June 28, 2012 --
Today the Supreme Court upheld the 2010 health care law in a dramatic victory for President Barack Obama. The lead up to today's decision has prompted debate between opponents and supporters of the Patient Protection and Affordable Care Act two years ago. Take a look at how we got to the health care system we have in place today.
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Prior to the 20th century, nothing even close to what could be called a health care system existed in the United States. Although the Civil War had led to some medical breakthroughs in terms of surgical techniques and pain management, medical knowledge, techniques and treatment availability at the time left little hope that patients would actually recover from severe ailments. As NPR's Alex Blumberg and Adam Davidson point out, medical treatments may have been downright medieval at the time, consisting of potions. But at least it was cheap. "In 1900, the average American spent $5 a year on health care ($100 in today's money)," they note in their report.
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In 1912, Theodore Roosevelt was the first presidential candidate to get behind the idea of a national health insurance plan. Roosevelt ultimately didn't win election that year. Proponents of government-provided health care tried to press the issue through state initiatives, only to see their efforts fail in 16 states. Roosevelt's plan may have certainly been ahead of its time, particularly since there weren't that many services that doctors could actually provide patients during that era.
At the same time, however, developments within the medical community changed the face of the industry. The horrors of World War I led to advances in the areas of wound care, sanitation, pain management and more, according to an article published in the Journal of the Royal Society of Medicine. Hospitals in the United States began to widely adopt the practice of using antiseptics to sanitize their facilities, preventing the possibility of medical personnel or patients becoming exposed to infection. That decade also saw the introduction of the first employer group insurance contracts (though not specifically for health insurance) as well as the first physician service and industrial health plans.
In 1928, Alexander Fleming made one of the most important discoveries in the history of medicine: penicillin, a life-saving drug used to treat countless millions. It would be decades, however, before penicillin would be mass-produced. Fleming's discovery was the signature achievement in an era that saw medical treatment become more effective, and, as a result, expensive. The Great Depression also fueled concerns about affordability of medical treatment as millions of Americans suddenly found themselves out of work. In 1929, Baylor Hospital provided the first group health insurance plan in the United States through an agreement with Dallas-area teachers. The plan was the forerunner of Blue Cross. The effort wasn't just meant to be in the best interests of patients, but also the hospitals. Patient facilities saw more empty beds as fewer patients during the Great Depression could afford treatment without participating in these collective prepaid health insurance plans.
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As part of his push to create a social safety net for Americans during the Great Depression, President Franklin D. Roosevelt advocated the passage of national health insurance. Roosevelt pushed ahead with efforts to pass Social Security first, a bill which intentionally omitted any mention of medical care to ensure its passage. Harry Truman attempted to carry on Roosevelt's legacy in 1945 by calling on Congress to create such a program. His efforts failed, partly due to criticism by the American Medical Association (AMA), who called the plan "socialized medicine." In this photo taken in 1937, First Lady Eleanor Roosevelt examines a chart of enrollment of health care insurance plans.
Like its predecessor, World War II would lead to new medical advancements, including the widespread adoption of antibiotics and the use of ultrasound. The war would also have a similar effect in terms of the spread of employer-sponsored health plans. Because the nation was in a state of emergency and had a legally mandated wage freeze as a result, employers had to attract workers to assist the war effort by providing them with benefits, including health insurance. Tax laws passed between 1943 and 1945 also gave breaks to employers who provided insurance to their employees, which gave businesses all the more incentive to offer coverage. Following the war, employer-sponsored health insurance became common. In 1951, around 77 million Americans had some kind of coverage, according to an insurance industry trade group. That era also saw one of the most celebrated medical achievements in history: Jonas Salk's polio vaccine.
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Although health insurance was widely available to employed Americans in the mid-20th century, the unemployed and the elderly were often excluded from these plans. President John F. Kennedy campaigned on the issue of insuring these groups. President Lyndon B. Johnson succeeded where Kennedy left off, securing the passage of a bill through Congress creating Medicare and Medicaid. At the bill-signing ceremony, shown here, Johnson presented former president Truman with the nation's first Medicare card. Within the medical industry itself, an increasing number of doctors began specializing in certain fields of medicine rather than acting as general physicians. By 1960, more than two-thirds of doctors reported themselves as full-time specialists, rather than general practitioners.
Starting with Richard Nixon in 1970, presidents have offered successive plans for covering the nation's uninsured, but they have have stalled for different reasons. In 1974, Nixon put forward a plan to cover all Americans through private insurance, only to have the Watergate scandal force him out of office. An economic crisis prevented Jimmy Carter from pushing forward with a national health plan. Congress late in Reagan's second term attempted to expand Medicare, only to have the law repealed the following year. Bill Clinton had a 1,300-page health care reform bill that was never even taken up for a vote in Congress. Since Nixon's presidency, health care costs have continued to rise, often outpacing inflation. This increase is due to a number of factors, including the increased use of new medical technologies for diagnosis and treatment. The Patient Protection and Affordable Care Act signed by President Barack Obama was intended to cover the 30 million Americans who live without health insurance, according to the bill's authors. It has been the most far-reaching piece of health care legislation since Johnson's signed the legislation creating the Medicare and Medicaid health care programs.
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Up to 1.5 percent, or one in 68 U.S. children on average, may have autism, according to new estimates released today by the Centers for Disease Control and Prevention.
This new estimate means that about 30 percent more children may have autism spectrum disorders (ASD) than previously thought. A 2012 report from the CDC estimated that one in 88 children have the condition.
The new report also found that more children with autism may have a high IQ than previously thought. Although some children with the condition have severe intellectual challenges, the new report estimates that about 46 percent of children with autism have average or above average intellectual ability (an IQ above 85), compared with the estimate of one-third of children with autism a decade ago.
For the report, researchers reviewed records from the CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network. They pulled data from 11 community centers where children with developmental disabilities are educated, diagnosed or treated.
The sample of children used in this report is not nationally representative, and the results may not generalize to the entire United States. However it is the most detailed picture, and the best estimate available, the researchers said. [Psychiatry's New Guide: 6 Things You Should Know]
The results showed a wide range in the number of children diagnosed with ASD based on their location, ranging from one in 175 children in Alabama to one in 45 children in New Jersey.
This difference is partly explained by the way data was gathered, for example, in Alabama, researchers had limited access to children's educational record.
In line with previous studies, the data continue to show that autism is almost five times more common among boys than girls: one in 42 boys have autism, compared to one in 189 girls. White children are 30 percent more likely to be diagnosed with autism than black or Hispanic children.
It is unclear exactly how much of the rise in diagnoses is due to increased awareness of the disorder, and how much is due to a true increase in prevalence, researchers said. It could be a combination of both, they said.
"Community leaders, health professionals, educators and childcare providers should use these data to ensure children with ASD are identified as early as possible and connected to the services they need," said Coleen Boyle, director of CDC’s National Center on Birth Defects and Developmental Disabilities.
Researchers found most children were diagnosed after age 4. The condition can be diagnosed as early as age 2, and children can be enrolled in early intervention services, the researchers said.
"Early identification is the most powerful tool we have right now to make a difference in the lives of children with autism," Boyle said.
Autism spectrum disorders are characterized by deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests or activities.
"The most important thing for parents to do is to act early when there is a concern about a child’s development," said Dr. Marshalyn Yeargin-Allsopp, chief of CDC’s Developmental Disabilities Branch. "If you have a concern about how your child plays, learns, speaks, acts or moves, take action. Don’t wait."
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This story originally appeared on LiveScience.com.
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