When we think of healthcare, generally the first things that would come to mind probably are efficient, fast, technological, professional; the list is near endless. However, healthcare has not always been the proficient system that we know it as today. Healthcare in the United States has evolved over a period over more than 250 years, constantly changing as new developments were made, research was conducted, and societal views were shifted. There were countless factors and reasons that the healthcare system evolved into what we know it as today, as well as infinite possibilities for its revolution in the near future.
Healthcare in the United States can be dated back to as far as the 1750s, back when healthcare and medicine were considered to be domestic concerns, typically with women responsible for taking care of the sick. Medicine typically consisted of homemade remedies, while medical procedures conducted by doctors were often not practiced or researched well enough to be understood or verified. The quantity of doctors and physicians was immensely insufficient, and the modicum that there were traveled excessively in order to perform their duties. During this time, the first American general hospital was established in Philadelphia. In 1765, the University of Pennsylvania opened its doors, becoming the first medical school in the United States. 5 years later, in 1770, the medical department of King’s College handed out the first M.D. degree after their establishment in New York.
In the early 1800’s, increased concerns about epidemics and spread of deadly viruses and diseases such as cholera and yellow fever led the city governments to set up health departments. During this time, private healthcare also began making its way into the American healthcare system. The mid 1800’s sparked a plethora of changes within the healthcare system, from the urbanization of the United States to the start of the Civil War. As the war went on, more citizens died from the spread of dangerous disease rather than as a result from the war itself. Increased government building of hospitals resulted in doctors no longer traveling extensively to treat all their patients, as they had done before. In 1846, the American Medical Association (AMA) was initiated, and went on to have significant influence over medicine and healthcare practice over the course of the following century.
Health insurance was initially introduced in the 1900’s by President Theodore Roosevelt.
“No country could be strong whose people were sick and poor.”
Theodore Roosevelt
Ultimately, the healthcare system was revolutionized not by the government, but rather by outside organizations, one of the most important being the AMA. Another was the American Association of Labor Legislation (AALL), whose insurance bill specifically targeted low and middle class families prone to injuries as a result of manufacturing jobs. However, many organizations objected. This included medical societies who preached concerns regarding doctors’ compensation, as well as private insurance companies, whose business would be undermined by AALL’s proposition. Eventually, the AALL wasn’t able to pursue their proposition due to lack of support from the governments in addition to the rest of the healthcare organizations. Concerns surrounding healthcare grew increasingly toward the end of the 19th century.
In the early 1920’s following the end of the war, doctors and hospitals began to charge more than the average American citizen could afford at the time. This issue exacerbated immensely when the Great Depression began in the 1930’s, pushing more and more into poverty and further increasing the already expensive prices. During the early 1940’s, however, the healthcare system once again found itself revolutionizing in creative ways. Following the Japanese attack on Pearl Harbor, the US government issued the Stabilization Act of 1942, which essentially limited salary increases in an attempt to keep inflation under control. Since companies could no longer use salary increases to attract workers, the concept of employer-sponsored health insurance was introduced, which is exactly what many millions of US citizens rely on today for their healthcare. The idea was a hit, attracting millions of workers who no longer had to worry about providing healthcare for themselves and their families or paying taxes on it. However, this proposal was still not a solution for the many millions of Americans who were unemployed as a result of the war. Several propositions were brought forward, many of which advocated for a national government based system, including the Wagner-Murray-Dingell bill in 1943. Much like the AALL proposition of the early 1900’s, the idea faced extensive opposition and was ultimately left unpursued for many years. In the 1950’s, during the Korean war, more and more medicinal developments opened up significant gateways for health across the country. This included vaccines for diseases such as cholera and diptheria, which had previously left the country drowning in illness. Arguably one of the most impactful drugs, penicillin, was developed during the time as well. Nevertheless, insurance prices and hospital prices did not get any better, and in fact doubled.
During the 1970’s more attempts working toward national health insurance were made, including President Kennedy and Nixon’s collaboration on a bill, which was ultimately abandoned and left unpursued due to lack of support. In spite of this, Nixon was still able to push toward advancements in the system, consisting of the Social Security Amendment of 1972 and the Health Maintenance Organization Act of 1973. Decades later, in 1990, President Clinton attempted to establish a universal health coverage system as well, advocating for the Health Security Act of 1993. This proposal as well was left unpursued, mainly as a result of economic and foreign affairs, as well as conflicts surrounding the logistics of the bill.
During the beginning of the 21st century, more government action was taken in order to extend healthcare coverage to the millions of Americans who didn’t have access to it. In 2003, George W. Bush pushed for Medicare to include drug prescriptions, which became known as the Medicare Prescription Drug, Improvement and Modernization Act. Years later, in 2010, President Barack Obama signed the Patient Protection and Affordable Care Act, which guaranteed affordable and quality care to health care. As Obama’s term came to an end, more propositions suggesting universal health coverage came forward, one of the most well known being Bernie Sanders’ Medicare for All plan, which he advocated for during his run for President in 2016 and 2020. The plan, which itself had many issues and conflicts, was left unpursued.
Even today, despite healthcare having advanced in medicinal and technological aspects, monetary conflicts within the system itself leave 25 million uninsured, and 37 million underinsured. Millions more rely on their employer for health insurance, which poses a problem for low-income families with unstable jobs. Options are near non-existent to limited for senior citizens, disabled, and undocumented people living in our country. Despite being one of the most significant national debates, one that nearly all of us have heard, not everybody in our nation is ensured good health, even though it should be accessible to all. Many of us have the privilege of not having to worry about sickness and our health as much, simply because we have access to hospitals, doctors, and medicines whenever we need them. These options are not available to millions of Americans, who can barely afford to put food on the table and don’t have the privilege of even considering paying thousands more just to see a doctor. In the future, pushing toward national coverage that makes health insurance accessible and affordable to all who live in the United States should be top priority.
“Health is a fundamental human right.”
World Health Organization
