I don’t know everything that changed from the glorious 50’s, but here’s one.
If you lived in my small home town in 1955 and your dad had a heart attack (myocardial infarction), he’d be transported by hearse driven by the undertaker (which doubled as an ambulance) to the hospital, placed in a regular hospital bed, given morphine as needed for pain, and the nurse would check on him every so often to make sure he wasn’t dead. A short paper-strip EKG trace would have been taken and shown to the doctor, who would have also checked his heart with a stethoscope.
In 1985, he’d be transported in an ambulance staffed by trained EMTs capable of extensive pre-hospital care, placed in a bed with telemetric heart monitoring, supervised by specially trained nurses in an intensive care unit, and be administered a clot-busting drug as part of a clinical trial of early hospital interventions. If his MI caused an arrhythmia, he’d be given shocks and/or drugs by the EMTs, nurses and doctors to restore a normal rhythm. Then, he’d be transported by ambulance to a major referral center and have his veins imaged. If they were significantly blocked, he’d have surgery during which a team composed of surgeons and other doctors and technicians would crack open his chest, connect him to a heart-lung machine, stop his heart, and bypass the blocked veins in his heart with a vein from his leg. After that, he’d have extensive cardiac rehab by trained personnel, with the aim of changing his lifestyle. He’d also take a regimen of expensive drugs aimed at preventing another heart attack.
In 1955, his bill would have been about $1-2000 in today’s dollars. Thirty years later, it would be about $100,000 in today’s dollars.
I’m sure there are a lot of other factors in why the middle class is having a hard time keeping up a 50’s lifestyle, but this is one of them. In the 50’s, the middle class could self-insure or have a cheap “major medical” policy, because there just wasn’t that much medical care to buy. The opposite is true today — there’s more to buy than the average middle-class family can afford, even with insurance.