Destination unknown
A walk through U.S. health-care reform history
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1900: Life expectancy in the United States: 47 years.
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.
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.
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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