American Healthcare


“[T]he law remained virtually unchanged longer in the United States than it did in Britain. By the time New Deal programs began to augment poor relief in the 1930s—because state and local governments during the Great Depression could no longer fund it alone—the oldest American states had been using the Elizabethan Poor Law, more or less, for 300 years.


The details varied from one state to the other, but four principles of the poor law were the same. First, parents and children were legally required to help each other when they were in need. If they could not, then the local government was legally required to step in. Second, poor relief was a function of that local government—whether a town, municipality, city, county, or parish—and not state or national officials. Third, all those who required aid had to be provided with basic provisions: food, shelter, warmth, and medical care. Fourth, all those in need who were not from the town where they sought care or shelter could be banished, with the intention that they return to their hometowns where they would be guaranteed assistance. Until the Great Depression, most Americans paid for health care out of pocket; it was only if costs were too great that they appealed to poor relief for help.”

-Gabriel Loiacono
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“This “social insurance” system is organized around regular contributions from wage earners. These contributions are then returned in the form of benefits (funeral expenses, pensions, unemployment insurance). It works, in other words, more like a toll road than a public right-of-way. The on-ramp to that toll road is a “covered job,” the point at which revenues are collected and benefits are disbursed.


Social insurance was embraced by American reformers early in the last century. At the time, the American state was ill-equipped, fiscally and constitutionally, to offer much more. And the “contributory” model was easy to reconcile with American ideals of self-help and small government. “The wage earner,” as one reformer argued, “has a more real basis for feeling that the benefits he receives are rights to which he as a citizen is entitled.”…


But those programs financed through general revenue were always vulnerable. Their budgets were uncertain. Their goals were questioned. And their recipients were suspect. Ronald Reagan’s “welfare queen” was condemned not because she defrauded the system, but because she did not contribute to it.


The social insurance idea is even more troublesome for health care. Before the 1940s, health insurance offered indemnity coverage, simply replacing the wages of those who were sick. Over time, health insurance began to cover the growing costs of medical care and hospitalization. As it did, the logic of social insurance collapsed.”

-Colin Gordon
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“A social security style system of “national health insurance,” proposed by President Truman in 1948, was denounced by the American Medical Association as “creeping socialism” and defeated by the conservative coalition in Congress, and a crazy quilt system of insurance company-administered health insurance based on type of employment and unionization came to take its place.”

-Norman Markowitz
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“[T]he leaders of the American Medical Association saw early health care models — union welfare funds, prepaid physician groups — as a threat. A.M.A. members sat on state licensing boards, so they could revoke the licenses of physicians who joined these “alternative” plans. A.M.A. officials likewise saw to it that recalcitrant physicians had their hospital admitting privileges rescinded.


The A.M.A. was also busy working to prevent government intervention in the medical field. Persistent federal efforts to reform health care began during the 1930s. After World War II, President Harry Truman proposed a universal health care system, and archival evidence suggests that policy makers hoped to build the program around prepaid physician groups.


A.M.A. officials decided that the best way to keep the government out of their industry was to design a private sector model: the insurance company model.


In this system, insurance companies would pay physicians using fee-for-service compensation. Insurers would pay for services even though they lacked the ability to control their supply. Moreover, the A.M.A. forbade insurers from supervising physician work and from financing multispecialty practices, which they feared might develop into medical corporations.


With the insurance company model, the A.M.A. could fight off Truman’s plan for universal care and, over the next decade, oppose more moderate reforms offered during the Eisenhower years.”

Christy Ford Chapin
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“Lack of adequate protection for the aged against the cost of health care was the major gap in the protection of the social insurance system in 1963. Meeting this need of the aged was given top priority by President Lyndon B. Johnson's Administration, and a year and a half after he took office this objective was achieved when a new program, "Medicare," was established by the 1965 amendments to the social security program”


-The Social Security Administration

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“The ACA marks a shift away from the 20th century model of offering individuals federal assistance based on membership and a clearly definable group of citizens. So, the ACA, I think this is a really interesting question, because the designers of Medicare in the 1950s absolutely believed that this policy would be the first step towards national health insurance, Medicare would start an incremental approach that would eventually include all groups like voting or even Social Security. So you know, one way to read the ad Yeah that this finally happened. Another way to read it is that the step by step approach to federal health insurance arguably enhanced the power of private insurers and failed to ensure cost control mechanisms created a financial crisis of such epic proportions that we needed something and that the ACA was the best feasible option and the least amount of structural change.”

-Tamara Mann

Listen to the Affordable Care Act Episode of History Talk here!

The lessons we have learned from HIV treatment activists also show us the need to regulate the global pharmaceutical industry so that profit-seeking cannot inhibit life-saving medications from reaching those who need them.

-Erin V. Moore, Read more here!

President Barack Obama “made it clear that the Affordable Care Act was only the latest iteration of government involvement in the health care realm. In fact, by the time “Obamacare” was passed, roughly 20% of Americans already had access to medical services via federal programs like the VHA, Medicare, Medicaid, or the Children’s Health Insurance Program.

None of those government initiatives came about without controversy.


The story of the establishment of the VHA provides insight into how major changes in U.S. health policy have materialized in the past. It also reveals that the ACA, while in many ways unique, is rooted in previous debates and policies.”

-Jessica Adler
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“Ever since President Barack Obama signed the Affordable Care Act into law 10 years ago Monday, it has faced legislative, legal and political assaults. The landmark health law, nicknamed Obamacare, has withstood more than 60 votes to repeal it from Republican-controlled Congresses, two Supreme Court decisions, the gutting of one of its main provisions (the tax penalty for not having insurance) and a president who campaigned on promises to get rid of it.”

-Abby Goodnough, Reed Abelson,

Margot Sanger-Katz and Sarah Kliff
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“The individual mandate is the requirement that all U.S. residents either have health insurance or pay a penalty. The mandate was intended to help keep the premiums for ACA policies low by ensuring that more healthy people entered the health insurance market…The 2017 Republican-backed tax overhaul legislation reduced the penalty for not having insurance to $0.”

-Selena Simmons-Duffin
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“The development of vaccines and extensive childhood vaccination campaigns are among the most important public health achievements of the past 200 years. They have saved millions upon millions of lives each year and in some cases eradicated dangerous diseases not only locally but globally. The Earth was declared smallpox-free in 1980; in 2000, the United States asserted itself rid of measles.”

Read about the top vaccine development milestones here!

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“The efficacy of vaccination as a tool of public health is irrefutable, not only against measles but many other highly infectious diseases as well. Thus, the Infectious Diseases Society of America, the American Medical Association, and the American Academy of Pediatrics all support the elimination of all nonmedical exemptions for childhood vaccines.


In spite of this certainty, we are seeing an increase in resistance to the use of this essential public health tool in some communities here and around the world. Why?

Anti-vaccination movements have existed for just as long as the practice of vaccination and have had complex and varied rationales. Over the past three centuries, resistance to vaccination has emerged out of ethical/theological debates, concerns about government overreach, and most recently (and most insidiously), out of a skepticism of science beginning in the 1990s.”

Jim Harris
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Want more?


Healthcare Crisis History 

America's Long Suffering Mental Health System
Origins: Current Events in Historical Perspective

A Guide to Following the Health Debate in the 2020 Elections
Kaiser Health Network

Doctor's Appointment

As to diseases, make a habit of two things — to help, or at least, to do no harm.


The Single Payer Debate:


What is the Single Payer Healthcare Plan?

In a single payer healthcare system, rather than multiple competing health insurance companies, a single public or quasi-public agency takes responsibility for financing healthcare for all residents. That is, everyone has health insurance under a one health insurance plan, and has access to necessary services — including doctors, hospitals, long-term care, prescription drugs, dentists and vision care. However, individuals may still choose where they receive care. It’s a lot like Medicare, hence the U.S. single payer nickname “Medicare-for-all.”

-Andrea S. Christopher, Read more here!
The Argument for Single Payer Healthcare

“The current funding of health care in the U.S., which imposes a mammoth burden on moderate-income workers, is not sustainable. There is broad agreement that everybody should have access to health care—just like all children should have access to education. Given the enormous costs—there’s no cheap way to treat heart attacks, cure cancers, or give birth—low-income families cannot afford health care on their own. The U.S. spends approximately $10,000 on health care per person per year; it is impossible for workers with low salaries to spend $10,000 per family member. Other wealthy countries have understood this basic truth long ago and fund universal health insurance through taxes that are based on ability to pay.


The key question, in the U.S. context, is how to conduct a successful transition to universal public health insurance that redistributes the burden of paying for health care. Do it fast or do it slow, the big picture is this: Fixing the injustice of our current health care funding system is possible and in fact straightforward. And if it came with a law mandating the conversion of premiums into wages, it would deliver the biggest pay raise in a generation to American workers.”

-Emmanuel Saez & Gabriel Zucman
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The Argument for Multi-Payer Healthcare

“Medicare for All is, to my mind, a Year Zero fantasy—it’s all about wiping the slate clean and starting over again, with institutions borrowed from some supposedly more enlightened society. But there is no such thing as Year Zero in a democracy, whether capitalist or socialist. The history of how we got to our present shambles will continue to shape, and deform, our health sector.


Instead of indulging the Year Zero fantasy, we ought to focus insurance subsidies on those who need them most and, just as importantly, shift from provider policies that do little more than shield hospitals from much-needed competition to ensuring that all Americans have the emergency and safety-net services they need. This will likely mean a heavier government hand when it comes to delivering emergency care and a lighter touch with respect to elective-care services, where more vigorous competition could redound to the benefit of the highest-performing hospitals while, over time, helping to contain costs. And how would we get politically powerful medical providers to acquiesce? It’s simple: Warn them that if they don’t, they’ll soon wind up with Medicare for All.”

-Reihan Salam
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