As Thomas Jefferson explained in the U.S. Declaration of Independence, (1776): it may be “self-evident that all men are created equal; that they are endowed by their Creator with certain unalienable Rights; that among these are Life, Liberty and the pursuit of Happiness.” But the rights don’t exist until they are “secured by governments” –until they are granted and funded. The right to liberty didn’t exist for black people who were being held as slaves before 1865 when the 13th amendment became law. Women didn’t have the “right” to vote until 1920 when enough states ratified the 19th amendment; the right to bear arms was established in 1791, but was never funded. Guns aren’t free; they aren’t supplied by the government. We have to buy them.
When asked if they thought health care was a right, people interviewed in Athens Ohio pointed to neighbors who were unwilling to work yet qualified for “Medicaid”, the taxpayer funded program for the very poor. “People should contribute to the cost”. Health care shouldn’t be free unless you’re really hard up. At the same time, as one citizen explained, “You shouldn’t have to worry about medical care anymore than you worry about “the fire department, or the police…or the roads we travel on.2 ”
The “health care” right—expectation—evolved over a number of decades piece by piece—group by group. It wasn’t mentioned in the U.S. Constitution for good reason. Before 1900 the care doctors provided was pretty awful. Like—the December morning in 1799 when 67 year old George Washington awoke desperately ill. He was retired, living at Mt. Vernon. The previous day he felt well and went out in the snow to “mark trees that were to be cut down.” Upon awakening the day in question he couldn’t talk and had trouble breathing. His wife sent for one doctor, then another. George and his wife Martha were two of the country’s richest people; they didn’t need subsidized care.
During the day three prominent physicians came to the home and plied their trade. The doctors were among the country’s best and they worked hard. On 4 occasions they bled the sick man and removed a lot of blood. His throat was swabbed, he gargled, his feet were covered with wheat bran, and he was given an emetic to induce vomiting. Nothing worked and Washington’s breathing got worse, so he dressed, thanked his 3 doctors, and made arrangements for his burial. That night he died. (So wrote his secretary Tobias Lear.)1
In 1781 we didn’t know bacteria and viruses caused infections. Doctors (and barbers) were skilled at cutting off wounded or infected limbs. For centuries European barbers, “in addition to grooming, and extracting teeth would bleed the ill and perform minor operations and some amputations.4” The procedure was bloody, painful, and accompanied by agonized screams. We didn’t anesthetize people until 1846 when a dentist named Morton started using ether to put people to sleep before he hurt them. Surgery was risky. Antibiotics didn’t exist. There were no blood banks. And most doctors hadn’t developed the skills needed to remove damaged organs safely.
In 1914, when the First World War started, physicians had a better understanding of illnesses and their cause, but they still were unable to do anything. My dad was six at the time. The family lived in a small, wooden, dirt floor, cottage in a Shtetl that straddled one of the main Ukrainian east- west highways. That year acting on orders from the Czar, the Russian army attacked Germany, entered their enemy’s territory, and fell into a trap. The second army was virtually` destroyed at the Battle off Tannenberg; thousands of the surviving soldiers retreated. When they came through my father’s town the fleeing Cossacks burned the family home to the ground. During the subsequent years the family crowded into one of the remaining cabins on the edge of the village. It was owned by an elderly Ukrainian who hadn’t left for mother Russia with his family.
During the war years no one bathed. Everyone’s garments and bedding contained body lice. One winter there was a typhus outbreak. The infectious disease is caused by a tiny bacterium (ricketsia) that lives in the lice. When people scratch and tear their skin the bacteria enter bodies and cause a severe illness: chills, high fevers, lethargy, rash, and a cough. Some people become delirious or lapse into a stuporous state. “During the eight-year period from 1917 to 1925, over 25 million people living in Russia developed epidemic typhus; three million died. Some claim epidemic typhus has caused more deaths than all the wars in history.3”
Antibiotics had not yet been discovered, so doctors could diagnose the disease but they had no treatment. When the town’s typhus outbreak became rampant a horse drawn wagon came around. People with high fevers and confusion were taken to a large hall full of beds. Most of them died. (In the 21st century Typhus is easily cured and prevented with the antibiotic Doxycycline.)
My father always remembered his boyhood, and when I chose to go to medical school he shrugged. Based on what he had witnessed, he concluded that doctors knew how to recognize and diagnose illness, but that’s all they could do.
Back then as now, most people who get sick recover. Smallpox once killed 30 % of those infected, but 70 percent mounted a defense and lived. After a person donates a kidney or half a liver (to be transplanted in another body) the donor usually recovers completely and lives a normal life. When a wounded or infected body is given the right boost it will usually do the majority of the heavy lifting.
- https://constitutioncenter.org/blog/did-george-washingtons-doctors-hasten-his-death-2 (https://www.mountvernon.org/library/digitalhistory/digital-encyclopedia/article/the-death-of-george-washington/
- Is Health Care a Right? by Atul Gawande. The New Yorker Oct 2, 2017
- Uptodate
- http://www.pbs.org/kqed/demonbarber/bloodletting/