05/31/2016 04:55 pm ET Updated Jun 01, 2017

Whatever Happened To Health Care?

"Mommy, I don't feel well."

"The doctor will be here in a little while."

And, soon the smiling man with a small black bag appeared at my bedside, and quite quickly I learned I had chicken pox, but that it would not last long.

That was more than 60 years ago. Whatever happened to the house call? Actually, whatever happened to health care?

Science? Demand? Innovation? Technology? Politics? Insurers? Doctors? Patients? Greed?

All of the above in one form, shape or sound or another have changed health care from those two words to healthcare - one word. And with that change came something that our grandparents never would have envisioned. Healthcare as a giant business representing more than 17 percent of the country's economy.

On a macro basis, we now think about Medicare, Medicaid, HMOs, for-profit and not-for-profit hospitals, population health, primary care, consolidation, medicine innovation and cost, just to start. On a micro basis, we now think about rules, reimbursement, co-pays, prior approval and, "how do I get through the complexity when I am hurting or sick."

Starting with Medicare more than a half century ago, government has become more and more involved in setting reimbursement schedules and standards of operation for hospitals and physicians.

Medicare and Medicaid respectively are among the largest budget items at the federal and state levels, and it is not difficult to see why the government would want to play a role in setting the rules by which the taxpayers' money is spent. The downside, however, is that between entrenched bureaucracy and politics, the intended horse occasionally shows up looking like a camel.

"Healthcare for all" is a terrific goal and should be part of the American fabric. Political healthcare, on the other hand, is creating problems. While the Affordable Care Act - "Obamacare" - may have been well intentioned, by the time it made its way through the vast two-party array of Senators and Congressmen, and of course the special interests that drive (and fund) them, the camel had arrived. Complicating the federal law is the fractured way that states handle healthcare for their citizens.

On the provider side, it appears that the projected shortfall in the number of physicians needed to make the ACA fully effective was underestimated as more and more "senior" physicians are retiring sooner than anticipated and those remaining in the system are responding to stricter compliance, reporting and electronic health record requirements by curbing the number of clinical hours worked, or becoming a concierge practice, where patients pay a premium for expanded access.

Moreover, the underserved areas where many newly insureds live often have a lack of providers, and patients in those areas must depend on community health centers and clinics that are often overburdened.

The irony is that the sick boy in the opening paragraphs was lucky he only had chicken pox, because many other illnesses would have been devastating or deadly. Today, we have all kinds of cures that didn't exist 60 years ago. Children with even the most threatening diseases, like leukemia, are often cured or brought to permanent remission.

There is a lot to dislike about healthcare today, but there is even more to appreciate.

The challenge is making this system work as efficiently as possible for those who rely on it and those who fund it, which in both cases is all of us.

Barry Koslow, JD, is president and CEO of MKA Executive Planners, a Massachusetts-based executive benefit and retirement planning firm. He can be reached at