Healthcare: 50 Years Later

Saturday night, I attended my 50th year high school class reunion: the Tyner High School class of 1967. On June 2, 1967, 252 of us walked the stage, received a diploma from Mrs. Potts and Mr. Dye and embarked on the next chapters of our lives.

It was a surreal evening. We paused to remember our 36 classmates who have passed—one in military service in Viet Nam but the rest from the risks of living life.

There was reminiscence of our most notable pranks, recall of Tyner Ram sports and colorful coaches, and recognition of the high school sweethearts that remain coupled (Wally and Suzanne Talent just celebrated their 49th wedding anniversary). And at our tables, chatter about who looked oldest, who’d gained the most weight, and who had the most hair remaining that wasn’t completely white.

In high school, we didn’t think much about healthcare. The prospect of going to Viet Nam loomed large: in our weekly assembly, it was sobering to hear the names of alums among the dead or missing. And anti-war demonstrations dominated news coverage by the three networks.

We were aware of the war but our interests were our cars, music and weekend activities. Our long-term plans were short-term: for some, college, for others a job and family, and for several, military service.

The big news for us in our senior year was that the Green Bay Packers defeat of the Kansas City Chiefs 35-10 in the First AFL-NFL World Championship Game, the marriage of Elvis Presley and Priscilla Beaulieu, the Beatles release of Sgt. Pepper’s Lonely Hearts Club Band and Pink Floyd, The Grateful Dead, Bee Gees, Beach Boys, Jefferson Airplane and the Byrds. Heavier items–like the passage of 25th Amendment to the Constitution, the Six Day War Israel won against Egypt, Jordan and Syria, President Johnson’sestablishment of the Corporation for Public Broadcasting, and colorful new Governors in California (Ronald Reagan) and Georgia (Lester Maddox)—were not of particular interest. And we knew nothing about those new programs—Medicaid and Medicare.

In 1967, the median household income was $7300 and a new house sold for $14,250.  A gallon of gas cost 33 cents and the minimum wage was $1.40. “Bonnie and Clyde,” “The Dirty Dozen” and “Cool Hand Luke” were the big screen hits and “The Fugitive,” “Beverly Hillbillies,” “I Love Lucy” “Star Trek” and “Peyton Place” ushered in color TV. Safety belts and shatter-resistant windshields were a novelty circa a new federal agency called the National Patient Safety Board that year and Thurgood Marshall was confirmed as a justice of the Supreme Court—the first African American to serve in our highest court.

We were oblivious to the world around us except for the nation’s turmoil about Vietnam. Interracial marriage was declared constitutional that year but we paid little attention: our schools were largely segregated so interaction with non-whites was rare. President Johnson’s 6% tax increase to pay for the Vietnam war didn’t impact us: we were living on our part-time jobs and loans for school. That Dr. Christian Bernard did the first heart transplant procedure in South Africa that year didn’t scratch: we knew little about surgery and had no clue about South Africa, or Russia, China, Brazil or India for that matter.

At dinner Saturday night, the serious table talk was about the world in which my classmates’ children and grandchildren now live. There was considerable discussion about the Veterans Health and Social Security and how significant Medicare is as a safety net. Some confessed to waiting to gain eligibility to get their knees and hips replaced, and all were curious about the fate of the program given the current political climate.

There was no talk about organ replacement or customized therapeutics. No mention of digital health, smart devices, robotics, artificial intelligence and connected health. No opinions about value-based purchasing or technology-enabled self-care. Each understood our system of health through the lenses of their personal experiences: paying for medications and treatments, getting appointments to see physicians and understanding paperwork were widely shared experiences. And each wished to age with dignity, without dependence on others.

In 1967, the healthcare system was an abstract concept. We paid scant attention unless we wrecked our cars or injured ourselves playing ball. We thought every physician infallible, every procedure evidence-based and every admission necessary. But today, healthcare matters and how our system operates confronts them daily. There’s confusion about Repeal and Replace and dissonance about the politics: they understand healthcare is expensive but they think there’s plenty of government money to cover anyone needing care.

I have spent 40 years trying to understand our health system, comparing it to others and attempting to identify ways to improve its effectiveness and efficiency. It’s daunting to stay abreast of the clinical innovations, regulations and economics that frame its performance, especially when obvious solutions seem so difficult to implement.

It’s not a system we learned about at Tyner. In 1967, our population was 204 million and our national health expenditures were 46.5 billion, 5.7% of our GDP or $253 per person. Today, for our population of 330 million, they’re $3.2 trillion, 17.8% of our GDP and $9990 per person. And they’re increasing at a rate of almost 6% annually—higher than food, fuel, housing and every other category of spending. Fesser Edwards taught a civics class that mentioned healthcare in passing, but there were no assignments to navigate the healthcare system nor instruction about how it operates. We were oblivious to its complexity and less concerned about its future. Today, we’re experiencing its complexity but, regretfully, still largely oblivious to its workings.

I have great memories of Tyner High and the life-long friendships that grew from those three short years we spent together. And now I have a new memory, of classmates who care deeply about our country and worry about the healthcare system on which they are increasingly dependent and about which they are anxious.

Paul

What to watch this week: (1) Efforts by Senate Republicans to craft a bill to Repeal the Affordable Care Act will continue. The sticking points are the unpopularity of the House-passed American Health Care Act which is opposed by three in four adults and concerns by moderate GOP Senators who believe its cuts in Medicaid and individual insurance subsidies are too deep and too soon. (2) The President has promised to issue one or more executive orders to address drug prices and FDA Director Scott Gottlieb is scheduled to testify before the Senate Appropriations Committee Tuesday. And (3), the 6th U.S. Congressional District race between Democrat Jay Ossoff and Republican Karen Handel which is widely seen as a referendum on the House-passed American Health Care Act. It is an affluent Atlanta suburb whose seat in Congress was previously held by Tom Price, the new HHS Secretary.