[HE] FG#1

• He introduced universal health insurance in Germany in 1883.

  Otto von Bismarck
• Otto von Bismarck introduced universal health insurance in Germany in 1883.
• By the early 20th century, essentially all European democracies had “sickness insurance,” either provided by government or mandated and provided by labor organizations or guilds, frequently with government subsidy.
• In Britain, Germany, and Russia, the motives were less altruistic than in some other nations. In those countries, the motive of conservative governments was to co-opt political positions held by labor, socialist, and communist parties.
• Was the first U.S. president to support the concept of universal health insurance.

  Theodore Roosevelt
• In _____, Theodore Roosevelt attempted to recapture the presidency as the candidate of the Progressive (Bull Moose) Party.

  1912
• This party’s platform included a plank calling for national health insurance, and it was an important part of Roosevelt’s presidential campaign.

  Progressive (Bull Moose) Party
• In 1912, they created a committee on social welfare, which concentrated on health insurance.

  American Association of Labor Legislation (AALL)
• In 1914, AALL recruited physicians to help draft model legislation, which the American Medical Association (AMA) House of Delegates endorsed in 1917.
• 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.
• The impetus to provide universal coverage stalled during the 1920s and early 1930s.
• 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.
• In 1939, Senator Robert Wagner introduced S. 1620, the National Health Act, to create national compulsory health insurance for all employees and their dependents.
• The Wagner–Murray–Dingell Bill was introduced in 1943. It would have provided comprehensive medical insurance for people covered by the Social Security program, both working and retired, and needy persons.
• In 1945, President Truman proposed, in a special message to Congress, a single comprehensive, universal national health insurance plan.
• In 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.
• In 1948, universal health insurance was part of the Democratic Party platform and one of the issues on which Truman campaigned most strongly.
• In 1954, premiums became tax-deductible.
• In 1960, incremental increases in coverage of the uninsured began, supported by a new set of allies who vote: the elderly.
• The Kerr–Mills Act, authorizing the federal government to make grants to states to subsidize costs for the elderly “medically indigent,” became law.
• It took another 5 years and President Johnson’s formidable persuasive skills for Medicare, covering all Americans over 65, to be enacted into law.
• Medicaid, designed to provide care for needy children, was passed in the same Social Security Act of 1965.
• In 1971, President Nixon proposed a plan of compulsory employment-based health insurance for all workers and their dependents.
• From then until the Clinton administration, the main government healthcare agenda was cost control, not access.
• In 1993, the Clinton administration rolled out the Clinton National Health Security Plan.
• It mandated employer coverage through purchasing alliances, defined a standard benefits package, relied on premium price competition among private health insurers to control costs, and subsidized premiums for those under 150% of the federal poverty level.

  Clinton National Health Security Plan
• By 2010, the fraction of the population lacking health insurance had reached more than 16%, a number that has increased steadily since the Census Bureau first began to gather this data in 1980.
• The United States has the most expensive health care of all Organization for Economic Cooperation and Development (OECD) nations, both in terms of per capita expense and as a share of the gross domestic product (GDP).
• Rising numbers of the uninsured, quality lapses, and rising costs have given impetus to recent efforts to reform the system with three goals in mind:

  ■ Greater access to care ■ Improved quality ■ Cost control
• Early in 2009, the 111th Congress of the United States began to consider a number of healthcare reform bills introduced by both the House and the Senate.
• After a great deal of debate and a number of compromises, Congress passed H.R. 3590 (Public Law 111–148), the ACA 2010, and H.R. 4872 (Public Law 111–152), the Health Care and Education Reconciliation Act, in:

  March 2010
• 2010: Insurers may not deny children coverage because of preexisting conditions. In addition, young adults up to age 26 can be covered by their parents’ health plans.
• 2011: Copayments for Medicare preventive services, including an annual comprehensive risk assessment and prevention plan, are phased out.
• 2012: Performance- and efficiency-based Medicare payments to providers are begun.
• 2013: Simplified and uniform insurance claims processing and payment are introduced
• 2014: All citizens and legal residents are required to have health coverage through employers, individually purchased plans, Medicaid, or Medicare or pay a penalty (phased in over several years).
• 2016: States may form interstate compacts allowing insurers to sell across state lines.
• 2018: Taxes are imposed on “Cadillac” healthcare plans with annual costs of more than $10,200 for individual coverage and $27,500 for family coverage (indexed to 2010-dollar purchasing power).
• 2020: There is a phase-out of the Medicare Part D coverage gap (donut hole).
• Some argue that health and health care are social goods, that is, that the health of individuals is good for society and all of its members. This is a kind of contractarianism or communitarianism.