In pre-20th century USA, for most Americans health care meant being looked after and tended to by family members or townspeople when one was ill or injured. The thought of paying a large sum of money so that you could visit a hospital would have been a foreign concept to most of America, which was rural at the time. However, there was the small-town doctor who could tend to colds and fractures, yet his fees were inexpensive (a little more than any other worker's) and his medical knowledge (in comparison to modern health) was relatively basic. In 1913, the American Medical Association (AMA) stated that only 10% of America's physicians were making a comfortable living. But times were changing.
With technological advances in the areas of transportation, communication, and medicine, there were more effective hospitals and doctors. They could now treat and cure more people; in some cases, these services were free, but in others meant lots of fees. There were different health plans in which a person could pay either a physician, hospital, or organization for his/her healthcare, but most were costly. However, some employers offered health insurance as part of the job, and the premiums weren't a lot of money at all. In Europe, healthcare 'reform' was one of the main issues. Specifically, in 1883 Germany, there was Compulsory Sickness Insurance, a precursor to national healthcare (socialized medicine). However, as healthcare and health insurance became increasing profitiable in the NineTeens, "critics said that it was 'made in Germany' and likely to result in the 'Prussianization of America' (Lepore, The New Yorker, 2009)." Obviously, the American government didn't even consider healthcare reform as the war with Germany continued. After the war was over, the cost of doctors and hospitals had not gone down, and neither had the anti-German sentiments that had helped silence the voices of healthcare reform 3 years previous. The Western world was trying to stabilize and return to normalcy; this, in addition the Red Scare of the Bolshievik revolution, meant no social reform of any kind was tolerated. As a result, the U.S. government did not regard it as an issue either until the Great Depression.
As America got deeper into the Depression, less and less people were able to pay the hospital and doctor's fees illness required, so less people even went to hospitals for treatment. Once again, some sort of national health coverage was considered in U.S. government. In 1935, President Franklin Delano Roosevelt wanted to include national healthcare as part of the Social Security Act, which was part of thew New Deal. However, pressure from the AMA and private insurance interests dissuaded Roosevelt from including the reform in his already controversial bill. Nonetheless, later on in 1938, Roosevelt's Administration sponsored the National Health Conference in order to address the problem of a large number of uninsured Americans--who would care for them and their needs? However, heavy publicity against National involvement in healthcare swayed public and political opinions against reform to the point that in 1939, the Wagner Health Bill, which included Federally-funded healthcare, was easily defeated in Congress. Moreover, that same year Germany invaded Poland and the Second World War began in Europe, shifting the earth's focus from the welfare of some Americans to the welfare of the whole of earth.
After WWII ended and America quickly surpassed its pre-war status, President Harry Truman tried to increase federal involvement in healthcare. "An ounce of prevention is worth a pound of cure" was the other Truman Doctrine. Despite this, his efforts only succeeded in preventing the passing of bills that would give the AMA and private insurance companies even more control over who got insurance and received treatment and who didn't. Truman based his actions on the belief that the lage profits physicians, hospitals, and insurance companies amassed were, essentially, ill-gotten gains taken from sick and ailing patients that had no other choice but to pay.
In 1960, the Kerr-Mills Bill gave Federal funding to States to aid the "medically indigent" (eldery) who were part of government health programs. However, many saw this bill only as a compromise between national healthcare and special interests. President John F. Kennedy, after his election, unsuccesfully attempted to convince Congress to consider Federal-funded healthcare. Nevertheless, Kennedy's fight against segragation and discrimination led to the passage of the Civil Rights Act of 1964, signed into law by acting President Lyndon B. Johnson after JFK's assasination. It was the beginning of the end of segregation and places like hospitals now had to extend federal funded programs and charity to colored peoples. This paved the way for the Social Security Act of 1965--another law that reflected Kennedy's desires and goals. This Act included 2 key government programs that help millions of Americans with healthcare and have come to be dubbed Medicare and Medicaid. Medicare primarily covers Americans 65+ years old and Americans younger than 65 who are disabled. It is fully funded by the Federal government. In contrast, Medicaid is a program that States can voluntarily enter into, where they can provide up to half of the funds for the need-based programs they administer. Eligibilty is mainly based on income and financial resources, making Medicaid a welfare service.
After the Medicare and Medicaid of the 60s, President Nixon called for comprehensive health insurance and presented the Comprehensive Health Insurance Act, which would have required employers to get health insurance for their employees and created a Federal Health Plan that any American could join and pay into based on their income. It was never passed; however, the HMO Act of 1973 was passed to regulate and promote managed care. During the 1980s, a bill was passed to make sure that healthcare plans could extend after retirement.
In 1993, the Clinton health care plan was unsuccessful and only served to create disunity among democrats (who created their own different reform plans) and unity among its opponents. Dissenters of this health care plan dubbed it "HillaryCare."
The Patients' Bill of Rights (which is rather self-explanatory) was proposed in 2001. The initiative was strongly opposed by the AMA and major Pharmaceuticals and was not passed in 2002.
In 2003, the United States National Health Insurance Act was proposed but initially had small support and was therefore not a big issue. However, that same year, President George W. Bush passed the Medicare Prescription Drug, Improvement, and Modernization Act, which, among other things, gave people on Medicare prescription drug benefits. In 2007, interest in the US National Health Insurance Act was renewed and in 2009 the bill was renamed the United States National Health Care Act and reintroduced to the legislative bodies. Although the bill is at the forefront of healthcare reform, focus is primarily on the Patient Protection and Affordable Care Act. Unlike HillaryCare and the health plans proposed by Roosevelt (either Teddy or Franklin, I'm not sure), Truman, and Nixon, the health plans that have been considered in Congress in the past 2 years only provide a subsidy, and don't address mandatory national healthcare. After a long process of politics as usual--Legislative debates, vote-counting, filibuster threatening, bill amending, compromising, and name-changing--the Patient Protection and Affordable Care Act was passed by the Senate and, eventually, the House of Representatives, after which it was signed into law by President Barack Obama on March 23, 2010. 7 days later, Obama signed the Health Care and Education Reconciliation Act of 2010 into to amend the Patient Protection and Affordable Care Act. On March 23, a lawsuit filed by 13 states challenged the bill. Alas, among their reasons cited was a violation of States' Rights...anti-federalism, non?
The best conclusion to give at this point in history is: the debate over the issue of healthcare (or pretty much any issue) continues.
For more info., check out these resources:
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