NPR Story
12:53 pm
Wed August 1, 2012

Does Access To Good Health Trickle Down?

I got a chance to travel a little bit recently — and no I won't be showing slides, no matter how much you beg me. And call me a nerd but on our little car trip I found myself thinking about health care.

Certain provisions of last year's health care overhaul are going into effect today and they remain controversial...but that's not what I want to talk about. I want to talk about something deeper, about our country's attitudes about health and wealth, which are in front of us even when we aren't looking for them.

I will start by telling you we forgot to pack a prescription. Not a life or death thing but important to the well-being of one of our group, an allergy sufferer. So, miles from home, using the internet we found a pharmacy, part of a big national chain, the same one we use at home. And 20 minutes later, just like that, we had enough to get us to our destination and back. It cost...not a whole lot, not enough to break the bank for sure, especially not for people with jobs and insurance. So it was, dare I say it, easy. Health care as a commodity, no harder to get than a candy bar or a can of soda.

Fast forward to the next day or so we decided to tour one of the country's great, grand historic homes, and why not? I'd read about it, the labor of love of one of the heirs of the Gilded Age. Not even the richest heir at that, but a lover of ideas and books, and travel and design.

Here's what i noticed: the place had dozens of bathrooms. This at a time when it was rare for a private home to have even one. And maybe I missed it but when we toured the servants' quarters — because you know I had to go there — what do I see but chamber pots? If you don't know what those are, think about the time your mom broke her hip and was in the hospital for week. Yeah, those.

So think about this: Upstairs, for the family and guests, the latest technology. Downstairs, the chamber pots. These for the people who cooked the food, washed the sheets and clothes, rocked the babies. And did I mention cooked the food?

Can I just tell you? It occurred to me that there is something very telling about this, a truth about the way health and health care still work in our country to a degree. Innovation certainly does trickle down. In this country most people can get eventually what the most privileged get first — whether technology, access to care or information. The question is, what happens until it does trickle down? And whose responsibility is it to see that it does?

We found out on our tour of the grand house that the lady of the house took a special interest in the health and well-being of the estate staff — visiting the sick, arranging doctor visits, promoting better nutrition by encouraging the workers to plant more varied food in their kitchen gardens. So that was health care as what? Altruism or self interest? And does it matter?

I learned from a wonderful book about the history of medicine called God's Hotel, that health care as practiced in the West has been always been linked both to faith and to the care of the poorest of the poor. I learned that at one time, almost every county in the country had an almshouse as well as a county hospital. The hospital to take care of the very ill, the almshouse to take care of the very poor.

In practice we now know some of these were places of horror but the underlying theory makes perfect sense, and shows that our current struggle is the same — is health care about mercy or justice? And if we agree that we should take care of the poor and the rich should take care of themselves, where does that leave the rest of us?

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