Catie Moore
The history of America’s healthcare leading to its current state is unique, particularly compared to other systems in first-world countries.
While its progression was sped up significantly by the Civil War, America’s healthcare has continued to evolve over the past century into a system that its citizens both love and hate.
From the beginning of the 1800s when not all doctors were professionally trained to the modern day where you can study for an online nurse practitioner degree, let’s dive into a brief history of the healthcare system in the United States.
The 1700s – Colonial Times
For the first few generations of colonists, medicine was rudimentary at best. Few physicians emigrated to the colonies, so it was instead women played a major role in administering care, especially regarding childbirth.
As a result of this, mortality during these early days was high. Malaria, diphtheria, and yellow fever ran rampant and were treated with folk remedies, and there was little to no government attention paid to public health.
It was not until 1735 that the first medical society was formed in Boston. In 1750 the first general hospital was established in Philadelphia as it was the largest of the 13 colonies, and in 1765 the Medical College of Philadelphia was founded.
The 1800s – The Civil War
With brutal conditions and a severe shortage of medical supplies and physicians, it was more common for soldiers to die of disease than from fighting in the Civil War during the 1800s.
A lack of hygiene and tight living quarters meant that measles, mumps, chickenpox, whooping cough, diarrhea, dysentery, and typhoid fever infected soldiers in waves. The upside however was it forced fast progression of surgical techniques, research, methods, and care facilities to help counter the rising number of deaths.
Federal and state governments also began allocating money to healthcare, and after the war ended in 1886 the US Army established the Hospital Corps. Although founded in 1849, the American Medical Association (AMA) began to gain momentum and its membership encapsulated nearly half the physicians from across the country.
At this point, healthcare was a ‘fee-for-service’ model where payment occurred at the moment of treatment. Some private insurance existed, however, it was nowhere near the levels the US experiences today.
The 1900s – Fast Progression
1910s – Post World War 1, Congress passed the War Insurance Act to cover servicemen in the event of injury or death, and it was later amended to extend financial support to the servicemen’s dependents. The program ended in 1918.
1920s – The other impact of WWI became more apparent during the 1920s as hospitals and physicians began to charge more than the average citizen could afford. In 1923, Baylor Hospitals in Dallas created a program in conjunction with local schools that provides healthcare to teachers for a monthly fee. The program quickly caught on across the nation, and the Blue Cross/Blue Shield nonprofit was born. Private insurers took notice of this popular initiative and began to enter the market.
1940s – As the world entered WW2, the US government’s focus shifted to the war effort. This involved the establishment of the Office of Economic Stabilization, with the key outcome of this being a nationwide wage freeze.
This wage freeze greatly impacted the healthcare system. As US businesses were unable to offer higher salaries, they began searching for new and innovative ways to recruit and retain employees. The solution? Employer-sponsored health insurance as an incentive.
The war also ignited the beginnings of today’s Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). As tens of thousands of workers headed to Henry Kaiser Shipyards in California, Washington, and Oregon to meet the country’s need for warships, the need to provide healthcare for large numbers of employees in remote areas arose. A pre-paid arrangement of care was developed which eventually became the Kaiser Permanente Health Plan, which in turn evolved into HMOs and PPOs.
1960s – After attempts by both Harry Truman and John F Kennedy to make significant healthcare changes, in 1954 President Lyndon B Johnson finally passed one of the largest healthcare acts in American history which included the Medicare and Medicaid programs.
In addition to providing health insurance to the elderly and low-income earners, programs were also established for retirement, disability benefits, and survivor’s benefits. During its first six months, Medicare covered the health care of more than 2.5 million Americans.
This first iteration of these programs ensured users over the age of 65 pay only $3 per month for health insurance which covered 80% of their health care services. The earliest forms of Medicare and Medicaid also required users to promise they were not members of the Communist Party.
1970 – 1980s – During the 70s National Health Expenditures (NHE) accounted for 6.9% of the Gross Domestic Product (GPD), and by the 80s it was at 8.9%. Because the US had not formalized a health insurance system (it was still just those who could afford to buy insurance) there were uncertainties surrounding the cost of providing healthcare to such large numbers. Several healthcare policies were proposed, and failed, during this period, including Kennedy and Nixon’s open marketplace which shared many similarities with the current Affordable Care Act.
1990s – In 1996 President Bill Clinton signed the Health Insurance Portability and Accountability Act (HIPAA) which established privacy standards for individuals. It also guaranteed access to personal medical records and placed restrictions on how pre-existing conditions were treated in group health plans.
Clinton also kicked off the Children’s Health Insurance Program (CHIP) which expanded Medicaid to include uninsured children up to 19 years old in families with incomes too high to qualify for Medicaid.
Modern-day healthcare offers more affordable options for minorities. Photo by Bermix Studio on Unsplash.
Modern-Day Healthcare
2010s – In 2010 the single most dramatic overhaul of the healthcare system since the introduction of Medicare and Medicaid in the 1960s occurred. The Affordable Care Act, popularized in the media as “Obamacare” was signed off by President Obama which mandated applicable large employers provide health insurance and also required all Americans to carry health insurance. The bill established an open Marketplace whereby insurance companies could not deny coverage based on pre-existing conditions. Citizens earning less than 400% of the poverty line would qualify for subsidies.
The Affordable Care Act remains in place today and has shown evidence of reducing the healthcare disparity for minorities. It has not, however, come without its challenges.
In 2022 President Joe Biden signed an executive order directing federal agencies to expand quality, affordable health coverage. Biden has also proposed eliminating the ‘family glitch’ – a circumstance where employer-sponsored health care insurance is only affordable for the employee and not for family coverage.
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