Destination unknown

A walk through U.S. health-care reform history

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1900: Life expectancy in the United States: 47 years.

Illustration: Greg Mably

1910s: President Woodrow Wilson proposes a single-payer system based on the plans of Germany and Great Britain, the only nations at the time with national health insurance. Opposition by labor unions and post-World War I animosity toward Germany blocks its adoption.

1915-1920: In 1915 the American Association for Labor Legislation drafts a model state medical care insurance bill to provide income for sick workers and their families. Some 16 such bills were introduced by 1920. None succeeds. At first, organized medicine offers cautious support but in 1920 begins opposition, which will last for decades.

Late 1920s: The first of what we now call HMOs arise. In Los Angeles, the Ross-Loos Medical Group opens. Employees of the county’s water and power department make monthly payments for care for themselves and families. And a farmer’s cooperative for health care forms in Elk City, Okla.

1930-1940s: Blue Cross and Blue Shield form and become the first organizations to enter the U.S. health insurance market. Their success inspires commercial insurers to enter the market as well.

1935: The Social Security Act passes. President Franklin D. Roosevelt responds to pressure from the American Medical Association, the insurance industry and business by cutting national health insurance from the legislation.

Illustration: Greg Mably

1946: The baby boom begins. U.S. births jump from 2.8 million in 1945 to 3.4 million in 1946.

1949: President Harry S. Truman proposes a single-payer plan financed through a payroll tax paid half by employers and half by employees. The American Medical Association fights the plan, saying it would turn doctors “into clock watchers” and “slaves.”

1964: The baby boom ends. U.S. births, which in 1957 peaked at 4.3 million, drop below 4 million in 1965.

1965: President Lyndon B. Johnson creates Medicare and Medicaid.
Early 1970s: Stanford medical alumnus Paul Ellwood, MD, and Stanford professor Alain Enthoven, PhD, coin the phrase “health maintenance organization,” aka HMO, defining it as preventive prepaid medicine delivered by organized groups of caregivers.

1973: Congress enacts the HMO Act, legitimizing HMOs, which had long been opposed by the medical establishment.

1970s: President Richard Nixon backs national health reform similar in concept to President Clinton’s managed-competition proposal, in which health-care service buyers would form purchasing cooperatives and force providers to bid against each other for their business. The plan fizzles when Nixon resigns.

1980s: HMO enrollment explodes. Escalating health insurance premiums push many employers to convert to HMO insurance as a low-cost alternative.

Illustration: Greg Mably

1993: President Bill Clinton introduces a health-care plan based on managed competition and names First Lady Hillary Rodham Clinton chair of the commission. The plan dies in Congress the following year after critics claim it would create a huge new government bureaucracy.

2000: Life expectancy in the United States: 77 years.

2003: President George W. Bush signs Medicare reform legislation offering prescription drug coverage to seniors and people with disabilities, starting in 2006.

2004: Bush argues for a cap of $250,000 for the pain and suffering portions of medical malpractice awards to help hold down health-care costs.

2011: First baby boomers reach 65 years of age.

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