Just in time for this year's commemoration, our weekly donor Dr. Charles Grossman has brought us a reminder of the enduring nature of this conundrum. Along with manuscript letters from Jonas Salk and Earl Robinson, this week's packet of materials for the Grossman Papers includes the text of a talk Grossman delivered on October 28, 1974, titled "National Health Insurance and the Poor." He begins:
My role is to tell you what these insurance plans will do for the poor. I was offered twenty minutes in which to explain this. After much reading and soul-searching I can only say in all honesty that what I have to say is so close to zero that perhaps I should stop here and sit down!While he, obviously, did not sit down at that point, Grossman did use this opportunity to remind the group that "Because the voluntary health insurance industry has really failed to offer coverage to most Americans, we are now facing the problem that should have been faced many years ago, namely that insurance coverage for all is a necessity."
One of the studies cited by Grossman in this speech was published by Mitch Greenlick et alii in Medical Care in 1972, "Comparing the use of medical care services by a medically indigent and a general membership population in a comprehensive prepaid group practice program" (1972 May-Jun; 10(3): 187-200). This study confirmed Grossman's own anecdotal evidence that people who don't have to worry about paying for a doctor's visit are much more likely to seek treatment early; the uninsured and the underinsured tend to delay seeking care until a condition is more advanced, and therefore, often more difficult to treat.
What Grossman's 1974 talk shows us, most of all, is that the issue of universal healthcare is not new, that the problems it seeks to solve are real and persistent, and that the solutions require a great deal of planning, forethought, and compromise. This week's events will hopefully shed more light on how we can get there from here.