The History of Healthcare in the United States

Health insurance was developed to provide guaranteed coverage for sickness, injury and preventable health measures. Currently, the United States is facing a major challenge in controlling the cost of health care and providing coverage for everyone. This is why it is so important for the government to develop a new health care insurance plan. The purpose of this paper is to explore the history of health care, the major improvements made to coverage through the years. Discussing the healthcare reform and the plans to improve the quality, and cost of health care for everyone in the United States.

Health insurance started in the early twentieth century when the working class of America faced the problem of sickness and injury resulting in missing work and lost wages. The first health insurance was disability insurance. It was developed during the civil war as a paid benefit to railroad and steamboat workers. Its only focus was to pay benefits to the insured when a railroad or steamboat injury occurred. Disability insurance was not designed, nor had the funding to cover hospital, or other medical expenses. The railroad and steamboat workers were unable to pay for the other medical expenses that accrued during sickness and injury. This dilemma caused the development of the first health insurance plan, called Blue Cross. Blue Cross began when a businessman helped a group of teachers pre-pay for medical care. The teachers made small monthly payments to a hospital in exchange for medical services as needed.

This idea of lending money to help the people pre pay for health care caught on quickly. Many companies struggling to survive during this time period adopted this idea of lending monies to cover health costs as an employee benefit instead of offering higher wages. This implementation of health care coverage guaranteed the sick or injured pre paid health care, and ensured that hospitals and doctors would be paid as well. With the guarantee of payment the first provider health care program was born. It was called Blue Shield. Blue Shield’s role was to negotiate with doctors and hospitals for reduced prices in exchange for a high volume of customers and guaranteed payment. To make up for the loss of revenue, doctors and hospitals raised their prices for patients who did not have group health insurance.

A lot companies during the 19040s and 50s were able to offer their employees health care benefits, but for some this was not an option. Many of Americans and small businesses during this time period could not afford group health insurance. This meant that the government had to come up with new programs to provide coverage for the uninsured people.

There was a need for an insurance that would benefit the disabled, elderly and unemployed American people. The Medicare and Medicaid act of 1965 did just that and provided health insurance coverage to millions of Americans in need. Medicare was a uniform national health insurance program for the elderly and disabled. Medicaid was a program that was administered by the states within federal guidelines. It financed health services for certain low-income groups. In 1966 there were 19 million elderly patients enrolled. It was a slow process, but eventually all the states participated in this program. By 1972 there were 18 million elderly, disabled, and poor families enrolled in the Medicare program. Though this was a big help with to the uninsured, there were still bigger issues that needed attention. Medical costs continued to increase and more and more people were unable to pay for their healthcare, especially those who did not qualify for Medicare or Medicaid. This prompted the HMO, which stands health maintenance organization.

The HMO is similar to Blue Shield, but it was more than just doctors and hospitals, agreeing to lower cost of care in trade for payment. It’s an organization of hospitals, primary care physicians, specialty doctors and labs which are all enrolled into the HMO program agreeing to accept a set payment price for the services rendered for everyone enrolled. The HMO is a prepaid insurance plan offered by the employer. The employee pays a set monthly fee and is guaranteed coverage for office visits, hospital stays, laboratory services, surgeries and much more. The HMO grew quickly, there were more than 8,000,000 members in the 1970s.

However this new health insurance plan had a few glitches of its own. There were a lot of restrictions that came with the HMO, first you had to choose a primary care that participated in the HMO, and you could only be seen at hospitals or use laboratories that were in network. The plan behind the HMO was to use preventative health care and help prevent unnecessary costs. The restrictions associated with the HMO had the people looking for another solution.

The PPO, which is the preferred provider organization is very similar to the HMO. The big difference between the HMOs and PPOs is the patient is able to choose a health care provider that is not in network or hospital but must pay extra to do so. The financial burden is placed on the patient rather than on the physician or the organization. Even though the PPO gave the American citizens freedom to choose whom they could see, it still wasn’t enough. The people of America are still looking for improvements to the health insurance.

Years later in 1993 During Bill Clinton’s presidency the health insurance issues came up again. He shared plans of a national health insurance, which Congress shot down, feeling that it would still be too restrictive and cost too much. Multiple other plans were discussed during this time, and like the national health care plan, they were too voted against. After former President Clinton’s failed attempt at health care reform, the Bush administration showed no serious efforts at achieving universal health coverage for the millions of uninsured Americans. When Barack Obama was elected as U.S. President, health care reform was once again a top priority.

On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) was officially signed into law (Also known as Obamacare). The goal of Obamacare was to give more Americans quality health insurance, and to reduce the amount of health care spending in the United States. It came with a number of new benefits and protections. One of them being young adults could stay on parent’s plans until the age of 26. It also helps to prevent against discrimination against things like gender and pre-existing medical conditions.

Obamacare itself didn’t replace your insurance, it regulated health insurance companies from faulty practices. It was a controversial plan because it raised taxes on the wealthy and businesses. But since then, newly elected president Donald Trump has been avidly trying to repeal and replace Obamacare. Donald Trump himself being a wealthy business man himself has openly criticized Obamacare on multiple occasions, both during his campaign and now as president. The Republicans in the House of Representatives have proposed a bill to replace the Affordable Care Act. The bill is known as the American Health Care Act.

It would change certain provisions of the Obamacare law. Trumpcare has been criticized for being similar to Obamacare. The main difference effecting the population being the coverage requirements. Under Obamacare, people who were uninsured were charged a penalty on their taxes. Under Trumpcare, there is no initial fee for not having insurance, rather there may be a fee for when you try to reenroll in insurance after a long gap of being uncovered. The other major change is to the elderly. Under Obamacare, there was a 3:1 ratio, meaning that an elderly person could be charged up to three times the price for the same plan that a younger person would receive. Now Trumpcare is proposing a 5:1 ratio. Things such as health benefits, enrollment periods and pre-existing medical condition coverage remain the same.

So in conclusion, the American healthcare system is forever changing. Law makers are always trying to find ways to make coverage more accessible and more affordable. Healthcare progress has been very slow and sometimes frustrating to the American population. Will we one day have a health plan that covers and satisfies the country? And what is the correct way to do so?

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The history of healthcare in the united states. (2021, Jun 22). Retrieved August 10, 2022 , from

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