The politics of Health-Care: a brief History
Posted by Lin Dworshak on Fri, Jul 15, 2011 @ 03:04 PM
To those of you who believe that politics has only recently set out to control health-care costs and operations; a brief look at the history tells a very different story.
Beginning in the 1900's when the AMA was established and an era of "organized medicine" began to take root, the right to medical care became in vogue. The railroads, became leaders in offering extensive coverage to its employees. In 1910 the AALU (American Association for Labor Legislation) organized it's first conference whose theme was "social insurance". At the same time, hospitals become modern scientific institutions valuing antiseptics and cleanliness and offering medication for the relief of pain. Opposition from physicians and the entry of US into WWI undermined the reform effort.
In the 1920's, reformers begin to emphasize the cost of health-care instead of wages lost to sickness. There is a growing cultural influence of the medical profession, and physician incomes are higher. About this time, General Motors signs a contract with Metropolitan life to insure 180,000 workers. The Depression changes priorities, with the greatest emphasis on unemployment insurance and "old age" benefits. The social Security act is passed in 1930's omitting health insurance. Blue Cross begins offering private coverage of hospital care in dozens of states and insurance for health-care as we know it today, began. In the 1940's penicillin became widely used saving thousands of lives. To compete for workers during WWII, companies began to offer health benefits, giving rise to the employer-based system in place today. President Roosevelt asks congress for an economic bill of rights to include the right to adequate medical care. Truman offers a national health program, proposing a single payer system that would include all Americans. Truman's plan is denounced as a communist plot by the AMA. (Sound familiar?)
In the 1950's, health care expenditures are 4.5% of the GNP. Attention is turned from reform to Korea. America will have private insurance for those who can afford it and welfare services for the poor. Federal responsibility for the sick poor is firmly established.
In the 1960's heath care costs are doubled. Major Medical insurance endorses high-cost medicine and President Lyndon Johnson signs Medicare and Medicaid into law.
In the 1970's President Nixon formalizes HMO's with legislation that provides federal endorsement, assistance and certification. He also introduces a National Health Care plan that is rejected. But his "war on cancer" centralizes research at the NIH. Inflation changes in the economy, unexpected Medicare costs and hospital expenses and profits causes health care costs to soar dramatically. At the same time technology and medicines see greater use and the American health care system is seen as "in crisis".
In the 1980's privatization and corporation become the hallmarks of health care. President Regan Medicare payments shift from payment for treatment to DRGs. Private companies quickly follow suit.
In the 1990's health care costs grow to double the inflation rate. While managed care does help to mitigate heath care costs, federal health care reform legislation is again defeated by the US congress.
The first time Medicare is viewed by some as unsustainable begins during the 2000s. Rescue efforts by congress fail, and the changing demographics of the work place lead many to believe that the employer based system for health care can't last.
And so here we are now in 2011. Direct to consumer advertising by pharmaceuticals and device companies have become common place. Life expectancy that was about 46 in 1900 has now risen to 77 as millions of so called "baby boomers" become eligible for Medicare. Health care reform is still viewed by some as a "socialist" plot even as health care costs now 16.7% of the GNP. Throughout this political history; technology and medicine has continued to bring life saving advances to the population of America as well as the world.
Although historically politics has played a significant role in the shift of health care from private funding to public funding; the idea of a single payer system is untenable to the majority of Americans. So we continue to struggle to find right answers to containing the cost of health care while continuing to use profits to advance technology, genome research and cancer eradication. I suspect that both the struggle and the advancement will continue, and politics will continue to play a significant role in the health care delivery system.