Grp 1

• A NEW ERA OF HEALTHCARE: ETHICS OF HEALTHCARE REFORM
• Healthcare Reform in the United States
• Health System Reform in the 20th Century
• Key Provisions of the Healthcare Reform Legislation of 2010 (ACA)
• Ethics Considerations Underlying Healthcare Reform
• In 2010, Congress passed and President Obama signed H.R. 3590, the ACA 2010, and H.R. 4872, the Health Care and Education Reconciliation Act. Together these constitute healthcare reform legislation that represents the culmination of more than a century of efforts to ensure access to high-quality affordable health care for all or most Americans.
• Three ways to provide universal coverage for a population

  • Private insurance coverage is required for all by individual or employer mandate (Bismarck model)
  • The government owns and provides all required medical services (Beveridge or National Health Service model)
  • The government provides health insurance (National Health Insurance model)

  
• The U.S. system is a mixture of these three.
• Otto von Bismarck introduced universal health insurance in Germany.
• Otto von Bismarck introduced universal health insurance in Germany

  1883
• Theodore Roosevelt was the first U.S. president to support the concept of universal health insurance. However, no legislation was introduced into Congress during his term.
• Theodore Roosevelt was the first U.S. president to support the concept of universal health insurance


  1901–1909
• In 1912, he attempted to recapture the presidency as the candidate of the Progressive (Bull Moose) Party. That party's platform included a plank calling for national health insurance, and it was an important part of Roosevelt's presidential campaign. He was not elected.
• The American Association of Labor Legislation (AALL) created a committee on social welfare, which concentrated on health insurance.
• AALL created a committee on social welfare, which concentrated on health insurance


  1912
• In 1914, it recruited physicians to help draft model legislation, which the American Medical Association (AMA) House of Delegates endorsed in 1917.
• AALL recruited physicians to help draft model legislation, which the AMA House of Delegates endorsed


  1914
• Several states (and one Canadian province) introduced bills based on the model; it was defeated in all with intense opposition from the American Federation of Labor (AFL), state medical societies, the insurance industry, and business interests.
• Many of the opposition expressed their positions in ideological terms, characterizing the proposed legislation as socialism, socialized medicine, Bolshevism, or Prussian. For many in opposition, the real motives were the threat to income, fear of government controls, or, in the case of the AFL, fear of losing its power to control what benefits its members had.
• In 1920, the AMA reversed its position from support to opposition, marking the beginning of its opposition to all efforts at reform until the 1990s.
• AMA reversed its position from support to opposition, marking the beginning of its opposition to all efforts at reform until the 1990s

  1920
• The impetus to provide universal coverage stalled during the 1920s and early 1930s.
• It was excluded from the Social Security Act (1935) because President Roosevelt was convinced it would cause the defeat of the pension portion of the bill.
• The Senate introduced a bill that would have enacted government health insurance, but it went nowhere


  1935
• Senator Robert Wagner introduced S. 1620, the National Health Act, to create national compulsory health insurance for all employees and their dependents. Benefits were to include physician's services, hospitalization, drugs, and laboratory diagnostic services. Employer and employee contributions, deposited in a health insurance fund, covered the cost of insurance. If enacted, the plan would have been administered by the states.
• Senator Robert Wagner introduced the National Health Act


  1939
• The bill died in committee. It did not have the full support of President Roosevelt and was strongly opposed by a conservative Congress elected in 1938. World War II also diverted attention from the issue.
• The Wagner–Murray–Dingell Bill was introduced. This bill was introduced, with modifications, repeatedly during the next several Congresses, but it never passed.
• The Wagner–Murray–Dingell Bill was introduced


  1943
• President Truman proposed a single comprehensive, universal national health insurance plan.
• President Truman proposed a single comprehensive, universal national health insurance plan


  1945
• Universal health insurance was part of the Democratic Party platform. Public opinion polls at the time showed that 71% of Americans favored universal national health insurance. Truman did not propose a National Health Service as in the United Kingdom.
• Universal health insurance was part of the Democratic Party platform


  1946
• Senator Wagner introduced a bill to establish national health insurance, but the Republicans had gained control of Congress and the committee killed the bill.
• Senator Wagner introduced a bill to establish national health insurance


  1948
• As employers scrambled for workers in a labor-short market, unions made health insurance one of the most important parts of contract negotiations. At the beginning of World War II, fewer than 10% of Americans had employment-based health insurance. This rose to nearly 50% by 1952.
• Employment-based health insurance rose from less than 10% to nearly 50% by 1952


  WWII
• premiums became tax-deductible. This reduced the broad concern for expanding coverage. By 1980, employer coverage had risen to 80%.
• Premiums became tax-deductible, reducing concern for expanding coverage

  1954
• incremental increases in coverage of the uninsured began, supported by a new set of allies who vote: the elderly.