The history and political impact of national health care reform

National Health Care Reform

The history of national health care legislation is one that is mired with political controversy and frustration since as long ago as the 19th century. Healthcare, mildly stated, is a very personal issue -- especially when, in this day and age, about half of the bankruptcies filed are a consequence of medical bills; of those, 75% of filers had health insurance (Pibel 2006). In the last year and a half, Americans have seen the controversy and the frustration, but national health -- or universal health care as it's been aptly named -- has been a topic for over 150 years. In 1854, the Bill for the Benefit of the Indigent Insane, was proposed and it proclaimed that it would set up asylums for the poor people who suffered from insanity -- as well as the blind, deaf, and dumb, through federal land grants to the states. Dorothy Dix was the activist responsible for the proposal and it was passed by both houses of Congress -- only to get vetoed later by President Franklin Pierce (Crockett 2002, 216).

In the 1912 presidential election, progressive health care reformers supported Theodore Roosevelt, but Roosevelt was defeated. In the year 1933, during the Great Depression, Franklin D. Roosevelt asked for draft provisions to be made to Roosevelt's pending Social Security legislation in order to incorporate publicly funded health care programs. However, the reforms were viciously criticized by the American Medical Association (AMA) along with state and local affiliates of the AMA as obligatory health insurance. In 1934, Roosevelt created an advisory Committee on Economic Security to determine the best manner in which to protect people "against misfortunes which cannot wholly be eliminated" (Quadagno 2006, 22). Roosevelt removed the health care provisions from the bill in 1935. The worry of organized medicine's resistance to universal health care became the norm for many decades after that.

After World War II, president Truman proposed national health care, but the idea was completely overpowered by opposition. The National Mental Health Act, however, was passed in 1946.

Medicare was signed into law in 1965, but not without controversy. Before the legislation was signed into law, a Virginia physician sent a letter to Representative Aime Forand (D-RI), who was the sponsor of the legislation, stating he "should be castrated and his progeny die in embryo" (Quadagno 2006, 9). Medicare was, on one hand, a win for the reformers, but it was also a winning situation for providers. Medicare wouldn't interfere with the health care system; they would simply serve as a neutral channel through which the federal funds would pass (9).

President Bill Clinton was a major proponent of health care reform as was First Lady Hillary Clinton -- yet, their 1993 health care plan wasn't signed into law. HIPAA (Health Insurance Portability and Accountability Act) in 1996, though, made sure that employees could maintain health insurance coverage in the event that they lost of changed their jobs and in the event that COBRA ran out.

In 2003, president George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act, which would offer a prescription drug plan for elderly and disabled citizens (Christensen et al., 2008, 239).

Barack Obama's Universal Health Care reform plan would create what was coined a National Health Insurance Exchange. The plan would include private insurance plans and Medicare-type plans. Coverage would be mandatory, no matter what the individual's health was, and premiums would not differentiate based on an individual's health status either. Simply stated, Obama's health care proposal would require that all children have health insurance, and employers offer health benefits or at least contribute to the cost of the new public program. Expand Medicaid and SCHIP individuals without access to other public programs or employer-based coverage could enroll in a new public plan, like Medicare, or in a range of approved private plans.

Obama's plan would require that all children have health insurance as it would require large employers to provide "meaningful" coverage or give a percentage of payroll monies to toward the costs of the public plan; small businesses would be exempt from this requirement (Kaiser Foundation 2010).

Obama's health care reform will make health care more accessible and more affordable and make insurers more accountable, as well as expand health care coverage to every American and make the health care system sustainable by stabilizing family budgets, the economy and the Federal budget.

The cost of Obama's overall health care bill will cost approximately $940 billion over 10 years, according to the Congressional Budget Office. The bill will include that by the year 2014 there will be significant health access reforms. Insurers will be prohibited from denying coverage to people with medical problems of charging them more money (CBS 2010).

While these numbers do sound manageable, Congress has not responded kindly to Obama's health care reform ideas. When Obama has even mentioned the idea of health care for illegal immigrants, the president was rudely interrupted by a heckler yelling, "you lie" ( ). Under Obama's proposal of health care reform, all Americans will have health insurance and the requirements will be similar to the rules that we have for mandatory auto insurance. It would also order business to, 1) offer health care coverage to employees or contribute to covering their costs of obtaining coverage (CNN 2010).

While Congress may not be confident in Obama's health care reform, Americans, in general, are still confident. Although, it should be noted, that Americans have lost a significant amount of confidence in the healthcare ideas of Obama and the rest of the democrats that are in Congress. What is obvious is that the debate of health care has raised very sensitive issues in all of America. Even members of Congress have witnessed hate crimes against them (McGowan 2010).