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Timeline of U.S. Healthcare & Government Programs

1600s to mid-1800s: Healthcare and Medicine was a ‘family affair;’ with ‘home remedies,’ ‘traditional medicine and cures,’ and few doctors to care for ‘the general welfare’ of the people.

1636: Plymouth Colony passed a law to aid disabled soldiers.

1636:  Harvard College (Massachusetts Colony) was established and in 1638 received America’s first printing press.  Harvard Medical School would not be established until 1782.

1660: London’s Royal Society founded.

1665: Philosophical Transactions was the first English Science Journal (London, England).

Early 1700s: Cotton Mather, a Puritan Minister and prolific writer, moves the idea of inoculations for small pox (learned of from a slave).  His father, Rev. Increase Mather, was the 7th president of Harvard (1685-1701).

1722: New Orleans (French territory; later Louisiana) opened a military infirmary which evolved into Charity or Royal Hospital (1734) – later reopened in connection to the 1834 Medical College of Louisiana – revived after Civil War by Tulane School of Medicine (1885).

1736: Friendly Society for Mutual Insurance of Houses against Fire was founded [bankrupted in 1740 by the Great Fire in Charles Towne (Charleston, S.C.)].

1751: Pennsylvania Hospital was co-founded by Benjamin Franklin and Dr. Thomas Bond.

1765: The University of Pennsylvania (1740) established the first medical college.

1766: The Medical Society of New Jersey was formed (the oldest in the U.S.).

1775: The Army Medical Service (U.S. Army Medical Department) was established for America’s Continental Army as Army Hospital.

1776: Continental Congress provided pensions for disabled soldiers; and in 1789 the First U.S. Congress did likewise.

1792: First marine insurance company founded in Philadelphia as Insurance Company of North America (merged in CIGNA in 1982).

1797: The Medical Repository was America’s first medical journal (New York).

1809: First monograph on heart disease written by John Warren, co-founder of Harvard Medical School and Massachusetts General Hospital (1821).

1811:  The first domiciliary and medical facility for Veterans was founded in Philadelphia.

1812:  In Boston, Warren (and James Jackson) started The New England Journal of Medicine and Surgery and the Collateral Branches of Science.

1845: New York Life (‘America’s largest mutual life insurance company’) was founded as the Nautilus Insurance Company.

1846: At the Boston Hospital, Dentist William Morton and Dr. John Warren performed the first major operation with ether anesthesia in 1846.

1847: Nathan Smith founded the American Medical Association (AMA) in New York; and in 1848 began annually publishing Transactions of the American Medical Association.

1849: Elizabeth Blackwell graduated from Geneva Medical College in New York.

1850: Franklin Health Assurance Company issued the first Accident policy – for 15 cents it paid up to $200 for injury due to railway or steamboat and up to $400 for total disability.

1864:  Travelers Insurance began selling Accidental Life Insurance; by 1899, 47 insurers had issued 463,000 policies.

1883: AMA began their weekly Journal of the American Medical Association.

1889: Johns Hopkins University (1876) established a School of Nursing in 1889 and J.H. School of Medicine in 1893.  JHUSOM required medical students have a 4-year degree for admission.

1899: Aetna Life Insurance and Travelers Insurance began offering Disability policies.

1902: Following Germany’s (1884) workers compensation model, Maryland passed first accident compensation law (declared unconstitutional in 1904 by their state supreme court).

1905: The AMA established a Council to set standards for drug manufacturing.  That same year the American Association for Labor Legislation (AALL) was founded in Wisconsin.

1905: The Socialist Party of America (1897-1946) was calling for ‘compulsory’ or ‘socialized’ healthcare.

1906: The AALL began to campaign for ‘compulsory health insurance.’ They had models based on programs in England and Germany. The AALL would continue to campaign for compulsory healthcare for years.  Their 1915 Review of Labor Legislation article stated: “To create a minimum below which no human being can fall is the most elementary duty of the democratic state.”

1910: Medical Education in United States and Canada: A Report to The Carnegie Foundation… by A. Flexner.  The 364 page report told of the history of medical education in America and addressed ‘the Proper Basis of Medical Education,’ ‘the Course of Study’ for various medical fields, State Medical Boards, and ‘Medical Schools’ in the various states.  Flexner wrote, “The medical profession is a social organ, created not for the purpose of gratifying the inclinations or preferences of certain individuals, but as a means of promoting health, physical vigor, happiness – and the economic independence and efficiency immediately connected with these factors…”  The reported that their were 91 ‘coeducational Medical Schools’ in 1909 with 752 ‘women students.’

http://archive.carnegiefoundation.org/pdfs/elibrary/Carnegie_Flexner_Report.pdf

1910: Montgomery Ward & Co. contracted with London Guarantee and Accident in New York for the ‘Nation’s first GROUP HEALTH INSURANCE policy;’ it paid weekly benefits up to ½ the employee’s weekly salary if injured or due to illness.  It paid the employee directly.

1911: Wisconsin established a workmen’s compensation system, followed by 9 states that year.

1912: Theodore Roosevelt’s Progressive Party campaigned for health insurance for industry.

1914: The AMA began to support the AALL proposal for compulsory Health Insurance.  It was still opposed by the American Federation of Labor (founded 1886).

1917: According to www.va.gov ‘history:’ “As the U.S. entered World War I in 1917, Congress established a new system of Veterans benefits, including programs for disability compensation, insurance for service personnel and Veterans… The first consolidation of federal Veterans programs took place August 9, 1921, when Congress combined all WWI Veterans programs to create the Veterans Bureau (Department of Veterans Affairs).”  4.7 million Americans fought in World War I.  (Expenditures for veterans increased 62% from 1924 to 1932.

1917: California Social Insurance Commission was formed to “report upon the various systems of social insurance …in different countries …cost of medical aid …present facilities… the present extent of voluntary health insurance in California through fraternal orders, trade unions and commercial insurance companies.”  The Report of Social Insurance Commission stated, “There has been a decided change in the attitude of American students of economic and sociological problems towards social insurance methods, so that instead of the general opposition of ten years ago the Commission finds among them at present an almost unanimous support of the compulsory social insurance method of coping with the problem of destitution in this country… Health insurance is the particular branch of social insurance which can and should be developed next in this country…”

1921-1925: Metropolitan Life began selling individual health insurance in 1921

1925: Committee on the Cost of Medical Care (CCMC) was established and issued their final report in 1932 – Medical Care for the American People.  The majority of the Committee in 1932 recommended National Health Insurance either voluntary or compulsory through taxation.  The Editor (Fishbein) of the Journal of the American Medical Association called the CCMC’s work an ‘incitement to revolution… socialist… communist.’

1929: Baylor Hospital Texas Baptist Memorial – 1903) offered a $6 per year (or 50¢ per month) prepaid hospital insurance plan – designed by Vice-President Kimball – to help school teachers at Baylor University and the University Hospital in Dallas to cover the cost of a 21-day hospital stay (75% of Dallas teachers quickly enrolled).  This same year the first HMO began in Los Angeles for the Department of Water and Power with the Ross-Loos Clinic.

1920s-1930s:   Health Care costs were rising; yet at this time, doctors were paid by a system called “fee-for-service.”

1934: President F. D. Roosevelt (1933-1945) appointed the Committee on Economic Security to addressed old-age, unemployment issues; and health insurance and medical care.  A matching state funds approached was suggested to the president.

1935: Social Security Act of 1935: according to www.ssa.gov, “Legislative History… An act to provide for the general welfare by establishing a system of Federal old-age benefits, and by enabling the several States to make more adequate provision for aged persons, blind persons, dependent and crippled children, maternal and child welfare, public health, and the administration of their unemployment compensation laws; to establish a Social Security Board; to raise revenue; and for other purposes… For the purpose of enabling each State to furnish financial assistance, as far as practicable under the conditions in such State, to aged needy individuals, there is hereby authorized to be appropriated for the fiscal year ended June 30, 1936, the sum of $49,750,000, and there is hereby authorized to be appropriated for each fiscal year thereafter a sum sufficient to carry out the purposes of this title…”

1936: Using Kimball’s Baylor plan, the Chicago Plan for Hospital Care was formed and their first policy was effective in January 1937.  They incorporated as Hospital Service Corporation and gained 36,000 members in their first 6 months.  In 1939 they adopted the Blue Cross symbol; and in 1947 the Blue Shield symbol.  Blue Cross for hospital services and Blue Shield represented plans with physician services (operating separately until 1975).  In 1975 the Blue Cross and Blue Shield plans merged under the Health Care Service Corporation.  Independent licensed BCBS associations followed in various states.

1938:  Federal Minimum Wage – set at 25 cents.

Late 1930s-1945-:  According to Kaiser Permanente, “Kaiser… evolved from Industrial Health Care programs for construction, shipyard and steel mill workers for the Kaiser Industrial companies during the late 1930s and 1940s.  It was opened to the public enrollment in July 1945.”  The Kaiser plan was a HMO type.

1942: Congress passed the Stabilization Act directing the president to issue an order to stablilize prices, wages and salaries.   President FDR issued Executive Order 9250 establishing the Office of Economic Stabilization.

1940-1950: According to the Bureau of Labor Statistics, “By 1940, the population of the United States was 132 million with only 12 million – a little less than 10% – covered by some form of health insurance.”  At that time, Blue Cross/Blue Shield held half that market for individuals.  By 1950 “one-half of the U.S. population had some form of health care insurance” and National Health Care expenditures passed 4.5% of GNP.

1942-43:  FDR created the National War Labor Board in 42’ and in 43’ the NWLB called for better benefits to soldiers, and equal pay for women and ‘colored laborers.’

1945: President Truman asked Congress for ‘Universal’ National Health Insurance saying, ““Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”  The AMA denounced Truman’s plan, which some Congressmen called a ‘Communist’ plan or plot.

1945: Senators Wagner, Murray and Dingell (first died in committee 1943 during WWII) proposal according to Aug. 1945, vol. 53; Canadian Medical Association Journal, “… The Journal of the American Medical Association of June 30 publishes a letter from U.S. Senator Robert Wagner… relative to the proposed Wagner-Murray-Dingell bill, which would expand the SOCIAL SECURITY ACT to include a vast program of Medical Care and Hospitalization Insurance…”

1946: Hill-Burton Act: When soldiers came home from World War II they found in 1945 that over 40% of the nation’s counties had no hospitals.  Senators Burton and Hill (whose father was the first surgeon to suture a human heart) had proposed progressive changes for Healthcare, and in 1945 Truman was on board, announcing the need for comprehensive medical insurance tied to Society Security.  In order to get the bill through, Hill added a provision allowing a ‘separate but equal’ clause for segregation (lasted until 1963).  The Act introduced state and local shared-matching funds with Federal ‘seed money’ and a biblical ‘joint tithing’ concept.  The Act provided medical services for free or reduced charges based on income.  By 1968 the Federal Government financed 9,200 new medical facilities under this Act.

1949: Liberty Mutual Insurance Co. issued a Major Medical Insurance policy to supplement basic medical expenses related to facility care and physician care.

1950s: Unions had negotiated for better health insurance and benefits in nearly every major industry, including with U.S. Steel, GM and AT&T.

1951-1967:  Two years after the introduction of Major Medical Health Insurance over 100,000 individuals were covered.  By 1960 it reached 32 million and 156 million by 1986.  According to the Social Security Administration (Bulletin Feb. 1969), by 1967 “between 75% and 87% of the civilian population under age 65 (depending on the source of data) had some form of health insurance coverage of hospital expense;” and about 66% had coverage related to physician visits.  They reported 82% of the civilian population with hospital plans: 73 million in group policies, 37M with individual policies, 67M with Blue Cross plans.

1966: Medicare began its coverage with all qualifying persons age 65 and older automatically covered under Part A.  More than 19 million enrolled.

1972:  Social Security Amendments of 1972 extended Medicare for individuals under 65 with long-term disabilities that qualified.

1977: The Department of Health, Education and Welfare created the Health Care Financing Administration (HCF).   In 1977 over 4.4 million Americans worked in health-related fields.

1980: The Social Security Disability Act of 1980 led to the creation of ‘Medigap’ plans to supplement traditional Medicare.  1982: AMA – ‘net income of practitioners was $99,500.’

1971-1991: Health care costs increased 399% versus 235% for the CPI and 70% higher CPI item.  Enrollment in HMOs increased form 2 million in 1970 to over 37 million in 1991.

1970 to 1990: In 20 years the Health Care costs increased nearly 400%.

1980 to 1989: National spending for physician services rose rapidly $63.1 billion to $117.6 B.

1981 to 1991: Percent of employees participating in Medical care plans decreased from 97 to 83, as required employee average monthly contribution for family coverage increased from less than $28 to $97 (Monthly Labor Review; March 1994).  Average monthly wage: $1,750 (1990).

1985: COBRA (Consolidated Omnibus Budget Reconciliation Act) became law.  It allows insureds to temporarily keep health coverage after their employment ends.  Coverage lasts up to 18-36 months (based on qualifying event) and costs up to 102% of the monthly premium charged to the Employer.  Required only by employers with 20 or more employees.

1993: President Clinton’s Health Care Task Force (600+ experts chaired by HRC) produced the complex 1340+page proposal for the Health Security Act or Clinton Plan.   The New York Times (October 28, 1993) stated, “After nine months of brainstorming and politicking, President Clinton delivered to Congress today a 240,000-word proposal for universal health insurance. It represents the most complex, detailed legislative blueprint devised by any President.”  It sought $1,500 annual individual out-of-pocket limits and $3,000 for families.   It spoke of “a single-payer system… established by state(s)” with ‘mandatory enrollments;’ except for those “optional enrollment of Medicare-eligible individuals (H.R. 3600 – 103rd Congress).”

1996: The Health Insurance Portability and Accountability Act (HIPAA) was enacted. Most significantly it dealt with “preexisting condition exclusions,” and “the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs.”

1998: The www.Medicare.gov webpage was launched.

2010: The Patient Protection and Affordable Care Act was signed by Obama in March.  Many provisions were phased in over 5 years.  The Act increased the age of dependent coverage on parent’s plans to 26.  It extended Preexisting Condition coverage and added mandated employer costs and penalties to individuals and employers for no coverage.  It dramatically increased the number of Americans on Medicare and Medicaid and the about of government subsidies for Americans.  Obamacare prohibited lifetime limits and required coverage of certain ‘essential health benefits.’  It created a Marketplace exchange and due to premium increases saw the reduction in both insurance agent commissions for individual policies (down to $0 in many cases) and insurers on the exchange.

U.S. Healthcare Crisis: 2017

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