The price of cure

A history of surgery in the New England Journal of Medicine paints a vivid picture of why healthcare is such a large part of the modern budget, while at the same time being such a new part that its cost continues to outrage our feelings and expectations.  Only a little over a century and a half ago, surgery was confined almost exclusively to the kind of interventions that could be completed so superficially and rapidly that they were somewhat likely to do more good than harm.  Live-saving amputations were the earliest examples.  Lacking anesthesia, surgeons put all their emphasis on brute speed.  With the discovery of ether, they slowly realized they could afford to take their time and refine their techniques.  With the further discovery of hand-washing and sterilization of equipment, surgeons found themselves able and justified in expanding their repertoires to more challenging areas, such as the torso, and to less emergent medical conditions.  Today, medical science acknowledges more than 2,500 standard surgical procedures, often performed with minimal invasiveness, and with a success rate undreamed of in the mid-19th century.

We no longer expect to die of such common troubles as appendicitis.  We don't yet, however, quite expect to pay for their cure.  Unlike food, shelter, and clothing, the provision of which has been an expected economic burden on individuals and families since the dawn of history, medicine still somehow strikes us as a miracle cure that some kindly wizard should bring to the door in a diamond phial.