The site now has the capacity to handle 50,000 concurrent or simultaneous users at one time.
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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The troubleshooter appointed by President Barack Obama to overhaul a bungled health care website rollout said Sunday that improvements had made a "night and day" difference in handling online traffic. The White House has admitted previously that the launch of Healthcare.gov, where people can sign up for health insurance, was a debacle and the Obama administration pledged that the vast majority of potential customers would be able to enroll online by the end of November.
Jeffrey Zients, an Obama advisor recently given the job of finding fixes to end the website woes and get the president's signature policy achievement back on track, said technical problems were being overcome.
"The site now has the capacity to handle 50,000 concurrent or simultaneous users at one time ... so the site will support more than 800,000 consumer visits a day," he said during a conference call with reporters. "We've doubled the system's capacity and Healthcare.gov can now support its intended volume," he added.
Additionally, the website is up and running successfully more than 90 percent of the time -- up from an estimated 42.9 percent through most of October, when people routinely experienced delays or could not gain online access at all.
"The bottom line: Healthcare.gov on December 1 is night-and-day from where it was on October 1," Zients said, citing improvements that include a technical support center monitoring the website 24 hours a day.
Some 400 bugs that were harming the website's operation have been eliminated, he said, though he did not provide data on how many people were signing up for insurance.
"We developed a prioritized punch-list of software fixes, hardware upgrades and user enhancements with the prioritization based on what has the biggest impact on system stability, capacity, speed and user experience," Zients added.
Julie Bataille, communications director for the Centers for Medicare and Medicaid Services said during the call with reporters that 80 percent of users are now able to apply for health insurance successfully on the site.
Healthcare.gov's rollout on October 1 sent Obama's approval rating tanking and pushed some of his fellow Democrats into open revolt, while sparking an opening for gleeful Republicans opposed to healthcare reform. Only approximately 27,000 people were able to subscribe for insurance via Healthcare.gov in October, according to official figures. Obama campaigned in 2008 on the promise of insuring some 30 million Americans who lacked health insurance.
On the Sunday morning CBS television show "Face the Nation" Democratic Senator Robert Menendez said the online debacle was "the equivalent of having a great item that you want to buy in the store, but not being able to get through the front door." Referring to Sunday's website update he said, "It sounds like the front door's been opened successfully now."
The website has been far from Obama's only hitch while implementing the hotly-contested legislation, which was derided by Republicans and only upheld in the US Supreme Court by a narrow 5-4 vote. On November 14, Obama agreed to change the law to try to help Americans whose insurance plans were canceled because they did not meet the more stringent requirements under the new reforms, after previous promises that no American would lose their existing coverage.
"We are two months into a sustained outreach and education campaign that will continue through the end of March," Bataille said, alluding to the need to raise awareness and get people back online to sign up for new health plans.