A scientist separates blood cells from plasma cells to isolate any Ebola RNA in order to test for the virus at the European Mobile Laboratory in Gueckedou, a remote corner of Guinea.
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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As the Ebola outbreak continues to spread throughout West Africa and some U.S. hospitals test sick patients for the virus, researchers are hard at work looking for ways to trick the highly-contagious, highly lethal organism.
They are using tools of molecular biology to mimic or interfere with the virus to make vaccines or treatments for the next outbreak. Many of these drug candidates are still stuck in the laboratory, pending federal approval and private money.
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The evolving and sporadic nature of Ebola has made it tough for researchers to follow the well-worn path for drug development, according to Justin Julander, research associate professor of virology at Utah State University, who is working on ways to use animal models to test drugs for Ebola, yellow fever and other super-diseases.
“The outbreaks are so random, you may have a huge problem,” Julander said. “It’s difficult to plan a clinical trial for something like Ebola.”
Here’s a rundown of current research:
Tobacco plant monoclonal antibodies The two American aid workers struck with Ebola in Liberia received emergency doses of a brand-new, untested drug made inside tobacco plants, according to Bloomberg News. The drug is made by San Diego-based Mapp Biopharmaceuticals. Genes for the antibodies against Ebola are combined with genes for a natural tobacco virus. The tobacco plants are then infected and the infection results in the production of new antibodies. The plant is ground up and the antibody is extracted.
Horse-killer Vesicular stomatis virus (VSV) affects horses and cattle and is spread by flies. But researchers are using it to deliver an antibody for Ebola’s surface coating. This vaccine is being developed by Canadian health authorities and a New York firm. It has protected monkeys in animal tests against the same strain of Ebola now in West Africa.
RNA interference Ebola blocks the body’s own antibodies, such as interferon. The drug BCX4430 blocks Ebola’s own messenger RNA from replicating. The drug was initially designed for bioterrorism outbreaks and its early development is funded by the U.S. military and produced by Tekmira.
A scientist separates blood cells from plasma cells to isolate any Ebola RNA in order to test for the virus at the European Mobile Laboratory in Gueckedou, a remote corner of Guinea.STRINGER/Reuters/Corbis
Convalescence plasma This age-old method was used by Dr. Keith Brantly, the American doctor infected while helping patients in Liberia. He was administered a serum taken from a local patient who survived Ebola and still had live antibodies in his system. The problem is that it only works during an outbreak, and only for that particular viral strain.
Common to all of the methods above -- drug treatment or vaccine -- is that they haven’t gone through clinical trials to assess whether they are both safe and effective in humans. While the National Institutes for Health and the Pentagon may fund early stage efforts with animal models, which are less expensive, drug companies are needed to come up with the millions of dollars needed for full-scale drug trials with human volunteers.
“A lot of these things are early days because they have not gone through phase 1 yet,” said Gaya Amarasinghe, assistant professor of pathology and immunology at the Washington University School of Medicine.
“A single approach is not going to be useful," Amarasinghe said. "There are circumstances where vaccines may be useful, or therapeutics and small molecules may be useful. The monoclonal antibodies may not be possible in a rural, high temperature setting. Multiple approaches are needed and a much better view of the basic science needs to be known.”
Despite the obstacles, some experts believe that this most recent outbreak will force both health agencies and pharmaceutical firms to commit the scientific and financial resources to stop Ebola more quickly.
“We learn from all these outbreaks,” said Heinz Feldmann, chief of the virology laboratory of the National Institute of Allergic and Infectious Diseases in Hamilton, Mont. “In developed countries such as the United States, they are not endemic. But in nations where they are endemic, we have a responsibility to help them. I hope this outbreak will trigger policy-making authorities to release the money to be ready for the next time.”