Old and Sick in America: The Journey through the Health Care System

By Muriel R. Gillick | Go to book overview

Prelude

For over seventy-five years, Americans have been arguing over whether medical care is a right or a privilege. We began arguing during the 1930s, when the first private insurance companies began to appear and when prepaid health care was born. We argued after World War II, when President Truman tried to introduce national health insurance. And seven years after the passage of the Affordable Care Act, which provided a path for every citizen to get health insurance, we are still arguing. But it’s only the young and the middle-aged whose rights and needs are being debated. For those over age sixty-five, the right to health insurance coverage is a done deal and it has been since the passage of Medicare in 1965. Seeing a physician, going to the hospital, getting rehabilitative care and, along the way, undergoing tests and taking medicines, are all part of the fabric of modern life for older Americans. So much so that we tend to assume that the way things are in health care—the organization of medical care—is the way things have to be. Physicians are rushed and the office is difficult to get to? That’s just the way it is. Hospitals make the oldest and frailest of patients disoriented and discharge them so quickly they have to go to rehab before returning home? That’s the way the system works. Medications are expensive and produce side effects? That’s the price you have to pay for a cure. Procedures are risky and perhaps unnecessary? That’s the chance you must take if you want the marvels medicine has to offer.

What happens to people as they journey through the health care system is actually not nearly so inevitable and immutable. It’s a product of our uniquely American version of medical care. How people react to sickness and to its treatment reflects their personalities, their culture, and the organization of medical care. The patient’s experience today is different from what it was fifty years ago and from what it is in other parts of the developed world. But it’s not just the patient’s reaction that has changed; what happens, what is done or not done, the tests they have, the drugs they take, in the most general sense, how they are treated, has changed. The question is, what determines the shape of medicine today and how did it get this way?

In the course of my last thirty years as a practicing physician, I’ve repeatedly asked why things are the way they are. How do large machines— computerized tomography (CT) scanners and magnetic resonance imaging

-ix-

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Old and Sick in America: The Journey through the Health Care System
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Prelude ix
  • Abbreviations in the Text xxi
  • Part I - The Office 1
  • Chapter One - Going to the Doctor 3
  • Chapter Two - The Lay of the Land 23
  • Chapter Three - From the outside in 41
  • Chapter Four - The March of Time, 1965–2015 61
  • Part II - The Hospital 79
  • Chapter Five - Entering the Palace of Technology 81
  • Chapter Six - The Varieties of Hospital Experience 97
  • Chapter Seven - The Hospital through Other Eyes 113
  • Chapter Eight - The Transformation of the American Hospital, 1965–2015 133
  • Part III - The Skilled Nursing Facility 151
  • Chapter Nine - Going to Rehab 153
  • Chapter Ten - Different Snfs, Different Miffs 169
  • Chapter Eleven - Movers and Shapers 184
  • Chapter Twelve - Now and Then 202
  • Finale 223
  • Acknowledgments 245
  • Notes 247
  • Bibliography 267
  • Index 293
  • Studies in Social Medicine 301
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