Healthcare has always been a hot topic of discussions and debates alike. Our system of providing healthcare to its people is not only complex, expensive and inaccessible to many, but is also a relatively a new phenomenon compared to other countries. In present situations where the status of ‘healthcare for all’ hangs in the balance of finances and politics, to understand the subject, it might help a bit to know about its history.

The country saw a health insurance plan for the first time during the era of the Civil War, back in the early 1860s. These plans which were initially offered by the Franklin Health Assurance Company of Massachusetts covered only against injuries arising from train or steam boat travels. However, they paved the way for more comprehensive plans which later began to cover against various injuries and illnesses. Soon after the company started, the industry boomed and by 1866 there were almost sixty organizations providing accident cover. Insurance companies then went on to issue cover for individual disability and illness with the first policy being provided around 1890.
Employer sponsored group disability policy was first introduced in the year 1911 and consecutively, 1929 saw the first group health insurance plan when a group of teachers from Dallas contracted the Baylor University Hospital’s medical services (for a 21 days of hospital care) by making small monthly payments to the institution. These 1300 teachers were helped by Blue Cross in making and facilitating the arrangement. Blue Cross then extended the option to other employee groups in Dallas and later on nationally. Taking a leaf from this arrangement, and also as the popularity of health insurance increased, many a big life insurance companies entered health insurance arena in the 1930s and 1940s.
Around the same time, the concept of Blue Shield was also taking form. Blue Shield provided employers of miner and lumber camps (where chronic illness and serious injuries made up the occupational hazard) who wanted to provide medical care for their employees. The arrangement would be the same as Blue Cross where they would pay physicians a monthly fee in return for their services. Following this, strong worker unions began to demand and bargained for better employee benefit packages. The impact of the war (World War II) was even more strenuous due to the wage freeze. During this time, because of the law, the employers were unable to attract employees by flaunting bigger salaries. Hence, they compensated by increasing their benefit packages and including health care.
It was in 1950s and 1960s that government health care plans began to expand with disability benefit being inducted into social security coverage in 1954. The health care had expanded so exponentially by the time that when the government introduced Medicare and Medicaid in 1965, private institutions were paying for almost 75% of the healthcare costs. But government programs picked up and by 1995, with the government paying for half the total cost of healthcare and companies and individuals paying for the other half.
The 1980-90s saw a rapid rise in the cost of health care and hence, many employers dropped the ‘fee-for-service’ plans in exchange for the cheaper ‘managed care plans’. Owing to this, by the mid 1990s most of the Americans (those who had health insurance) were covered under the managed care plans.
In 1993, President Bill Clinton tried to introduce various reforms in the health care system which would guarantee health insurance for all American citizens. However his plan was downplayed by the Congress who considered it as too expensive and too regulated. Instead they passed a few smaller changes like the Mental Health Parity Act and the Insurance Portability and Accountability Act. The Bush administration too planned for health care reforms but they were lost amidst the huge bills (invoices) of the War on Terrorism.
It was President Obama’s administration that showed the first signs of actual health care reforms. Popularly known as ‘ObamaCare’, the reforms can be summarized by referring to two acts – the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act. However, ObamaCare is touted to be full of flaws and drawbacks by critics and people are still getting used to the system even after it completes its first anniversary.
Ever since the first health insurance policy or coverage, the complexity of health care in the nation has grown only exponentially with passing time. People all around are still vying for proper health insurance coverage; especially those millions who have been rendered jobless as a result of the recent recession. Due to the steep rise in unemployment, Medicaid has also seen a surge in applications. Whether they get proper health insurance and health care remains a question of time.