Healthcare

HEALTHCARE IN THE United States encompasses myriad activities, from basic research performed under the National Institutes of Health to Medicaid, which provides medical care to the very poor. Even though the federal government does not provide Americans with actual health insurance, it nonetheless funds over half of the nation's overall health expenditures. Because the United States does not have national health insurance, however, the discussion of healthcare in America tends to revolve around that issue. The fragmented nature of the U.S. healthcare system reflects the dominance of conservative, right-wing views that oppose government financing of medical care.

Until the 20th century, government influence over healthcare was minimal. In 1798, the state began a program of health insurance for mariners, but that was the extent of its involvement. At the turn of the century, during the Progressive era, a noticeable shift occurred in government toward healthcare. Theodore Roosevelt enacted the Pure Food and Drug Act, which governed the contents of food and drug products for the entire country. By 1914, most states had enacted workmen's compensation laws to handle injuries and illnesses related to employment. Following on the heels of this development and the enactment of the British program of national health insurance for workers, Progressive reformers initiated a call for compulsory health insurance for low-income American workers. Such action occurred at a time when American medicine was undergoing considerable reform as well, calling on the state to regulate medical education and licensing requirements. It was in that atmosphere that reformers commenced their campaign for compulsory health insurance and alliances began to form right and left.

Health insurance was a new concept at the turn of the 20th century. Only since the late 19th century had medicine begun to exhibit curative powers with the new discoveries of antisepsis and anesthesia. Hospitals had traditionally served as refuges for the poor until new technology, such as the X ray, forced patients to come to a central location for treatment. Doctors prided themselves on the sliding scale they used to charge patients based on the patient's ability to pay. Likewise, the American Medical Association (AMA), founded in 1846, began to renew itself into a powerful professional and political force determined to preserve the autonomy of the profession. Alarmed by the threat of state control, healthcare came into the political arena and forces took sides on the right and left. From the perspective of the right, which included organized medicine, the most desirable situation for the nation's health would be to preserve the sacred trust of the doctor-patient relationship while funneling funds through complementary channels such as research and infrastructure.

The doctors allied themselves with powerful business interests in the legislative battles that followed. Leaders of big business were particularly helpful against compulsory insurance because they opposed provisions that would force them to pay part of the cost for their employees' medical care. The Progressive movement coincided with a surge in the labor movement, and so conservative business leaders, fearful of socialism, took steps to stem the tide of worker discontent with welfare capitalism. Under this system, employers provided various “welfare” benefits to workers, including limited medical care. Eventually, employers looked to new group-health insurance policies that were being offered by large insurers, again to stymie the efforts of reformers. In the legislatures and in Congress, the insurance industry and organized medicine elevated lobbying efforts to new heights as they struggled to maintain their autonomy from government interference. In 1920, the AMA declared the issue of compulsory health insurance dead.

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