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.
How the Civil War Changed Modern Medicine
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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Washington (AFP) - A girl who was born HIV-positive but was treated early and showed no signs of the disease for years has seen her infection return, US doctors said Thursday.
The girl's story had raised hopes that doctors may have found a way to cure young children who are born HIV-positive, simply by giving them strong anti-retroviral drugs shortly after birth.
"Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child's care and the HIV/AIDS research community," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Known widely as the "Mississippi baby," she was born to an HIV-positive mother in 2010 and was given a potent dose of anti-retroviral medication 30 hours after birth.
She continued taking the medications until the age of 18 months, when doctors lost track of her. When she returned five months later, doctors could find no sign of the virus, even though she had not been taking her daily pills.
The child continued to stay off treatment and showed no sign of the virus for more than two years.
"Typically, when treatment is stopped, HIV levels rebound within weeks, not years," said Deborah Persaud, professor of infectious diseases at the John Hopkins Children's Center in Baltimore.
Persaud described the child's response as "unprecedented."
Now age four, she was tested during a routine clinical care visit earlier this month, and was found to have detectable HIV levels in her blood.
She also had a decreased T-cell count and the presence of HIV antibodies, signaling that her body was fighting the infection and that HIV was actively replicating again in her body.
The girl, whose identity has not been released, is now being treated once again with anti-retroviral medication and is doing well, Fauci said.
"The case of the Mississippi child indicates that early anti-retroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for anti-retroviral medication over a considerable period," said Fauci.
Researchers must now turn their attention to understanding why and how the child went into remission, with the hope of extending that time period even further in future cases, he said.
The Mississippi baby's case was detailed in the New England Journal of Medicine in 2013.
Earlier this year, researchers reported a second case of an infant, this time in California, who was treated within hours of birth and whose HIV remained undetectable nearly a year later.
However, that child was still taking anti-retroviral drugs, and doctors said they would not consider taking her off them until she reached the age of two.