A brief history of health care in America

By David Cotton

Healthcare in America was founded on great principles. Our elected representatives all have good intentions for the constituency.

Healthcare in America started on a great premise but has evolved slowly over the last 140 years. Sir Winston Churchill once stated, “Those that fail to remember history are condemned to repeat it,” the following paragraphs depict a very basic history of healthcare in the United States over the past 140 years.

Theodore Roosevelt (1901–1909)

As America moved into the twentieth century, continued industrial growth increased the need for worker protection. The American Association of Labor Legislation (AALL), lobbied for sick pay, maternity benefits and a death benefit. The American Medical Association (AMA) initially supported their efforts, attempting to push a compulsory national insurance program.

Working people and their unions provided fierce resistance to any mandatory plan. The people worried that government insurance would be expensive and ineffective, the Unions and private insurance companies feared they would lose influence and money. 62,000 new doctors entered the medical corps and feared the government would never compensate them. The AMA withdrew support and the plan never advanced.

President at the time, Theodore Roosevelt believed there needed to be some protections available, but never initiated a plan. Roosevelt stated, “no country could be strong whose people were sick and poor.”

Herbert Hoover (1929–1933)

The end of World War I, the “Roaring 20’s,” ushered in a time of prosperity for America, Doctors began charging more and more for their services, working class Americans were in jeopardy of not being able to afford minor procedures and treatments. The “Stock Market Crash,” of 1929 and the following depression should have provided the perfect opportunity to introduce and pass a national insurance program.

Franklin Roosevelt (1933–1945)

Franklin Roosevelt proposed just such a plan to Congress as part of the “New Deal.” Extreme opposition from the now very wealthy and powerful Doctors Union, (AMA) caused the insurance portions to be stripped from the plan, resulting in the passage of “Old Age” benefits called the “Social Security Act of 1935.”

As the United States entered into World War II, the government capped wages and limited wage increases to employ everyone and focus money and assets on the war effort. Corporations, to avoid new wage regulations, created “employer-sponsored insurance plans,” as a recruiting tool for new employees. Employees enjoyed the benefits of this plan, and it has continued to spread.

Employer plans remain virtually unchanged to this day. Toward the end of the war, a universal health care bill was introduced by liberal democrats, to limit employer insurance plans and bring money into the government coffers, as well as help working class and poor Americans. The bill was introduced in 1942 and again in 1945 never making it past committee.

Harry Truman (1945–1953)

Harry Truman became President in 1945 with the passing of FDR. The “Truman Plan,” for government insurance failed in Congress as conservatives deemed it Socialist, and accused Truman of “towing Moscow’s line.” During this time, huge advances in medicine caused the price of medical care to more than double. The Korean War ended the debate on health insurance until the 1960’s.

John Kennedy-Lyndon Johnson (1961–1969)

The government began tracking health care as part of the Gross Domestic Product (GDP) in the early 60’s. When John F Kennedy became President, the National Health Expenditures (NHE) were five percent of the GDP. JFK proposed a health care plan in the first year of his Presidency, and it failed miserably in Congress.

Lyndon B Johnson became President after the assassination of Kennedy. He used portions of Kennedy’s bill but focused on seniors and disabled persons; his plan passed, “the Social Security Act of 1965,” now referred to as Medicare and Medicaid. Johnson also pushed the Hill-Burton Act through Congress resulting in hospitals and research facilities obtaining grants from the government in exchange for free treatment for some poor citizens.

Richard Nixon (1969–1974)

Senator Edward Kennedy (D-MA) introduced a health care plan in 1971. President Nixon did not feel the government had the right to control that aspect of citizens lives; they attempted to work together to create a bipartisan plan. Kennedy eventually bowed out of health care altogether under pressure from unions. Richard Nixon forced through two significant health care improvements, The Social Security Amendment of 1972, and the creation of the Health Maintenance Organization Act (HMO).

Ronald Reagan (1981–1989)

The remaining years of the 1970’s saw health care fade as an issue. A recession took firm hold of the nation and an oil crisis caused people to spend more money on other necessities. The next significant health care event was the Consolidated Omnibus Budget Reconciliation Act (COBRA), signed by President Ronald Reagan in 1986. COBRA was designed to allow employees to keep their employer health insurance plans if they continued to pay the premiums. COBRA is the first attempt to ensure people were not excluded from insurance for pre-existing conditions, by not having to terminate a policy when leaving employment and trying to attain a new policy when you have an impairment.

William Clinton (1993–2001)

William “Bill” Clinton introduced the Health Security Act of 1993, which never made it through the House of Representatives. Clinton was able to sign in to law Health Insurance Portability and Accountability Act (HIPAA), which established privacy standards for individuals and Children’s Health Insurance Program (CHIP) which increased Medicaid assistance to uninsured children up to age 19.

Employers once again made the most significant changes to healthcare by creating new HMO’s for employees. HMO’s require employees to have a primary care physician and do not allow patients to seek a specialist without a referral. The NHE’s growth slowed dramatically in the 90’s, primarily due to HMO’s.

George W Bush (2001–2009)

George W. Bush introduced “Medicare Part D,” adding prescription drug coverage to the Medicare program. The health care issues in America again took the back seat to the “Global War on Terrorism” until President Barack Obama took office.

Barack Obama (2009–2017)

President Obama worked with Senator Edward Kennedy; they revived the bill that Kennedy and Nixon conspired on in 1971. The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA), or Obamacare, went through many revisions on strictly partisan lines and ultimately passed both houses of Congress with not one Republican vote. Since the ACA has become law, Americans have never been so divided on health care issues.

Donald Trump (Present)

The ACA has been extremely controversial and has divided the nation. Donald Trump was elected President partly on a platform promising to repeal and replace the ACA. The first GOP attempt to repeal and replace never made it to a vote in the House of Representatives. Trump and GOP leadership promise to try again and ultimately pass new legislation getting rid of individual mandates.

History seems to repeat itself like a long “cycle of abuse,” in America. Traditionally Democrats push for more government control and Republicans push for smaller government and a free market. We have not learned from our history. Therefore we are condemned to repeat it until our elected officials learn to compromise. Partisan politics will continue to fail health care and the citizens of the United States.

History seems to repeat itself like a long “cycle of abuse,” in America. Traditionally Democrats push for more government control and Republicans push for smaller government and a free market. We have not learned from our history. Therefore we are condemned to repeat it until our elected officials learn to compromise. Partisan politics will continue to fail health care and the citizens of the United States. Maybe our employers should take the lead and begin to fix the problems as they have done in the past.