Private Health Care Systems history

Following the particularly bloody battle of Shiloh in April of 1862, the state of Ohio sent boats to the scene, which they converted into floating hospitals.

After the war ended, in 1886, the United States Army established the Hospital Corps.

In 1901, AMA reorganizes as the national organization of state and local associations.

In 1906, the American Association of Labor Legislation (AALL) finally led the campaign for health insurance.

The Progressive Party, also known informally as the Bull Moose Party, was formed in 1912 and nominated former President Theodore Roosevelt as its candidate for the presidential election.

In 1914, reformers sought to involve physicians in formulating this bill and the American Medical Association (AMA) actually supported the AALL proposal.

In 1917, the AMA House of Delegates favored compulsory health insurance as proposed by the AALL, but many state medical societies opposed it.

By 1920, 16 European countries had adopted public health insurance.

In 1923, Baylor Hospitals in Dallas created a unique program, in conjunction with local schools, to provide healthcare to teachers for a pre-paid monthly fee.

In the 1930’s, the focus shifted from stabilizing income to financing and expanding access to medical care.

The resulting Social Security Act of 1935 created the first real system of its kind to provide public support for the retired and elderly.

Though it never received FDR’s full support, the proposal grew out of his Tactical Committee on Medical Care, established in 1937.

Whereas FDR’s 1938 program had a separate proposal for medical care of the needy, it was Truman who proposed a single egalitarian system that included all classes of society, not just the working class.

The essential elements of the technical committee’s reports were incorporated into Senator Wagner’s bill, the National Health Act of 1939, which gave general support for a national health program to be funded by federal grants to states and administered by states and localities.

First introduced in 1943, it became the very famous Wagner-Murray- Dingell Bill.

In 1944, the Committee for the Nation’s Health, (which grew out of the earlier Social Security Charter Committee), was a group of representatives of organized labor, progressive farmers, and liberal physicians who were the foremost lobbying group for the Wagner-Murray-Dingell Bill.

They assessed their members an extra $25 each to resist national health insurance, and in 1945 they spent $1.5 million on lobbying efforts which at the time was the most expensive lobbying effort in American history.

The nation focussed more on unions as a vehicle for health insurance, the Hill-Burton Act of 1946 related to hospital expansion, medical research and vaccines, the creation of national institutes of health, and advances in psychiatry.

After Truman’s surprise victory in 1948, the AMA thought Armageddon had come.

Finally, Rhode Island congressman Aime Forand introduced a new proposal in 1958 to cover hospital costs for the aged on social security.

By 1960, the government started tracking National Health Expenditures (NHE) and calculated them as a percentage of Gross Domestic Product (GDP). At the start of the decade, NHE accounted for 5 percent of GDP.

By 1963, 77 percent of Americans had hospitalization coverage, and over 50 percent also had coverage for routine medical expenses.

The law represented the most significant overhaul and expansion of healthcare coverage since the passage of Medicare and Medicaid back in 1965.

When the Medicare program began in 1966, 19 million people enrolled.

In 1970, 9% of medical students are women; by the end of the decade, the proportion exceeds 25%.

In 1971, Senator Edward (Ted) Kennedy proposed a single-payer plan (a modern version of a universal, or compulsory system) that would be funded through taxes.

The eligibility expansion in 1972 contributed to Medicare's increasing costs.

By 1980, NHE accounted for 8.9 percent of GDP, an even larger leap than the decade prior.

The Tax Equity and Fiscal Responsibility Act of 1982 had given Medicare beneficiaries the option of enrolling in Medicare through private plans rather than through the traditional fee-for-service Medicare plan.

By 1990, NHE accounted for 12.1 percent of GDP — the largest increase thus far in the history of healthcare.

Shortly after President Clinton was inaugurated in January of 1993, he established a healthcare task force led by first lady Hillary Clinton.

In 1996, Clinton signed the Health Insurance Portability and Accountability Act (HIPAA), which established privacy standards for individuals.

↑ Center on Budget and Policy Priorities, "Overview of Medicaid Provisions in the Balanced Budget Act of 1997, P.L. 105-33," September 8, 1997

By the year 2000, NHE accounted for 13.3 percent of GDP — just a 1.2 percent increase over the past decade.

The price and importance of pharmaceutical drugs had increased sharply over the decades since Medicare's original passage, and by 2004 the average Medicare beneficiary was spending over $1,000 out-of-pocket each year on prescription drugs.

↑ Centers for Medicare and Medicaid Services, "Brief Summaries of Medicare and Medicaid," November 2009

The 2010 passage of the Affordable Care Act (ACA), also known as "Obamacare," introduced experimentation and uncertainty into the industry, which has been and will be watched closely over the next several years to gauge the lasting effects of its policies.

In 2012, 91 percent of doctors accepted new Medicare patients, while 71 percent accepted new Medicaid patients.

The first open enrollment season for the Marketplace started in October 2013, and it was rocky, to say the least.

But by 2014, the Congressional Budget Office concluded that Medicare Part D spending had proved lower than either estimate.

By 2015, about 15 million Medicare beneficiaries—30 percent of all Medicare beneficiaries—were enrolled in Medicare Advantage plans.

Nevertheless, 8 million people signed up for insurance through the ACA Marketplace during the first open enrollment season, with enrollment peaking in 2016 at 12.2 million (with 10 million of those receiving subsidies to help pay for insurance).

Since Donald Trump was sworn in as the 45th President of the United States on January 20, 2017, many have questioned what would happen with our healthcare system — specifically, what would happen to the ACA, since Donald Trump ran on a platform of “repealing and replacing” the bill.

In January of 2018, the Trump administration allowed states to add work requirements to Medicaid, requiring beneficiaries to prove that they either work or go to school.

Eliminating the penalty immediately caused insurance premiums to rise, even though the elimination of the penalty didn't go into effect until January of 2019.

Hungry to notch a win on healthcare prior to the 2020 election, the Trump administration continues to push ahead on initiatives designed to reign-in healthcare costs.