"Mad Men" returns for its seventh season on AMC on Sunday night, with Don Draper, Joan Holloway, and the rest of the extended Sterling Cooper family back for an extended final go.
As a health care wonk, one joy of watching "Mad Men" has been how the show's creators have used the characters' behaviors—and their interactions with the nation's health system—to consistently tweak our nostalgic view of the 1960s. (When the show debuted, the plot was set in March 1960; by the time the sixth season wrapped up, "Mad Men" had advanced all the way to November 1968.)
Writing at the Advisory Board Daily Briefing in 2012, I took a deep dive into how health care's changed since the days of Don Draper, interviewing doctors and nurses who began practicing 50 years ago and highlighting five examples from the show.
The macro-level transformation in health care is also captured in the charts below, which are excerpted from a massive infographic we created for the Daily Briefing. (For the full infographic, click here or scroll to the bottom of this post.)
Here are four of the biggest health care shifts from 1960 to 2014.
1. Health care has become big business.
The show doesn't focus on one of the most significant changes to the nation's health care system—the long political battle over Medicare and Medicaid that culminated in 1965—although Season 4 does devote a throwaway line to the debate at the time. "If they pass Medicare, they won't stop until they ban personal property," an older man grumbles at a Christmas party.
That obviously hasn't happened, although it's striking to think how public programs have come to dominate the nation's health spending. More than half of all hospital discharges are from patients covered by Medicare or Medicaid, and that trend is only going to increase—about 10,000 Baby Boomers enroll in Medicare every day, and Obamacare's Medicaid expansion could further grow that program by more than 21 million in the next decade. By 2030, more than 150 million Americans may be covered by Medicare and Medicaid.
The advent of Medicare also launched a new era: Health care as big business.
Rosemary Gibson of The Hastings Center recently pointed out a striking statistic that sums up the transformation.
- In 1965, there were zero health care companies on the Fortune 100 list.
- In 2013? There were 15.
2. We're much more mindful of being healthful.
The idea of personal healthfulness is basically non-existent when "Mad Men" opens. Everyone drinks, no one exercises, and even characters who suffer from various medical maladies can't make the connection between their behaviors and outcomes.
Take Roger Sterling, the suave fellow ad man who's a mentor to Don. Roger's a frequent smoker…and in mid-puff when he suffers his second heart attack of Season 1. ("Not again," he grimaces, cigarette in hand. Although don't fear for Roger; his character's back to smoking, drinking, and eating steaks in no time.)
Today, we're much more conscious of the importance of exercise and a balanced diet, and smoking rates have plummeted among adults. But one surprise: For all of the martinis seen quaffed on the show, we actually drink more today.
3. Health care itself is much, much better.
This is practically a given, but better prevention, detection, interventions, and management have all contributed to massive improvements in treatment and outcomes. Writing at Forbes, Matthew Herper took a closer look at some of those innovations, like how the catheter revolutionized heart care and the introduction of randomized control trials to better test for medicines that work.
The numbers bear out the transformation. Life expectancy has gone up nearly a full decade since 1960, and if you survive to age 65, you're expected to live an extra five years. Heart disease remains a serious concern, but a heart attack has gone from a lethal event to a chronic disease that can be managed with medications and other therapies.
And even though the cancer incidence rate has skyrocketed—in part because of improved detection—the mortality rate has plummeted.
4. We've come far on gender equality—although we still have a ways to go.
As depicted by the show, the U.S. health care system of the 1960s is openly paternalistic.
Doctor-patient confidentiality apparently doesn't apply to women: Don Draper regularly gets a rundown of his wife Betty's therapy sessions—from Betty's doctor.
And another female character's manic depression is treated in a barbaric way: She's forced to undergo electroshock therapy by her husband, ultimately losing some of her memory.
Much of that changed, certainly, as the broad push for equal rights trickled down to medicine. But don't discount the shifting gender and power roles within health care, as more women became doctors or advanced nurse practitioners. Even nurses' attire changed in an important way, from skirts in the 1960s to scrubs today.
And yet, gender equality in health care still isn't fully realized in the year 2014. Male doctors today still are much better compensated than female doctors, partly because of the specialties they choose. And even though female nurses outnumber male nurses by 10 to 1, men still get paid 10% more.
See for yourself how health care's changed; the full graphic's below.
