Chapter 10 – History of Change From 1900 to 2010: Comprehensive Reform

Chapter 10 in Jonas’ Introduction to the U.S. Health Care System discusses the efforts of comprehensive health care reform in the United States from 1900 to 2000. There continues to be issues within our health care system, despite many years of attempts in moving towards a more comprehensive and universal system. Access to care and high costs continue to be some of the biggest issues of the health care system in the U.S., even though we are one of the wealthiest countries in the world. One of the main goals of these efforts was to achieve universal health coverage through National Health Insurance (NHI). NHI is a system of universal health coverage in which the government, rather than private insurance companies, provides health insurance to all citizens. The U.S. health care system does not guarantee universal coverage, and many Americans remain uninsured, resulting in worse health outcomes.

The first national health insurance program emerged in the 1880s in Germany through a Sickness Insurance Act. This was surprisingly brough on by a conservative constitutional monarchy. By the time the U.S. was starting to push for NHI, most industrialized countries in Europe already had some variation of it. Although there was significant support for NHI in the beginning, support decreased, and reform movement slowed down as World War I began. There were various proposals for a NHI system put forward on the national political agenda since 1912 when Theodore Roosevelt included it in his Bull Moose Party platform. One step that was looked upon as progress toward universal coverage included the Hill-Burton Act of 1946, which provided funding for hospital construction.

In the late 1940s, President Harry Truman proposed for national health insurance, which was opposed by the American Medical Association (AMA). Medicare and Medicaid programs were created because of President Lyndon B. Johnson’s Great Society program of the 1960s. These programs provid health coverage to seniors and low-income individuals and are still around today, although I think they could use more funding and expansion. President Richard Nixon’s health care proposals in the early 1970s were like Truman’s proposals but were ultimately defeated due to opposition from the AMA once again. In the 1980s and 1990s, there was a series of changes to the health care system, including the expansion of private health insurance coverage and the creation of health maintenance organizations (HMOs).

President Bill Clinton’s comprehensive health care reform proposal in 1993, known as the Clinton health plan, was shut down in Congress due to opposition from the insurance industry, business groups, and of course, the AMA. If it was successful, this would have provided universal coverage, regardless of American’s employment status or preexisting conditions. It would have required employers to provide health insurance to their employees or pay into a national health insurance fund. It would also have established regional health alliances to negotiate with health care providers and manage and regulate health care spending. Costs would be controlled, and quality of care would be improved.

One of the main arguments against the Clinton health plan was that the government would have too much control over the healthcare system and would ultimately reduce quality of care. Opposers also argued that it would increase taxes and government spending substantially. However, if we look at other countries who have achieved universal health care, many spend less than what the U.S. currently spends on health care. Some opposers also did not like that employers would have to provide insurance coverage to their employees, which would result in increased business expenses. Although the Clinton health plan ultimately failed to pass into law, many of its provisions served as the basis for later health care reform efforts.

Finally, in 2010, the ACA was signed into law by President Barack Obama. This represented the most significant effort at comprehensive health care reform in the 20th and 21st centuries. The ACA aimed to increase access to health care, reduce costs, and improve the quality of care, but its implementation has been controversial and subject to political and legal challenges.

It’s unfortunate, and somewhat unethical, that the AMA opposed many of the efforts of national health insurance throughout the years. This was mostly due to their fear that the system would negatively affect the independence and financial stability of physicians. The AMA also believed that the government would exert too much control over the practice of medicine and potentially lead to decreased quality of care. Quality of care in the U.S. is worse than other countries, despite having such a high expenditure. If everyone in the U.S. was insured, more people would seek preventative care and have much better health outcomes.