I’m reading Jean Edward Smith’s biography of Franklin Delano Roosevelt, and one key moment is when FDR is vacationing on Campobello Island by the Maine/Canada border and is suddenly stricken with fever and paralysis. This is his famous infection with what was either polio or Guillain-Barré Syndrome. The Roosevelts were quite wealthy, and swiftly sent for the well-known doctor William Keene to interrupt his vacation in Bar Harbor and come treat him.
According to Smith the bill for these services was $600 in 1921 which would be about $6,000 in today’s money.
So what does that tell us about the evolution of health care costs over the past hundred years. Well, it sort of doesn’t tell us anything other than offering a reminder that “health care costs” is a very ambiguous concept. If you wanted a doctor to interrupt his vacation in Bar Harbor and come see you at home in Canada and diagnose your Guillain-Barré Syndrome today that would probably cost you more than $6,000. But then again, in 1921 they couldn’t correctly diagnose the illness! And even if they could diagnose it, they couldn’t treat it. And they couldn’t treat polio either. You were just screwed.
In general, the “health care costs” problem was not that troubling 100 years ago largely because it paled in comparison to the “there’s nothing useful we can do for all these sick people.” A less affluent family wouldn’t have been able to afford that doctor’s visit FDR got, but it didn’t do any good anyway. A lot of what passes for discussion of the health care issue these days is just blind to this, and lumps all spending together as “costs” and says it’s bad. But while measures to reduce the price of useful services or the incidence of useless ones are both great, spendings tons of money on genuinely useful treatment is also great. Spending half life paralyzed from the waist down sucks. If by increasing spending you can prevent that, you’d be crazy not to.