words Al Woods
To many within the industry, it can seem that healthcare services remain obstinately the same, even as providers and patients call for change. Yet, the truth is that the United States has seen an outstanding revolution in healthcare in a remarkably brief period of time.
The healthcare industry is better right now at addressing the needs of providers and patients than it ever has been in American history — and to truly appreciate that fact, you might be interested in journeying through the evolution of the U.S. healthcare system.
At this period in history, mortality was high; science and medicine as we know them today were still in their early stages, and most Americans did not have access to reliable information about the effective treatment of disease.
Boston doctors united to form the New World’s first medical society in 1735, sharing information about disease and treatment strategies and working together to form regulations to make practicing medicine safer for all. As the end of the 1700s approached, more cities in the American colonies began developing their medical services. Philadelphia gained the continent’s first general hospital in 1760; five years later, the city opened the first medical school in the colonies: the Medical College of Philadelphia.
Throughout the 1800s, and during the Civil War in particular, advances to medical science came rapidly. Surgical techniques, medical drugs and anatomical understanding helped doctors treat patients more effectively. Medical facilities became more organized as a result of the large number of casualties suffered during Civil War battles.
Perhaps most important during this period is the founding of the American Medical Association (AMA) in 1849. Founded as a national group of physicians and surgeons, the AMA helped doctors around the country stay abreast of evolving medical knowledge and techniques while providing a united voice for doctors in evolving legal scenarios. By the end of the 1800s, the AMA comprised more than half of all American doctors and wielded surprising political power.
At the turn of the 20th century, President Theodore Roosevelt said, “no country could be strong whose people were sick and poor.” Yet, despite being a major proponent of universal healthcare, Roosevelt did little to advance a unified American healthcare system. Instead, unions and non-government agencies looking for better workers’ rights fought for better healthcare for the average American.
In the early 1910s, the American Association of Labor Legislation (AALL) introduced bills to various state legislatures that would make health insurance (including maternity and death benefits) compulsory for all employees with the costs split between employers and states. Unfortunately, powerful groups like private insurance companies and the AMA were against such laws, fearing interference with profits.
After World War I, health insurance became even more important. The War Risk Insurance Act covered medical expenses for service members and their dependents, but the rising costs of healthcare made medical treatment financially untenable for most other Americans. Private insurance companies began to adopt the Blue Cross/Blue Shield system, which provided healthcare services to groups willing to pay a monthly fee.
When the Great Depression plunged most Americans into poverty, President Franklin D. Roosevelt pushed for a national health system — and the AMA and private insurers again pushed back. The compromise was the Social Security Act of 1935, which provides various types of public support to the elderly and encourages states to develop public provisions for the unemployed or disabled.Fortunately, subsequent presidents continued pushing for more comprehensive health coverage, and in 1965, President Johnson expanded the Social Security Act to create Medicaid and Medicare.
The need for high levels of production during World War II led Henry Kaiser, the owner of shipyards in California, Washington and Oregon, to develop the Kaiser Permanente Health Plan, which arranged healthcare for employees of the shipyards. This system developed into the modern-day employee-sponsored HMOs and PPOs, but even then, employer-sponsored healthcare was not enough to cover all Americans.
The Affordable Care Act
Almost every president since has tried in some way to fix America’s healthcare system, helping the average American afford the health services they need. Congress, too, has tried and failed repeatedly to create better national health programs.
Our current system is the Affordable Care Act (ACA), popularly known as Obamacare thanks to the president who pushed it into law. The ACA extends the private insurance model, making requirements for coverage that allow Americans with low and no income to obtain coverage. Today, over 31 million Americans utilize ACA insurance coverage, and as the coronavirus epidemic lingers, that number continues to climb.
The American healthcare system has never been static, and though the ACA has been in place for more than a decade, calls for changes to the current system have become louder in recent years. Healthcare professionals can continue to provide value to patients and the system at large by evolving their practice through engagement with an online short course for healthcare management. Then, even as the healthcare system evolves, healthcare providers and their patients will continue to thrive.