by Senile M. Ethane

Created on: July 16, 2009

Healthcare in America has been going downhill for years. The cause must be confronted before any solution can fix it. But even though it is staring everyone in the face, few seem to recognize the problem.

No, it's not the fact that too many people are uninsured, although that is one of the consequences. And no, its not that there is big money and politics fueling the crisis, although that often stands in the way of fixing it.

The root of the problem is simple at its root. Most individuals simply have no idea how much their health care costs. Therefore, they have unrealistic expectations of what care they should be "entitled" to and make unreasonable demands on it with no regard for the cost.

No, I am not blaming the individual patient for the problem. I am blaming a handful of "wrong turns" made decades ago that have led to these unintended consequences.

Let's start with catastrophic medical insurance.

Believe it or not, there was a time when there was no such thing as medical insurance. When a child developed a rash and a fever, you called the doctor. He came to the house, diagnosed the illness, and told you what sort of care you should provide. In more serious cases, perhaps he prescribed some medicine. In most cases, bed rest, some aspirin or cough syrup and some TLC from mom, and everything would turn out fine. The doctor would leave and send you a bill.

His overhead was relatively low. He probably had an office with a nurse to assist him and another person to answer the phone, make appointments and do the billing and bookkeeping. So his charges were at least as reasonable as a call for help from any other professional.

But every once in a while, someone would suffer an accident or a serious disease and require extensive medical care. In such cases costs would mount up and have a devastating effect on a family.

So catastrophic medical insurance was born. In most cases, individuals could still afford their day-to-day medical costs. If a kid fell off his bike and scraped his knee, mom could wash and bandage it as well as anyone. And a bump on the head was considered a lesson taught that one should be more careful next time.

Medical insurance only came into play if things got serious. Since this was not very common, spreading these costs among a large number of people averaged out to a reasonable level that most people could afford and still leave room for a profit for the insurer. And those who could not afford insurance, braved the risks and if the worst happened,

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