The King's Visit

[Brontodon]

Today is the 138th anniversary of the visit of the King of Bohemia to 221b Baker Street which touches off A Scandal in Bohemia.  Watson writes:

>> One night—it was on the twentieth of March, 1888—I was returning from a journey to a patient... <<

 

[Carol the Dabbler]

Thanks for that historical reminder!

Watson's write-up is historical in another way, too.  I can't speak for the UK, but here in the US, doctors haven't made house calls since the 1960s.

 

[Brontodon]

I remember the doctor coming to see me at home when I was a child.  I also remember my mom paying him $5 or $10 for the visit -- and that wasn't a copayment!

[Carol the Dabbler]

On 3/20/2026 at 9:14 PM, Brontodon said:

I remember the doctor coming to see me at home when I was a child.  I also remember my mom paying him $5 or $10 for the visit -- and that wasn't a copayment!

The dollar sure ain't what it used to be!  But I don't think that's the whole story -- when I was born, my parents didn't have medical insurance, even though my father had a union job -- apparently insurance wasn't a "thing" yet.  But even with just that single blue-collar job, they paid the hospital and the doctors themselves -- without going broke!

I'm pretty sure the current high cost (even adjusted for inflation) of medical care is largely due to the prevalence of insurance -- because A} people feel like the care is "free" so they often go to the doctor even when they could easily have cared for themselves at home (so the cost of insurance goes up to cover that), and B} every time insurance starts covering something new, the doctors and hospitals start pushing it.  For example, most hospital rooms in the US used to be "semi-private" (two beds/patients per room), but once insurance companies started covering private (one-bed/patient) rooms, the hospitals remodeled, because they could get paid more per square foot with private rooms, even though the cost per patient was higher.  And of course the patients didn't complain, because they were now getting what had been a luxury at no extra cost to themselves (except for higher insurance costs).  Been years since I saw a semi-private room (and I don't even remember wards).

 

[Brontodon]

You are absolutely right about the effect of health insurance on medical costs.  Insurance inserts itself between the consumer of services (the patient) and the provider of services (the doctors, hospitals, etc.).  This distorts the normal economic relationship between consumers and providers.  As you say, the consumer does not care about the cost of care because someone else is paying for it.  This is counter to almost every other economic transaction there is.  Since the consumer doesn't care, the provider can charge whatever it wants.  The only limitation is now how much the insurance company is willing to pay, which leads to numerous mechanisms to control costs, such as copayments, coinsurance, allowable amounts, preferred provider organizations, HMOs and managed care networks, etc.

Elementary, my dear Watson!  🙂

[Caya]

The US system of healthcare may be many things but „elementary“ sure isn’t a term I‘d use for it.  

[Brontodon]

That is a fair assessment!