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 New Zealand woman's 2.2 gallon a day Coca-Cola habit was a major factor in her death, a coroner found Tuesday, urging the soft drink giant to put health warnings on its caffeinated products.
Natasha Harris, a 30-year-old mother of eight from Invercargill in southern New Zealand, drank huge amounts of the fizzy beverage for years before her death in February 2010, coroner David Crerar found.
He said Harris suffered from a number of health conditions which could be linked to the "extreme" amounts of Coke she downed, playing a role in the cardiac arrhythmia that finally killed her.
"I find that when all the available evidence is considered, were it not for the consumption of very large quantities of Coke by Natasha Harris, it is unlikely that she would have died when she died and how she died," he found.
He added that Harris's Coke habit "was a substantial factor that contributed to the development of the metabolic imbalances which gave rise to the arrhythmia".
A pathologist found Harris, who did not drink alcohol, had an enlarged liver due to fatty deposits caused by excessive sugar consumption and low potassium levels in her blood, which can affect cardiac function.
Her family said she complained of a "racing heart" before her death and they considered her addicted to Coke, which she drank throughout her waking hours.
"(She would) go crazy if she ran out... she would get the shakes, withdrawal symptoms, be angry, on edge and snappy," her mother-in-law Vivien Hodgkinson told the inquest into her death last year.
Harris's family told the inquest she had all her teeth removed after they went rotten due to excessive soft drink consumption and at least one of her children was born with no enamel on its teeth.
Crerar said the family had not considered her Coke habit dangerous because the drink did not carry any health warnings.
He recommended "that Coca-Cola give consideration to the inclusion of advice as to quantity of caffeine on labels (in) its products and... adding appropriate warnings related to the dangers of consuming excessive quantities of the products".
He also said authorities should examine whether health warnings were needed and consider lowering the maximum amount of caffeine allowed in carbonated beverages.
However, the coroner also said all the ingredients of Coke were "entirely legal (and) are enjoyed by millions".
"Coca-Cola cannot be held responsible for the health of consumers who drink unhealthy quantities of the product," he said in a written finding.
Coca-Cola Oceania said in a statement that experts had been unable to agree on what caused Harris's heart attack and Crerar had acknowledged that he could not be certain what was behind it.
"Therefore we are disappointed that the coroner has chosen to focus on the combination of Ms Harris' excessive consumption of Coca-Cola, together with other health and lifestyle factors, as the probable cause of her death," it said.