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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A religious couple in Calgary, Canada, face trial following the death of their toddler son who died in November of 2013, allegedly brought about due to a belief-based diet and lack of medical care.
The coroner determined that the parents, who are Seventh Day Adventists, hadn’t taken their 14-month-old boy, John Clark, to a doctor since birth and are strict vegans. According to an article on CTV News:
“An autopsy and additional tests confirmed the child’s death was the result of a Staph infection complicated by malnutrition. According to police, the parents, Jeromie and Jennifer, attempted to conceal the infant’s failing health. ‘We believe that the family followed a strict dietary regiment based on their beliefs,’ said CPS S/Sgt. Doug Andrus.”
Calgary police determined that John Clark was not born at a hospital but instead at home—a lawful practice, but one that led to the child not receiving any neonatal care or indeed any medical attention at all during his life. The infection the boy died from would have been easily treatable with antibiotics had his parents brought him to medical attention during its early stages. The child, weakened by the extreme vegan diet enforced by his parents, was not healthy enough to allow him to recover on his own.
The Seventh Day Adventist Church is known for promoting a healthy lifestyle among its members, including not smoking, avoiding “unclean” food products mentioned in Leviticus (such as pork) and vegetarianism. The church does not officially endorse veganism, though according to an article in the Calgary Sun, “more than 60 percent of Adventists are vegetarian.”
The rise over the past decade of health eating, driven by a renewed health consciousness, has also given rise to an increase in the number of babies and children dying of starvation induced by their vegetarian and vegan parents. As an article in “The New York Times” notes:
“A vegan diet is dangerous for weaned babies and toddlers, who need plenty of protein and calcium. Too often, vegans turn to soy, which actually inhibits growth and reduces absorption of protein and minerals. That’s why health officials in Britain, Canada and other countries express caution about soy for babies.”
This is not the first time that parents have gone on trial for child abuse or neglect for refusing their children medical attention. Some religions cite Biblical scripture favoring prayer and faith over modern medicine.
Other religions, including Followers of Christ Church, Christian Scientists, and Scientology, have doctrines that prohibit or discourage followers (and, by extension, those in their care) from modern medicine. Jennifer and Jeromie Clark are charged with criminal negligence causing death and failure to provide the necessities of life.