Health Reform in The USA
Since the health care reform debate seems to keep dragging on, I figured it might be interesting to some of us if I outlined a short summary of the history of this issue. Some of you probably think this all just start popping up this year, or last year. You would be wrong. Your parents and grandparents probably debated this issue. And it looks like their generations actually got something done!
If you think I left something out, please feel free to register and comment! These are just notes, rather than an essay. I just wanted to give everybody an outline of the basics of heath reform ideas, progress, and battles in this century.
By the way, I got inspired for this by Health Care Reform – Where are We Now?
Teddy Roosevelt, FDR and Truman
In the 1910s Teddy Roosevelt was actually a progressive candidate. He campaigned on the promise of national health care, women’s voting rights, and safer working conditions for workers. He lost that campaign to Woodrow Wilson.
First Heath Insurance?In 1929, the year my own mother was born, Baylor Hospital in Dallas started a pre-paid program with a local teacher’s union. They intended to build a model for health insurance. A couple of years later, and Oklahoma doctor formed a farmer’s cooperative health association. Members formed a flat fee, and they could access health care.
The First Time Medical Plans Were Called Socialist: Wilbur was the interior secretary for the US in the 1930′s He formed a commission to study the issues of affording health care, which was found to be beyond the reach of many Americasns. This study called for the formation of group health insurance plans. Guess what. The American Medical Association called it socialist!
As early as 1935, FDR wanted a national health care plan to be included in the Social Security Legislation. Harry Truman, the next president, wanted a fund that everybody would contribute to, like we contribute to social security, to provide the money for this plan. This was left out of the New Deal, and the AMA continued to call it socialist.
Growth of Early Health Insurance:But the late 1930′s, pre-paid hospital plans are becoming more popular though. They tend to exclude the elderly and the unemployed.
Congress Funds Hospital Growth and Equality- By the end of WWII, congress realizes that their is a big gap between the price of heath care and what people can afford. They financed a lot of new hospitals. They also made mandatory to provide charity care. They also forbade discrimination based upon race, religion, etc., though it was still ok to provide “separate but equal” care.
The 1950′s – Labor starts adding health benefits to their collective bargaining agreements. Group health plans become more popular. In 1954, these health benefits become tax exempt.
The 1960′s and JFK – Kennedy worked very hard to develop the US Medicare and Medicaid programs. Medicare, of course, is our national health plan to cover senior citizens and disabled people. Guess what the American Medical Association called it – Socialist! Medicaid is the state and federal program to cover very poor people.
The 1960′s made some progress. A lot more people were covered. But then health care spending started to spike by the end of the decade.
1971 – Republicans and Democrats -Nixon proposed a bill that would require employers to provide a minimum amount of coverage. I mention this so you don’t only think that Democrats wanted health care reform. When Nixon was president, he also helped fund the growth of the HMO (Health Maintenance Organization) system in the US. Senator Edward (Teddy) Kennedy proposed a single payer, universal health care system for everybody. This was the start of his life-long battle to introduce comprehensive health care reform.
In 1976, Carter brought up national health care again. He did get elected, but then the nation fell into a deep recession.
The 1980′s
COBRA is signed into law in 1986. This act forces some employers to extend group health benefits to terminated employes for several months. It also requires emergency rooms to screen and stabilize all patients, regardless of health insurance or financial status.
In 1988, the Medicare Catastrophic Coverage Act prevents seniors from falling into financial ruin because of health costs. It sets ceilings on charges and the amount that Medicare beneficiaries must pay. This plan passed by a large majority, but ironically, it is repealed a few years later under pressure from advocacy groups.
President Clinton and The 1990′s
President and Hillary Clinton championed a massive overhaul of the US health insurance system. They proposed universal coverage based upon the idea of “managed competition”. i.e. health insurance would still come from private companies, but those companies would be tightly regulated. Powerful interest groups line up on the other side to defeat this idea.
The Clinton’s Health Security Act,of course, failed to pass. Why? The main reasons that experts cite are powerful lobbying and partisan politics. Does this found familiar? At that time, though, medical groups, health insurance and drug companies, and possibly the administration’s combative strategy, were thought to bring about the downfall.
CHIPS – In 1997, the Children’s Health Insurance Act did pass. This program helps cover children of low to moderate income families who lack private insurance. By 2008, over 7 million children were covered by this state and federal national health care program.
The 200′s
In the 1990′s, increased managed care had held down health care costs. But by the early 2000′s, costs had started to rise again. The Clinton plan may have been mostly buried, but the problems had only been delayed.
Bush and Medicare Prescriptions – In 2003, Bush (a Republican) expanded Medicare to cover prescription drugs. Medicare Part D was born.
Meanwhile, health care spending continues to spike. Now business groups are starting to get more concerned about the growing cost of covering employees. Some surprising companies, like Wal-mart, are beginning to suggest they would be open to the idea of health care reform. Medical groups are no longer shouting, Socialist, in the streets either. Even health insurance companies are beginning to suggest they would be open to reform if they get to participate in the process. The health insurance companies are less than excited about any more national health plans though.
Obama campaigned on a platform of health care reform. I still believe he was sincere about this, but just had no idea how tough it would be. Hillary Clinton, a veteran of the health care reform wars from the 1990′s, was more conservative in her promises. Voters didn’t think she believed in change, and Obama won. As time passed, we recognized that her more conservative statements were probably more correct.
2009 – 2010 – Well the Congress passed a bill, and then another bill got mired down in the senate. In September, the Baccus bill was proposed which is supposed to merge the two bills and add Republican ideas so they don’t get left out. Meanwhile, we are seeing quite a storm of partisan politics as everybody wants some face time.
What’s Different Now in March of 2010?
Well I don’t hear medical groups, or even private health insurance or drug companies, using the S word. Plenty of Republicans and those nutty guys on Fox news did not get the memo, so they are still using the S word. Whoops, what happened to my unbiased outline of the history of health reform?
Well, stay tuned…..
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