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Health care reform finds champions, opponents over centuriescomment (0)

June 27, 2013

By Sondra Washington

Health care reform finds champions, opponents over centuries


It is hard to imagine the United States without networks of doctors, clinics, hospitals and insurance companies, yet this country’s health care system was not established formally until around the early 1900s. Since that time, our leaders have steadily adjusted and reformed the program to accommodate medical advancements and to suit the country’s changing health care needs.

For hundreds of years before then, Americans had to provide their own health care. Whether from the scarcity of medical professionals, expensive costs of treatments and therapies or the common culture of using at-home or natural cures, many U.S. citizens might never have been treated by a medical doctor during the country’s foundational years, and large numbers of people died from common illnesses. Even when some did see a doctor, treatments prescribed at the time could have been as deadly as the illnesses from which the people suffered.

In the 1600s, when Pilgrims needed serious medical attention whether on the journey from England to America or at Plymouth, they often depended on people who had merely shadowed established physicians as they were treating other patients. At times, the colonists were cared for by individuals called “barber-surgeons,” as barbers often performed surgical procedures on patients at this point in history. Despite all of the cures and techniques the Pilgrims might have used, nearly half of the colonists died from a “great sickness” during the first winter in Plymouth, according to the Mayflower Society.

Nearly 200 years later, commonly used medical practices could have still been making people sicker instead of curing their ailments. According to the History Channel, when President George Washington “awoke with a bad sore throat and began to decline rapidly” in 1799, he received a bloodletting treatment in which a lancet is used to cut open a patient’s vein to drain some of its blood. Although this was a common practice and Washington apparently requested the procedure, his physicians “drained an estimated five to seven pints (of blood from him) in less than 16 hours.” Three days later, Washington died “leading to speculation that excessive blood loss contributed to his demise.”

Through the years as medical practices advanced, American citizens had access to better treatments, but these improvements came with drastically increased medical costs that many people could not afford. Soon Congress began drafting legislation to help remedy this problem. In 1854, both the U.S. House and Senate passed the Bill for the Benefit of the Indigent Insane, which proposed to make “a grant of public lands to several States for the benefit of indigent insane persons,” but it was vetoed by then President Franklin Pierce. He believed that the states and not the federal government were responsible for providing for the needs of indigent persons whether insane or not.

After the Civil War, the War Department established the Freedmen’s Bureau, which was an “unprecedented social reconstruction that would bring freedpeople to full citizenship,” according to the U.S. National Archives and Records Administration. This bureau “operated hospitals and temporary camps” for former slaves among numerous other services, but the program lasted only seven years.

Over the next several decades, countries around the world began offering forms of “social welfare” that would set the foundation for the type of health care programs Americans have today including medical care and wage replacement for sick workers. Then after serving two terms as president, Theodore Roosevelt ran a third time calling for “universal health care for all Americans.” According to CNN, “health insurance was largely unavailable … and paid sick days or maternity leave were unheard of.” Although Roosevelt lost the presidential race, his attention to this subject might have inspired other people who were considered “progressive reformers” to “argue for health insurance,” PBS reports.

In one case, legislators in California “passed a constitutional amendment providing for universal health insurance” but “a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it ‘would spell social ruin to the United States,’” The New Yorker reports. One pamphlet sent to California voters featured “a picture of the Kaiser and the words ‘Born in Germany. Do you want it in California?’” On voting day, the amendment did not pass.

In the 1930s, the Great Depression caused politicians to change their focus to other types of necessary insurances and social reforms. President Franklin D. Roosevelt signed into law the Social Security Act “to establish ‘a system of federal old-age benefits’ and to provide states with funds to build local health departments,” according to CNN. At this time, the American Medical Association (AMA) reportedly lobbied against “compulsory health insurance” fearing that “nationalized health care would take away a doctor’s autonomy.”

But during World War II, American companies lost a great deal of their regular employees to the war, and they began trying to attract new employees to their companies by offering health insurance. A forerunner of this idea was General Motors, which signed a contract with Metropolitan Life to insure 180,000 workers after World War I, according to PBS.

In the 1940s, President Roosevelt again attempted and failed at reforming the nation’s medical care. He asked Congress for an “‘economic bill of rights,’ including (the) right to adequate medical care,” according to CNN and PBS. 

Then President Harry Truman offered a “national health program plan, proposing a single system that would include all of American society.” The act included “a provision requiring facilities to provide access to all patients without discriminating on the basis of race, nationality or religion,” but this plan was also “denounced by the [AMA] and [was] called a Communist plot by a House subcommittee.” 

Eventually in 1953 and 1954, President Dwight D. Eisenhower established the Department of Health, Education and Welfare, authorized a “‘military Medicare’ program to extend health insurance to dependents of service members in the U.S. Armed Forces” and approved the Federal Employee Benefits Act providing health coverage to members of Congress and other federal employees and their families, according to CNN.

Over the next few decades, Medicare and Medicaid were signed into law by President Lyndon Johnson who also signed the Economic Opportunity Act in his War on Poverty “to address high levels of unemployment and poverty.” A national system of health centers resulted from these efforts. In addition, President Richard Nixon signed the Social Security Amendment and renamed “prepaid group health care plans as health maintenance organizations (HMOs)” including federal assistance in these areas.

For all the advancements in the American health care system, some measures still failed in Congress. One of these was President Jimmy Carter’s National Health Plan proposal, which would have provided coverage to low-income and disabled Americans funded by “employer and employee payroll taxes,” CNN notes.

Another attempt to overhaul

But under President Ronald Reagan’s administration, workers and families who lost health benefits were allowed to continue receiving benefits for a certain period, CNN adds.

President Bill Clinton again sought to overhaul the U.S. health care system to “ensure individual and family security through health care coverage for all Americans,” but his measures failed to pass Congress and were opposed by the health insurance industry and the AMA. A few years later, the states received matching funds from the government to extend health coverage to children from low-income families.

President George W. Bush then signed the Medicare Prescription Drug Improvement and Modernization Act into law providing “prescription drug insurance coverage to those who are enrolled in or entitled to Medicare,” according to CNN.

Now America’s most recent health care reform, the Affordable Care Act (see story, page 5), is being implemented under President Barack Obama’s administration. Like the modifications that preceded it, this act was also debated heavily both in Congress and between American citizens on either side of the issue before passing into law. As future presidents and leaders address the rising cost of health care and needs of American citizens, no one knows how many more debates will arise on this issue.

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