The health of any nation should be a top priority for leaders and elected political representatives, but in the United States it took several centuries for the nation to begin to come to terms with providing health care for its citizens. This paper covers the gradual implementation of health care services and doctor training facilities in the U.S., and also covers the recent attempt by President Barack Obama to reform a chaotic, poor-functional and expensive health care system. Thesis: It is a scandal of massive proportions that a well-functioning, citizen-friendly universal health care system cannot be instituted in America, the world's most democratic superpower. Until the divisive and toxic political climate can be reformed, there is no chance of major reforms -- or for universal health care coverage -- in these United States.
Past Health Care Services -- Early America
Health care in colonial America in the 16th and 17th centuries was very primitive, and when the first settlers arrived from Europe, they found that the native peoples endured what Robert L. McCarthy and Kenneth W. Schafermeyer describe as "significantly high mortality rates" (McCarthy, et al., 2007, p. 9). The Native Americans suffered from malnutrition, violence, accidents, fungal infections, anthrax, tapeworms, syphilis, yaws, and tuberculosis, the authors explains (9). Add to that the fact that the European settlers brought diseases with them, including influenza, which had not been experienced in North America previously, and such new illnesses as "malaria, yellow fever, smallpox and measles" (McCarthy, 9).
The result of the new settlers' arrival with diseases the native peoples had no resistance to was "…a catastrophe of monumental proportions that resulted in the destruction of a large majority of the indigenous population and facilitated European domination of the Americas" (McCarthy quoting Gerald Grob on page 9). As to the settlers themselves, they arrived on the shores of the "New World" somewhat "debilitated from sea travel" and in the first months and years in North America many fell victim to dysentery and malnutrition, which McCarthy explains was due to poor food and water supplies (9).
McCarthy goes on to detail what the colonists tried to do to upgrade the disposal of garbage, to maintain clean streets, and to implement certain sanitation policies with regard to water and human waste; however the colonists received "little success in enforcement" (9). So basically there were no policies per se in regards to healthy communities and healthcare for citizens.
The British government had not implemented any "broad public policies to address problems of health and illness" nor had the British encourage the establishment of "health practitioners or institutions" to provide health care for the colonists, McCarthy goes on (9). As was stated earlier in this research, health care ideas and solutions were very primitive in the colonies. Indeed, when colonists became ill, they tended to use "healing arts" and they also turned to "religious comforts" because there were few if any physicians available, McCarthy explains on page 10.
The healing arts used by the colonists included improvised materials that "relied on a combination of folklore: mineral, plant, and vegetable herbal remedies" and magic, McCarthy continues. Mercury and opium preparations were also commonly used, as well as the Native American health remedies like "cinchona bark" which contains quinine (10).
In fact, the British physicians that could have come over to the New World and administered health care services resisted making the epic crossing of the Atlantic because they did not look to the colonies, "which had small and widely scattered populations, as locations that offered great professional or economic opportunity" (McCarthy, 10). In other words, there was no money to be made in the colonies so the doctors stayed put in England.
Past Health Care Services -- 18th & 19th Century America
Harry A. Sultz and Kristina M. Young explain in their book that women in colonial America treated the sick at home and used "medicinal herbs, the advice of friends, and some self-help publications of questionable credibility" (Sultz, et al., 2010, p. 151). The European physicians that did come over during the colonial period -- McCarthy had asserted that very few came due to the lack of salary available in the New World -- trained others in apprentice relationship situations. There was of course no formal method of testing these trainees to see if they really had acquired sufficient doctoring skills, and the newly trained "physicians" were "free to practice with no outside control," Sultz explains (152).
There still were no policies regarding the health care of the colonists in 1756, but the very first medical school was established in Philadelphia at that time. Another medical school was founded in 1768 at what is now Columbia University, albeit both schools combined only graduated "a handful of students each year," Sultz reports (152).
Interestingly, the most common way for doctors to be trained (through the middle of the 18th century) was through the apprentice format (and not through medical school training) and so the Philadelphia Hospital began to "…charge students who were not apprenticed to physicians on the staff" (152), Sultz continues. Soon, the Philadelphia Hospital actually charged an "aspiring physician" a fee in order for that aspiring physician to be "formally apprenticed" to the hospital for five years, and after the five years the candidates were given a certificate that proves they had the training, Sultz explains (152).
What policies were in place to help ensure that health care in the early development of the U.S. was being given serious consideration? By the year 1800 there were only six medical schools in the country, but they were gradually gaining credibility, Sultz goes on; in 1821 Georgia became the first state to restrict medical licenses to those who have graduated from medical schools. Clearly the MD degree was becoming "the standard of competence"; and in fact by 1892 Harvard became the first medical school to make four years of study the requirement for a medical degree and Johns Hopkins had its own 4-year requirement in place by 1893 (Sultz, 152).
[It is worth noting that at the start of the Civil War, health care and sanitary conditions in the United States were "deplorable"; no army nurses and no "organized medical corps" were on hand to treat the wounds of the soldiers (Daly, 2005). Thanks to the "few hundred sisters from religious orders" -- all volunteers -- the sick and wounded did receive some attention, Daly explains. And in June, 1861, recognizing the glaring lack of health care for Union soldiers, President Lincoln's Secretary of War appointed iconic humanitarian nurse, Dorthea Lynde Dix, to supervise the training of Army nurses (Daly) and Dix held "rigid standards."]
Medical societies began to emerge in the 18th century and by the turn of the 19th centuries almost all the states had medical societies, Sultz explains. In 1847, the American Medical Association (AMA) was founded and in 1876 the Association of American Medical Colleges (AAMC) was founded by 22 medical schools. The establishment of those organizations was a good step towards providing a more reliable and acceptable way of training doctors, but more profoundly important to the development of health care in America was the establishment of the Council on Medical Education (by the AMA) which created the Journal of the American Medical Association (JAMA).
This was important because the JAMA -- with support from the Carnegie Foundation -- began to "investigate and rate medical schools" (Sultz, 154). Led by Abraham Flexner of the Carnegie Foundation, all 155 medical schools were visited, studied, and rated in Flexner's 1910 report called "Medical Education in the United States and Canada" (154). Sultz believes the research conducted and published by Flexner was the "most important educational reform" that the AMA contributed because the report "…was an accurate and searing description of abuses in the medical schools" (154). Some of the schools were a "disgrace" and a "plague spot," according to the report. Some schools even closed, due to the blistering honesty that Flexner portrayed in his narrative; but the most vital result of the report at that time was to stimulate support for medical education "…from foundations and wealthy individuals" (Sultz, 154).
Health Care Services -- 20th Century America
The National Health Survey of 1935-1935 was, according to Dr. George Weisz, the first national survey to focus on "chronic disease and disability" (Weisz, 2011, p. 438). By focusing on "morbidity" the reformers that pushed for this review could argue (based on reliable data) that the "health status of Americans was poor" and the survey also provided "strong links between poverty and illness" (Weisz, 438). The survey is believed to be the last large-scale publicly financed epidemiological survey" in the U.S. that was launched to support "radical health care reform," Weisz continues. The National Health Survey served to become "the main data source" on which the federal government "framed its health proposals," Weisz concluded (446).
Meanwhile, by the 1950s and 1960s the federal government was providing research grants to medical…