Thursday, October 31, 2013
Health Care Reform Wayback - A Brief History of Health Care Reform in the USA
Is Health Care Reform New? As somebody who is very interested in the progress of health care reform as a taxpayer, private consumer of health insurance and services, and as a professional, I have been trying to follow the current health reform debates. I am getting a little frustrated with the lack of progress on either side of the aisle, and also by some of the knee jerk reactions by politicians and their groupies.. You would think that the current administration, and its political adversaries, had just invented health reform or the cries of outrage that sound against it.I decided to do my best to outline some of the highlights of the health reform attempts, failures, and progress in the past 100 years or so. I am not a professional historian, by any means, so some may feel as if I left out important things or took them out of context. I am trying to be balanced, but take all the blame if I neglected something you feel is important.Teddy Roosevelt In the 1910'sTeddy Roosevelt ran on a very progressive platform in the early part of the last century. His campaign promises for 1912 included protection for workers safety on the job women's right to vote, and a national health care program. He was president of the United States, by the way, from 1901 - 1909. But he lost the election of 1912 to Woodrow Wilson. It is interesting to note that this Roosevelt was a Republic. Wilson was the Democrat. Never assume that American party politics are set in stone.Early Models of Current Health Insurance and Cries of SocialismIn 1929, Baylor Hospital in Dallas, Texas came up with a pre-paid program for a large areal teacher's union. This is considered one of the earliest models of health insurance. Now here's the irony. A few years later, an Oklahoma doctor formed a farmer's association with a pre-paid plan. Members of the association would pay into the plan, and then get services covered. The American Medical Association called this doctor's plan socialism!Despite this, pre-paid hospital and doctor plans continued to grow in popularity around the US. However, they usually left out the unemployed and elderly.The New Deal in the 1930's Another Roosevelt, FDR, also wanted to implement national health reform. He wanted to include it as part of social security legislation. That did not work out, but even Truman wanted to set up a national fund. for health care. He figured everybody could pay in, like we do for social security, and then it could make sure that people's most severe health needs were met. All of this was left out of the New Deal, and the AMA continued to criticize it as socialism.Post World War II By the end of the second world war, it became a lot more obvious that there was a big gap between health care costs and what mos people could afford. Congress did pass a bill to build a lot more hospitals. They also required hospitals to provide charity care. They had a clause to forbid discrimination on race, religion, etc. But they did allow separate but equal care, which did not always turn out to provide equal care to everybody.In the 1950's, labor unions began adding health benefits to their collective bargaining agreements. This really formed the basis for the group health insurance many people enjoy at work today. So group health plans became more popular, and in 1954, Congress voted to make this benefits tax-exempt.The 1960's JFK fought hard for national health care, but again he was met with cries of socialism. But Medicare and Medicaid, regarded as American institutions now, did emerge despite this. Medicare is the US national health plan for seniors and disabled people. Medicaid is the national health plan for very poor people.Despite the fact that millions of Americans had heath insurance coverage for the first time, in the 1960's, health care spending and costs were beginning to rise.The 1970's - Nixon and Carter President Nixon, a Republican, worked for health reform. He proposed a bill that would require employers to provide minimum health insurance coverage. Under his administration, money was allocated for the development of HMOs and managed care to contain costs.Carter ran for president, and national health care was a large part of his campaign platform. Even though he won, the severe recession put these plans on hold.The 1980's and COBRACOBRA is the national law that requires some employers to extend group health benefits to terminated employees for several months.The 1990's and The ClintonsProbably the most famous previous attempt to dramatically reform health care was under President Clinton. Hillary Clinton, then first lady, spear headed this work. You will probably not be surprised to learn that political critics of the pan delighted in calling it socialism. Experts contend that the plan failed because of partisan politics on both sides. The drug and insurance companies, and the American Medical Association (AMA) also spent a lot of time and money getting the Health Security Act defeated.CHIPS - I cannot leave the 1990's without mentioning CHIPS. This is the state and federal children's health insurance program which covers millions of children from lower and moderate income families.21st Century Health ReformI have to credit George Bush, a Republican, with passing the Medicare Prescription plan in 2003. This is also known as Medicare Part D, and it helps fund prescription insurance for Medicare beneficiaries.Obama ran on a platform that included health reform. It seems like it is as tough to pass now as it was during the time of Teddy Roosevelt, FDR, Truman, and Bill Clinton. Politicians are still making deals behind closed doors, and of course, people are still shouting socialism.But some things have changed. The AMA now supports health reform. Many businesses are concerned about spiking costs of covering employees, and representatives have admitted they would like to see some reform that would help them. Even insurance companies have said they will cooperate.Hopefully, we can see some progress. I have no idea what will (or should) happen next.