselves, more or less. This is also true of people with non-standard sexual preferences, more or less. The tension these days between progressives and reactionaries on these equality issues makes me sick to my stomach. Why, in the name of all that is good and holy, can we not just get along? 

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