The Tuskegee syphilis experiment began in 1932.
190 ■ Chapter 8
■ First test tube baby born (1978) ■ Biotechnical Explosion (1979) ■ Cyclosporine developed (1979)
At the end of the 1970s, efforts were developed to “control” the costs of health care, yet the seductiveness of the “advances” in technology actually began the out-of-control escalation of the rise of health care costs. The following are ex- amples of events in the 1980s that further fed the rising costs of health care and the emerging expectation of people to be entitled to better and better levels of technological diagnosis and illness care that would provide longer life expectancies:
■ Nuclear magnetic resonance introduced (1980) ■ The beginning of the HIV/AIDS epidemic and the HIV virus isolated
at the Institute Pasteur, Paris (1981) ■ Monoclonal antibodies (1984) ■ Retroviral oncogenes (1985)
The 1990s to the present time have presented even greater challenges to the availability and affordability of health care. In 1993 and 1994, President and Mrs. Clinton made an extraordinary effort to study our complex health care system and sought ways to reform it. That effort did not materialize, and the present political energy has shifted from health care reform to welfare re- form and the saving of Social Security and Medicare. The nation’s 76 million baby boomers will soon be able to retire, which will necessitate large payouts from Social Security and Medicare, but it is unknown how many workers will there be to contribute to the system. The size of the shortfall depends on the changes in longevity, the birth rate, and immigration rates (Zitner, 1999). Ef- forts such as managed care (Saltus, 1999) and the discounting of payments for medications for the elderly were short-term and controversial approaches to managing funds. These efforts, too, have not succeeded.
Meanwhile, the costs of health care continue to soar, causing some hospitals to downsize their nursing staff in an effort to reduce costs. Ultimately, it was believed that the Clinton plan would create a few giant insurers, and health maintenance organizations (HMOs) would dominate the market; most people would be forced into low-cost plans, doctors would be employed by the insurers or HMOs, hospitals would be controlled by insurers and HMOs, care would be multitiered, the bureaucracy would in- crease, costs would not be contained, and financing would be regressive. The overall goal of health care reform was to make health care accessible, comprehensive, and affordable—a right and not a privilege of all residents of the United States. However, technology is advancing and our use of it is increasing, and we continue to spend vast sums on the care of patients in the last year of life while delivering less and less preventive care. In addition, the costs of for-profit care continue to explode, and the dominant force in managed care is the for-profit HMO.
Health and Illness in Modern Health Care ■ 191
The following are examples of health care events in the 19