The History of Medicine in the U.S. Provides Lessons for Our Future

The practice of medicine has evolved dramatically since the 19^th century when it was really a cottage industry and a physician was like a tradesman. Back in those days, there wasn’t much a doctor could do to cure patients. Medicine lacked a scientific basis and even where the science was understood, there were no medicines that worked.  The doctor’s role was often to provide a sense of hope and comfort to the sick or dying.

It’s quite fascinating to look back at the history of medicine where the original hospitals were alms houses for the poor, created by philanthropic organizations to care for the sick and dying who had no place to live and no family to take care of them. Up until the early 20^th century, people pretty much received medical care at home and died at home.

Interestingly, from the very beginning of modern day medicine, Americans never had a debate about whether healthcare is a right. We’re now experiencing the ramifications of our indecisions as we delve deeper into healthcare reform and ponder how we can provide a better, healthier future for all people. If you look back to 1964, President Lyndon Johnson introduced Medicare legislation to provide health coverage for seniors. Medicaid legislation was also passed, but was not set up to care or provide healthcare coverage for all of the poor in this country. Originally, through the Aid to Families with Dependent Children (AFDC) program, Medicaid covered mothers and their children. Later, Medicaid covered the indigent elderly, so that there would be coverage for older people who needed nursing home care but couldn’t afford it. It is a little appreciated fact that most States pay much more of their Medicaid budget for nursing home care than they do for hospital and physician care. (Today, for a fee, Americans can learn how to get Mom and Dad’s money so that they qualify as poor and the government (Medicaid) will pay for their nursing home care).

It wasn’t really until the 1990’s and 2000’s that individual states started creating special Medicaid programs for poor adults to cover doctor bills and acute hospital care, in large part because of the AIDS epidemic. In 2010, the Affordable Care Act saw the expansion of Medicaid as one of the ways to provide health insurance to a larger segment of the lower income uninsured American population.  Unfortunately, with the ever increasing cost of medical care and the downturn in the economy, the move to cover more poor people is a major factor in the near bankruptcy of a number of states.   

 Leaving aside for a moment the question of how we pay for care, it’s amazing how far medicine has come. Thanks to the tremendous technological advances of the 20^th century and a better understanding of the science behind medicine, physicians now have tools that actually cure patients and they have training that is rooted in science. The combination of clinicians (doctors, nurses, and others) that are scientists and medicines and tools that work, has led us to the thing that we know as the modern day hospital and modern day medical care.  

Over the past 60 years or so, as the practice of medicine has become more sophisticated and complex, we’ve seen physicians organizing into groups. In this new climate, it’s become increasingly challenging for a physician in solo practice to function on his or her own, partly because these practitioners don’t have enough hours in the day to attend to all of their patients’ needs, nor the resources to implement the new systems to deliver state-of-art care.  Solo practitioners work extremely hard and have dedicated so much of their lives to the practice of medicine. These physicians have been faced with difficult decisions and many have merged into group practices which offer a number of benefits - giving patients expanded access to medical care and giving physicians a more efficient way to deliver care (without sacrificing their personal lives). And today, as we continue to navigate the uncertain waters of healthcare reform, GBMC is working to strengthen its employed network of primary care physicians, while also offering support to independent community physicians.

Medicine as it used to be is ending. We are moving toward a new era of better health and better care at lower cost. At GBMC we want to be a part of the national solution. We are building on the beauty and power of the commitment of hard working, well trained doctors and other clinicians as we create new models to make it easier for them to get the job done. I’m proud to say that the GBMC Healthcare system is very good and will get even better!