Healthcare has been an ongoing issue in the United States for quite some time. In fact, in 2004, it topped the list of America’s most worrisome issues, ranking higher than terrorism and second only to jobs. Healthcare is under constant attack from the public. It is often criticized of its sharply rising costs – we spend more on healthcare than most other industrialized nations, and these increasing trends don’t seem to be subsiding. It is also criticized for being inaccessible – healthcare services are not available to everyone, and even when they are available, many cannot afford to pay for them. Hopefully by studying the history of our healthcare system, we can get a better understanding of how we ended up in our present situation.
Currently, we consider healthcare to be the responsibility of a third party separate from ourselves, and expect that others to provide it for us. But up until a hundred years ago, healthcare was considered to be a personal and familial responsibility. At the end of the 18th century and beginning of the 19th century, society was mainly agrarian. The majority of people lived in rural areas where access to doctors was limited. Thus, many came to depend on local homeopaths, herbalists, midwives, and barbers, and home remedies were regularly administered. In other colonies, where religion was very prominent, there was little demand for practitioners since sickness was thought to be punishment for immoral conduct.
Medicine was still quite primitive at this time – it was not regulated, and anyone could become a “doctor”. Yet these doctors were not highly regarded, for their treatments could not be depended on to be successful. These treatments were often based on four humors – blood, phlegm, black bile, and yellow bile – where stable health was thought to be due to a balance between these humors. Thus, in order to cure illnesses, they would withdraw amounts of these bodily fluids to try to achieve a balance. Since medical treatments were often provided by under-qualified practitioners, healthcare was rather affordable.
Yet gradual progress took place during this time. In 1751, the first hospital in the nation, Pennsylvania Hospital, was founded by Dr. Thomas Bond and Benjamin Franklin “to care for the sick-poor and insane who were wandering the streets in Philadelphia.” Then, in 1765, the first medical school was established at the University of Pennsylvania. Thus launched the idea of having an educated medial field. By the mid-1800s, the healthcare market had slowly become professionalized by college educated doctors. Yet there were still a number of under-qualified practitioners still in the business, which caused medical standards to remain low. So in order to instate professionalism, the American Medical Association (AMA) was founded. Laws were passed that made medical licenses a requirement for physicians. Since the few legally practicing doctors no longer had to compete with un-qualified practitioners, they were free to increase their costs. This marks the beginning of the high prices of healthcare, as comparable to our modern system.
During the Civil War period, a few advancements were made. The first health insurance plans were introduced during this time. Although they primarily covered accidents related to rail or steamboat travel, the paved the way for more comprehensive plans, including the first individual disability and illness policy established in 1890. Also during the Civil War, doctors began to specialize in various fields, beginning with the start of ophthalmologists in 1864.
One great development of the 19th century was the understanding of the cause of infection. With the introduction of antiseptic procedures, rates of infection related with medical care were drastically reduced. Also, doctors were no longer relying on balancing humors, but were instead focusing on symptoms and demographics. As medical treatments improved and cures proved to be more successful, the fear of medical care lessened, and respect for and trust in doctors improved.
Significant progress towards modern healthcare became obvious during the Industrial Revolution. The Industrial Revolution marked the beginning of the need for modern healthcare. Society became much more urbanized, moving away from its original rural state. These denser populations concentrated healthcare needs. People began to work away from home, which made it more difficult for families to supply home care. Specialization increased the dependence on others for services. In other words, now that an individual was being trained for and working solely in a specific job, he had to rely on others to provide him with what he was unfamiliar or inexperienced with. Also, industrial accidents and illnesses increased the need for healthcare services. For instance, the railroad industry developed the leading employee medical program (keep in mind that building railroads was a very dangerous job).
Many more advances were made in the beginning of the 20th century. According to PBS, the AMA’s membership increased from 8,000 in 1900 to 70,000 in 1910 (half of the country’s doctors), furthering the concept of organized medicine. Also during this decade, doctors no longer provided free services to their patients. Hospital improvements were made –there were only a few hundred in the nation in 1900, but by 1930, there were 7,000. They also became much cleaner, since the rise of the nursing profession improved hygiene and quality of care. But with the growing prices of healthcare, groups such as the American Association for Labor Legislation (AALL) began fighting for federally provided health insurance. Yet many of their efforts were unsuccessful.
By the 1920s and 30s, the federal government started limiting its healthcare coverage, which was especially evident following the Great Depression with the Social Security Act. Also during this decade, the Blue Cross offered the first privatized health insurance coverage. Then, during WWII, companies began to provide health benefits in hopes of attracting more workers, which led to our current employer-based system. Following WWII, President Truman proposed the first national healthcare program, but it received little support from the public, which viewed it as a “communist plot.” Thus, the healthcare system adapted into our modern system, where many Americans receive private coverage from companies and the poor rely on welfare. Then in the 1960s, President Johnson passed the Medicare and Medicaid Act, which provided healthcare to low-income people. But since his presidency, healthcare costs have continued to escalate.
As we can see from the history of America’s healthcare, our modern system is a product of various fundamental factors, the most important and reoccurring ones being economic competition, private practice, and government regulation. Hopefully we can learn from our previous courses of action and use this knowledge to better our current situation.
Sources:
http://www.pbs.org/healthcarecrisis/history.htm
http://72.14.253.104/search?q=cache:o4j5qhSy3OsJ:www.chernoffdiamond.com/academy/appendix%2520c.pdf+healthcare+history&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a
http://www.citizenshealthcare.gov/healthreport/healthreport.php
http://select.nytimes.com/gst/abstract.html?res=F40717F93D5C1A728DDDA90B94DE405B808AF1D3
http://www.californiaspine.com/en/medical_history_and_ethics/history/history_of_health_insurance.htm
http://select.nytimes.com/gst/abstract.html?res=F50E12F73B5B157493C0A8178AD85F448785F9
http://www.uphs.upenn.edu/paharc/features/creation.html
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