With all of the talk of healthcare reform and very turbulent launch of Health Insurance Exchanges, it’s time to step back and ask: How did we get here?

Today’s debate about how people should be insured and how healthcare should be provided is the result of historic trends that are intersecting at this moment in time. It wasn’t too long ago that treatment options were very limited for just about any ailment and life expectancy was less than sixty years old. Governments had no involvement in provision of healthcare to their populations and the concept of insurance as a way to pay for healthcare was unheard of. What happened? Well, many things. First, industrial revolution resulted in great wealth creation and ability to invest in research and development in many areas, including Medicine. At the turn of the twentieth century, the top causes of mortality were almost all infectious diseases. Cardiovascular disease was not in the top 10 causes of mortality worldwide. Why? People have to live long enough to develop cardiovascular disease and many people died with infectious disease or in wars. With the discovery of penicillin and the subsequent creation of the pharmaceutical industry, improvements in sanitation, and anesthesia and surgery, suddenly many of the universally fatal illnesses became treatable. People were now living longer and developing new illnesses, which meant opportunities for new research to discover new drugs to combat these illnesses. Heard of statins? How about ace inhibitors? These two classes of drugs are responsible for improving survival rates of two of the deadliest chronic diseases. So, now people are living longer and new, exotic treatments are coming out everyday to take care of their arthritis, alzheimer’s, and bad knees.

Wait a minute! Who is paying for all of this? That’ll be the focus of part II.