The History and Evolution of Healthcare in America: The Untold Backstory of Where We've Been, Where We Are, and Why Healthcare Needs Reform

Overview

From the beginning of mankind, health and health issues have played a major role in life, but the issues and care have evolved enormously from the time when the first settlers set foot in America to the present. In The History and Evolution of Healthcare in America, author Thomas W. Loker provides a historical perspective on the state of healthcare and offers fresh views on changes to Obamacare.

Insightful and thorough, The History and Evolution of Healthcare in America offers a...

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The History and Evolution of Healthcare in America: The Untold Backstory of Where We've Been, Where We Are, and Why Healthcare Needs Reform

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Overview

From the beginning of mankind, health and health issues have played a major role in life, but the issues and care have evolved enormously from the time when the first settlers set foot in America to the present. In The History and Evolution of Healthcare in America, author Thomas W. Loker provides a historical perspective on the state of healthcare and offers fresh views on changes to Obamacare.

Insightful and thorough, The History and Evolution of Healthcare in America offers a look at

• what healthcare was like at the birth of the nation;

• how the practice of providing healthcare has changed for both caregivers and receivers;

• why the process has become so corrupt and expensive;

• what needs to happen to provide both choice and effective and efficient care for all;

• where we need to most focus efforts to get the biggest change;

• what is needed to get control over this out-of-control situation.

Loker narrates a journey through the history of American healthcare-where we've been, how we arrived where we are today, and determine where we might need to go tomorrow. The history illustrates how parts of the problem have been solved in the past and helps us understand what might be necessary to solve our remaining problems in the future.

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Product Details

  • ISBN-13: 9781475900736
  • Publisher: iUniverse, Incorporated
  • Publication date: 4/12/2012
  • Pages: 402
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.89 (d)

Read an Excerpt

The History and Evolution of Healthcare in America

The Untold Backstory of Where We've Been, Where We Are And Why Healthcare Needs More Reform
By Thomas W. Loker

iUniverse, Inc.

Copyright © 2012 Thomas W. Loker
All right reserved.

ISBN: 978-1-4759-0073-6


Chapter One

I. (1492 – 1776) Health and the New World

Imagine ...

It is the early evening of November 1, 1633. A cool, dark, fog envelops you in a disquieting silent shroud as you make your way down the dark cobblestone streets of Gravesend in northwest Kent. The night airs settle around you as oil lamps and candles cast faint, flickering light through the salt glass windows. From a short distance, you can hear the soft roar of England's mighty river Thames. Sticking to the shadows, you search for a tavern called, "The Gravedigger's Refuge."

The soles of your hobnail boots click and clack as you creep down the dark streets. Your broadcloth shirt is damp, and the chill seeping into your bones is unbearable. You don't feel well. The shivers grip you, and they are not just from the cold. You pray this is not the first sign of consumption, dropsy, or the dreaded cholera that held your homeland in its grip when you fled.

As you made your way across Europe through Flanders to England, you left each and every town just as disease and pestilence took hold of them, devastating the populations. The plague or fever seemed to follow you. Each time you found a home in a town and commenced to develop some skill, disease began to rip the town apart, along with your hope to learn a trade and make a living. So you fled west—always farther west.

At last you see a tilted tombstone slung above a doorway, the sign of The Gravedigger's Refuge. A wave of weariness and hunger nearly overcomes you as you push open the door. You worry that your poor command of English and your Flemish accent will betray you. You feel close to salvation, and fulfillment of your simple wish for escape to the New World. But, at this very moment your most pressing need is for a warm hearth, a few morsels of food, and a place to rest.

"Eay Yo" calls the portly man behind the bar, "what's yer pleasure be?" His waistcoat is bursting at its seams, and the few remaining hairs on his head are askew. There is a dangerous air to this man, as well. On your guard, you respond, "A simple draught and some palaver 'el do." As you sit to make your drink, you inquire as to how a man can find some "bed for the night and fair and safe work for the future." "S' yer trade mate?" asks the barman. You say but one word, "carpenter."

The barkeep fixes his gaze on you and slowly moves from behind the bar. The code word "carpenter" has worked. The man pulls up a stool and leans forward, which causes you to recoil. His breath emits a foul stench, for sure, but it also makes you nervous, for you have heard that vapors cause disease.

"So," he begins. "You's a papist?" You nod solemnly, though it is a lie. "I wouldn't have reckoned that from yer accent," he says, "but then again, I ain't been far."

He pauses to look over your shoulder before continuing. "I knows ya needs fast and complete passage, and yer lucks good, mate. There's two ships leaving tomorrow morning. You reports to the Master of the ones called The Dove. Tells him yer name is Thomas Loker. Tells him, you's good with maul, trunnel, and caulk and he will be sure to take you as carpenter's mate."

You ask about the cost, and the man replies, "Yer bed and yer drink is six pence apiece, but the palaver is eight shilling. And mind you, you'll need give me another eight for the Master if'n you expect to get the job." You are startled by the expense, but you dig in your purse and pay out sixteen shillings twelve pence.

"That's all there is," he says, grinning from the feel of coins in his hands. "Get there early, as I ain't the only bookie in Gravesend." You mount the stairs to your bed, only to find that your bed-mate is a frail man with a hacking cough. There is more comfort to be found on the floor, and you make your bed there for the night.

As you drift off to sleep, you wonder why the barkeep assumed you were a Catholic. You have been accused of many things as you made your way from your homeland over the past year. You've been called a bagger, bumbler, bounder, and stranger, but never a religious. Certainly you're no carpenter, either! But, if you need to be a Catholic to make this voyage, then a Catholic you'll be!

You wake at dawn the next morning and make your way down to the docks on the south bank of the river. Two ships stand ready for sailing. One is a giant vessel of 400 tonnes or more, while the other seems too tiny for oceangoing, no more than 50 tonnes. You find the Master, and, as instructed, you tell him your name is Thomas Loker and that you're good with maul and other carpenter's tools. He assigns you to the Dove, the smaller of the two ships, but first, he insists that you make the oath to Lord Baltimore and the Crown. You pledge to do your best to make passage and to stay true to the Catholic faith. You learn the terms of your passage. You promise 10 years carpenter's service in the new land, and you will be granted a parcel of land and earned status as a freeman. What luck! All you seek is simple passage out of Europe and its disease, famine, and pestilence. Now you will have both a trade and soil of your own in the new world of freedom called Mary's Land.

Within a few hours of leaving England on November 2, 1633, you find out that the papists are leaving to avoid arrest and persecution because of their Catholic faith. By the second day, the Dove is caught up in a pounding storm and, while the larger 400-tonne Ark is barely making way, your boat, the Dove, is foundering badly. The ship is taking water, and you are deathly sick, as is most of the motley crew. You have forgotten all about the luck of this venture, your oath to Lord Baltimore and the King. Now all you want is to be back on dry land. Taking on any of the diseases you are fleeing would seem a welcome relief to how you feel now. Even an English jail would serve a man better than this sickly, bouncing, and leaking coffin. Finding some shelter back at the Isle of Wight, your Captain anchors the ship in the sheltering bay, keeping all hands on the ship and away from shore. After a few days respite, you are back at the rolling sea.

After a few weeks, most have their sea legs; but other problems rear their ugly heads. Your bunk mate catches his thumb in the mizzen sheet and skin and nail are torn from the end. Having no ships surgeon, treatment of the injury is left to the captain. A plaster of roots and white powder is applied—yet the next day he complains of the pain. The Captain orders an additional draught of rum to help. The infection worsens. While your larger sister ship, the Ark, is nowhere in sight, you do come upon another ship, the Dragon, a large well-armed merchant vessel, and you sail in trail to her during the dangerous passage. In the next week, consumption shows itself in some of the crew. Again, the Captain provides his medicinal ministrations. The first unfortunate crew members pass within two weeks. The captain remarks at one of the buggers' good luck, "Aye, with a surgeon on board treating him instead of me, he would have only lasted a few days. You know I read this philosopher, Francis Bacon, who said, 'The remedy is worse'n the disease!'"

Always feeling ill, you pray to God that you don't get sick, because you know that the Captain is correct. More people are dying from the treatments than from the illnesses or injuries themselves. You are left to wonder—if they had just left some of these poor, sick people alone instead of giving them these awful tasting remedies, would they still be alive today?

With in a day of the discovery of the crewmen with the consumption, your bunk mate's thumb is still not healed and begins to smell bad. He is suffering from fever. With a healthy dose of rum for both the Captain and the patient, the Captain takes a meat knife in hand from the cook and quickly hacks off the man's thumb at the base. Once again, he provides a poultice to stem infection; he pours rum down the amputee's throat for the pain. Later, as you lay next to him in sleep you still hear the echo of his screams; yet there is something else about this difficult voyage you will never forget. The fever never breaks; your bunk mate dies within days. His corpse, with its skin mottled from infection, is cast over the side.

Over the next few weeks, others succumb to consumption, fever, and other mysterious diseases. Everyone is worried about the pox or plague, but none shows its lethal countenance. The ship's stores were packed well, not just in barrels, but in the new-fangled lead cans. While the meat packed this way has a bit of distaste, it is much better than the daily salted meat and fish. Even though the ship has no surgeon, the Captain has some patent remedies. They include cinchona bark (quinine), "Anderson's Scotts Pills," "Daffy's Elixir" and "Lockyear's Pills." He also has a book of recipes showing how to mix other curatives with the new drugs—quicksilver (mercury), strychnine, and arsenic.

If asked, the captain proudly tells all who will listen that, with these wonders, he can cure; "The Stone" in babes and children, Convulsion fits, Consumption and Bad Digestives, Agues, Piles, Surfeits, Fits of the Mother and Vapors from the Spleen, Green Sickness, Children's Distempers, whether the Worms, Rickets, Stones, Convulsions, Gripes, King's Evil, Joint Evil, or any other disorder proceeding from Wind or Crudities, Gout and Rheumatism, Stone or Gravel in the Kidneys, Colic and Griping of the Bowels, the Phthisic both as cure and preventative provided always that the patient be moderate in drinking, have a care to prevent taking cold, and keep a good diet, Dropsy, and Scurvy. It seems the captain believes no surgeon or physician is needed on board as he can fix anything with these cures. So far they ain't worked. Just like back home, people are still dying from injury and disease.

In January 1634, you make Barbados and find your larger sister ship, the Ark, getting ready to depart. After only a day or so to resupply, you are again off to the New World. Just like on the Dove, many on the Ark are also sick with fever and injury. While you didn't know "doodly squat" about carpentry when you left Gravesend, you have learnt to keep at it till it stops leaking ... You learned that if 'n you just keep working hard somehow it'll all come together.

On March 3, 1634, you make your way from the Atlantic Ocean into a large, rough, but beautiful, bay called Chesapeake. On March 25th you make land at St. Clements Island. The papists, of whom you are now one, make a mass to thank the Almighty for his good graces and your safe arrival. Two days later, you catch your first glimpse of the land that is now to be your new home.

Pulling up the St. Mary's River early in the morning, you see two fingers of land that come to an opening on the bay. On deck, the air is cool and heavy. All sounds muted—the eerie quiet wraps you just like that evening in Gravesend when you found the barkeeper and began this journey. Large trees stand on either side of the river. You welcome them as good shelter from the storm. The land ahead gently slopes to a sandy beach in the north of the inlet, forming a marsh where the fingers join. The creaking in the rigging almost drowns out the moans of the sick below. Muskrat, mink, and otter are abundant on shore. Deer, duck, swan, goose, and many other fowl are everywhere. The days are warm and nights cool. This land looks perfect, except for the dampness of the air and the bugs that appear everywhere, and bite you.

You are thankful for your final arrival—and none too soon either. As for the godforsaken Dove, it is full of shipworms and leaking mightily. Despite all your effort, to you your repairs are all too obviously ill-fitting and improper. As you disembark from what has become your ship, now moored in the St. Mary's River right next to the Ark, and go ashore; the remoteness and isolation of this new place, like the damp morning air, begins to settle on you. You know that Indians are about because at night you have seen their torches and fires, but so far no contact has been made. You know that the Potomacs are fierce warriors and that the Susquehannocks and other nations are equally as fierce. Not ten years ago, the venerable Captain John Smith in the Virginia colony had much of his detachment murdered by the Powhattan Confederacy of the Algonquins.

Arriving at the shore of this small bay, at the joint of the fingers with a gradually slopping sandy beach in front of a stand of tall trees, you realize that everything you will need to survive will have to be made. And, that you, along with the only other carpenter, who sailed on the Ark, will need to hew by hand all the building boards and fashion stools, benches, tables, chairs, bowls; carve treenails, spoons, and all manner of implements. Farm tools like hoes and axes will need new handles. Carts will need new wheels. Homes will be built and then rebuilt due to rot, storm damage, and from fires started by the rendered fat oil lamps and fireplaces. Each house will need a kitchen—located away from the main structure to help protect the house from fire. And, here you have no idea how to do most of this. As you sit on the beach and watch others disembark, you see dozens come off with fever, scurvy, and mental prostrations. Some no longer seem right in the head. This adventure has been a trial from the beginning, and here you sit: no house, not much in supplies, few soldiers to protect you, and many people counting on you, and a few others, to form a new colony in order to survive.

You spent nineteen years fleeing disease and pestilence across Europe only to arrive in this land with even more sickness at your heels. Over one-third of your ship's company and that on the Ark as well, has perished on the trip. Over one-half of the settlers that have arrived are sick with one malady or another. The treatments, salves, patent medicines, and mixtures brought from England have shown no benefit during the voyage. The papists are buoyed that their prayer to God will bring Providence, but with your own faith not yet formed, you feel it will be the hands of Man that brings the cures. Still you feel at last you have a chance, a hope that you can finally build a life and make a family. Yet your stomach aches, your back spasms; still you don't feel well.

Little do you know that your small, ill-prepared, sick collection of Catholics fleeing the persecution of the Protestants in England will not only survive but found a new community that they will call Maryland . You have no idea that, in only a few hundred years, your descendants will thrive in this small town. That, the area in which you sit, will become, 300 years later, the campus of St. Mary's College of Maryland on the very land that was once part of your original grant. No, today you rightly focus on the tenuousness of your life and the fact that Indians, disease, fire, crop failure, or failure of resupply by subsequent trips from Lord Baltimore 's company could spell the death of you and all with you. For you, and all the others, the daily struggle for survival is a simple fact of life and it will largely remain such until the birth of your great, great, great, grandson in 1872. Not many will feel well, most of the time.

Disease and Conquest

The history of the New World is a history shaped by violence, illness, and contagion. Within ten years of Columbus's first voyage in 1492, England, France, and Spain had all laid competing claims to what would someday become the United States. These were the disputes that could only be extinguished by colonial settlement of territories in question, which guaranteed that the price for acquiring these new lands would be paid, not just in treasure but in human lives.

(Continues...)



Excerpted from The History and Evolution of Healthcare in America by Thomas W. Loker Copyright © 2012 by Thomas W. Loker. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Contents

Advance Praise for the History and Evolution of Healthcare in America....................v
Introduction: From the Mayflower to Medical Mayhem....................xix
I. (1492 – 1776) Health and the New World....................1
Imagine ....................3
Disease and Conquest....................9
II. (1777 – 1849) Hospitals & Physicians Never the Twain Shall Meet....................13
Imagine ....................15
Humorous Bleedings and Cathartics....................22
Hospitals and the Birth of Health Insurance....................27
Physicians, Apothecaries, and the Patent Medicine Manufacturers....................29
Going Under....................33
III. (1850 – 1899) Medicine Becomes an Industry....................35
Imagine ....................37
Physicians Seek Safety in Numbers....................43
Wealth, Power, and Panic....................45
New Medicines: Selling the Cures....................47
Physicians Take Control....................51
The Apothecary's Dilemma....................53
Nurses to the Rescue....................55
The General Welfare....................56
IV. (1900 – 1929) The Progressive Era and its Aftermath....................59
Imagine ....................61
Muckraking....................71
Government to the Rescue....................79
Physicians Rise in Power....................87
Pharmaceuticals from the Medicine Men....................90
The Law and Malpractice....................92
The Life and Death of a Patent Medicine King: Dr. Morse's Indian Root Pills....................95
Final Thoughts....................104
Chapter 4 Addendum Medical Advances 1900 – 1929....................106
V. (1930 – 1949) New Depression, New Deal, New War....................109
Imagine ....................111
The First Great Depression....................116
Henry J. Kaiser's Health Solution....................122
World War II....................126
The Push for National Healthcare Insurance....................135
The Nation Gets the Blues....................138
Final Thoughts....................142
Chapter 5 Addendum Medical Advances 1930 – 1949....................143
VI. (1950 – 1979) Hearts, Minds, Government vs. Ourselves....................145
Imagine ....................147
The End of Polio....................155
War, War, and More War....................157
Television: the People's Medium....................159
Kennedy and Johnson....................162
The Battle of the Sexes....................173
Vietnam: the Made-for-TV War....................176
America's New Drug Culture....................181
Free Love - Free Clinics....................187
The Rise of the HMO....................197
1950s....................197
1960s....................198
1970s....................199
VII. (1980 – 2010) Helplessly - Hoping:....................201
Imagine ....................203
Reform, Reform, and Reform Again....................221
It's the Economy, Stupid....................225
The Medicaid-Medicare Confusion....................238
The HIV-AIDS Epidemic....................240
The DOCs Split With the DOCtrine....................245
Hillary Care: It Took a Village....................250
Chapter 7 Addendum: Key Governmental Actions 1980 – 2009....................253
VIII. Where We Are Now....................263
Where Are We Now?....................265
Recent Legislation....................268
WE Are a Huge Part of What Is Wrong....................269
The 'Let's Make a Deal' Mind-set....................271
There is a Way—If WE Want to Take It!....................272
Chapter 8 Addendum Medical And Technological Advances 1980 – 2010....................273
IX. A Road Map to Sanity....................275
The Fundamental Issues....................277
Cost Matters....................281
Pricing Options for Healthcare....................285
Transparency in Pricing....................290
Transportability of Insurance....................292
Reducing the Cost of Practice....................296
Full Coordination of Care and Benefits Across All Sources & Virtual Teams....................301
Tort Reform....................306
What Role for Government?....................309
What Role for WE the People?....................317
Ask Your Own Questions....................321
Chapter 9 Addendum:....................323
Effective upon Passage:....................323
Provisions Already in Effect....................325
Effective by early 2012....................329
Effective by January 1, 2013....................329
Effective by January 1, 2014....................330
Effective by January 1, 2017....................333
Effective by 2018....................333
X. Recommendations:....................335
Other Steps....................340
XI. Epilogue....................343
Imagine ....................347
XII. Works Cited....................357
XIII. List of Tables, Charts, and Figures....................361
XIV. Index....................363
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