Timeline: History of the U.S. Health Care System

It seems that the medial profession is on the brink of significant change.  I'm talking about more than just the passing of Obamacare; I feel a change of attitudes and a transitioning of roles is in the air.  You can feel it.  People are looking more and more to the internet to solve their medical dilemmas.  Nurse practitioners are pushing to expand their roles.  The complexities and often injustices of medical payment systems are being exposed.  These changes strike fear in many providers- no one likes change.  I can't help but think that massive changes in structure and attitudes toward health care like this must have occurred in the past. 

I really wanted to create some sort of amazing, artistic info-graphic for this post, sort of a pictorial of the history of health care in the U.S.  Unfortunately, I am illiterate in graphic art and my meager attempts at a crash course in various graphic art softwares failed miserably.  So, I will stick with the goo 'ole list format.  This is how the U.S. health care system arrived at it's current (messy, complicated) state:

Early 1900's:

Organized medicine begins.  Physicians band together to create the American Medical Association becoming a powerful influence over health care legislation.  U.S. lawmakers choose not to make legislation surrounding health insurance policy.

1912:

Theodore Roosevelt campaigns on the issue of mandatory health insurance, supported by many progressive groups.  Their efforts are set aside with the beginning of World War I.

1920's:

The cost of health care increases relative to other sectors and medical attention becomes increasingly more difficult for the middle class to afford.  Politically, no changes are made to health care law however some companies such as General Hospital and Baylor University begin to offer health insurance to their employees.

1930's:

The Great Depression brings emphasis on offering government based benefits to Americans.  However, in the passing of the Social Security Act health insurance is omitted.  The American Medical Association voices strong opposition to a health insurance program as it would increase bureaucracy and limit doctors' freedom.  Despite resistance, Blue Cross begins offering insurance for hospital care in some states.

1940's:

During World War II, employers begin to offer health insurance coverage to compensate for wage controls placed on employers.  This is the beginning of the employer-based system we have today.  President Harry Truman proposes a nationalized health care system that includes mandatory coverage however it is ostracized by the American Medical Association whose members deem Truman's plan "socialized medicine".

1950's:

Few legislative changes are made to health care as attention is diverted to Korea.  Tax incentives are given to employers offering health insurance plans further propogating the employer-based health system we have today.  Medicine continues to advance with more medications developed.  The first successful organ transplant is performed.  The price of hospital care doubles.

1960's:

President Lyndon Johnson signs Medicare into law providing comprehensive health coverage for individuals age 65 and over.  Medicaid covers long-term care for the poor and disabled. A boom in the number of companies offering private health insurance erupts.  By the end of the 1960's, 69% of doctors are specialists.

1970's:

The cost of health care exponentially increases after the passage of Medicare and Medicaid.  President Richard Nixon signs the Health Maintenance Organization Act to help reduce costs.

1980's:

Health care makes a move to become more privatized as health care businesses begin to consolidate creating larger hospital systems.

1990's:

The cost of health care rises at a rate double the rate of inflation.  Managed care groups increase to help mitigate cost.

2000's:

Medicare's sustainability is called into question.  Many also begin to doubt the efficacy of the employer-based health insurance system.  Some states enact reform laws to expand coverage to larger numbers of uninsured individuals.  Direct-to-consumer advertising takes off in the medical field.  For example, pharmaceutical companies advertise new medications on TV to the general public rather than just to providers.

2010:

Barak Obama signs the Affordable Care Act. 

Yes, I know, not the most riveting post of the week.  But I think it is important we as health care providers recognize the steps that landed the health care system where it is today.  After all, even if you aren't a history buff, hate politics or are just apathetic, changes in the health care system affect how we as nurse practitioners practice and are paid. 

Any predictions as to what changes we will see in the next few years?  How do you think health reform will affect nurse practitioners?

Comments

Your post turned up when I was searching for a concise way to explain the history of US healthcare, and I found it riveting :-) May I borrow liberally for a handout for a briefing to a leadership development program to get them up to speed on how we arrived at the events of 2012?

- Sue Lani Madsen

Very nice, concise overview! Really helps to add context to the new reform.

- D Chiang

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