History of Health Reform in a Center-Right Nation

According to the most recent Gallup poll, 41 percent of Americans self-identify as conservatives, 36% as moderate, and 21 percent as liberal.

Peter Wehner, “U.S. Remains a Center-Right Country,”Commentary Magazine, July-August, 2012

Don’t know much about history

Don’t know much about biology

Don’t know much about geography

Lyrics, “What a Wonderful World,” 1959

August 18, 2012 –  If you do not know much about the history of health reform in the U.S.,  I recommend you read  Jonathan Oberlander’s’ “Unfinished Journey – A Century of Health Reform in the United States” (New England Journal of Medicine, August 16, 2012). 

Dr. Oberlander is an unabashed Obamacare supporter.  For him, an alternative title might read, “A Century of Health Reform Disappointment in a Conservative Nation.”  

Oberlander’s position  is reflected in this statement, “U.S. Policy is a story of progress – but also abject failure." His references are all written by Obamacare supporters, and his  language near the end of his article reveal his bias,”If Mitt Romney wins the presidency, however, and Republican secure majorities in the House and Senate,  major provisions of the law could be overturned… U.S. health policy stands at a crossroads. Will we continue down the path of reform or move backward?”

Oberlander’s article is well worth reading.  It highlights the history of health reform . It lays out  21 milestones of  health reform proposals-   progressive proposals, legislative triumphs,  and legislative failures.

1.      1915 – American Association of Labor Legislation proposes compulsory health insurance; model bills are later introduced  in several states but fail to pass.
2.      1943 -Senators Robert Wagner and James Murray and Congressman John Dingell introduce legislation to establish national health insurance through Social Security.

3.      1945 – Harry S Truman becomes first U.S. President to propose national health insurance; legislation fails to pass.

4.      1946 – Congress passes the Hill-Burton Act to fund hospital construction.

5.      1951- Truman administration proposes federal health insurance for elderly Social Security beneficiaries.

6.      1965 – Congress enacts Medicare and Medicaid.

7.      1971- President Richard Nixon announces health reform plan requiring employers to insure workers and subsidize coverage of lower income Americans; it does not pass. 

8.      1972 – Medicare is expanded to include persons with end-stage renal disease and permanent disabilities. 

9.      1973- HMO Act encourages devlopment of health maintinance  organizations.

10.  1977- President Jimmy Carter proposes a program to contain hospital costs; bill is defeated in Congress. 

11.  1983- Medicare adopts prospective payment for hospitals.

12.  1985- Consolidated Omnibus Budget Reconciliation Act (COBRA) allows workers who lose employer health insurance due to job loss to continue coverage up to 18 months, paying premiums themselves.

13.  1986 – Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to screen and stabilized all patients seeking emergency care, regardless of insurance status or ability to pay.

14.  1989 – Medicare adopts a physician fee schedule.

15.  1990 – COBRA requires state Medicaid programs to cover children 6 to 18 years living in families with incomes below the poverty level, culminating in series of Medicaid expansions that began in 1984.

16.  1993 – President Bill Clinton proposes universal health insurance, but Health Security Act fails to pass Congress.

17.  1996 – Health Insurance Portability and Accountability Act (HIPPA) limits employers’ ability to exclude pre-existing coverage for new employees.\

18.  1997 – Congress enacts the State Children’s Health Insurance Program (SCHIP)

19.  2003 – Medicare Modernization ACT +(MMA) adds prescription drug coverage to program and creates tax-preferred Heath Savings  Accounts to be paired with high-deductible health insurance 

20.  2010 – Congress enacts Patient Protection and Affordable Care Act (ACA)

21.  2012 – Supreme Court rules that ACA is constitutional but restricts federal government’s ability to take away funding from states that opt not  to expand Medicaid. 

Tweet:   The history of health reform in center-right America is a story of Presidential triumphs and failures leaving 20% of nonelderly uninsured.