Technology changed a lot of things...So did increased costs. So did different types of treatment options along with the types of drugs and treatments excluded under some insurance plans.
Fifty years ago a doctor's choices were limited. The CEO of a Fortune 500 company and the local dog catcher received about the same kind of care. Now, with boutique medical practices and the growth of HMOs, there is a wide division between the type of care available to the dog catcher and the CEO.
Mostly, this doesn't matter -- unless you want a house call or a suite for your hospital stay. But for serious illness, it's a matter of life or death.
there is a wide division between the type of care available to the dog catcher and the CEO.
Nowadays the dog catcher has an employer-provided insurance plan. It doesn't provide the range of options and choice of specialists that the CEO's plan (and personal cash) does, but I don't think there's any significant difference in lifespan between people employed full time in low paying jobs vs. high paying jobs. And frankly, the difference displayed by the non-working/welfare class has more to do with failure to maintain a healthy lifestyle, than with the lesser quality of public hospitals and Medicaid-participating doctors.
100-150 years ago, medical care beyond home remedies was on a cash-for-services basis. While most doctors would accept delayed payment, barter, etc. there was also a strong cultural value to avoiding debt. People who didn't have much money didn't call for the doctor unless circumstances were really dire, by which time it was often too late. And poorer people tended to live in rural areas, where less sophisticated doctors practiced and newer medicines and medical equipment were simply unavailable.
I'd be really surprised if the quality gap between medical care of the rich vs. poor is greater today than back then. However, I think the left has done an awesome job of promoting the belief that as society as a whole has gotten wealthier, more and more people are being excluded from the benefits.