How’s it going, Bad Things Family?
In this episode we touch on topics such as the development of the healthcare system in
the United States and hot button issues such as universal health care and socialism.
Tempers can flare when discussing this in the United States, so we’re interested in
hearing your opinions.
Keep watching to find out who really benefits from the current US healthcare system.
Have you ever visited a doctor in the United States?
If so, then you might be all too familiar with the ridiculously complicated web of insurance
coverage and medical billing.
Amazingly, the system that people depend upon for lifesaving treatment can easily financially
ruin those it is supposed to save.
What’s even more infuriating is that people in the United States have been asking for
universal health care for over a century.
Why has the idea been met with such resistance?
And who really benefits from the current healthcare system?
The first Federal public health initiative was signed into law by President John Adams
in 1798.
It was intended to provide prepaid medical care for sailors who entered US ports.
Every sailor paid 20 cents per month into the plan.
The funds were then used to provide medical care and build hospitals that provided medical
services.
The next initiative for public access to health care didn’t occur until 1854.
Dorothea Dix was an advocate for the mentally ill throughout most of the 19th century.
During the Civil War, she was superintendent of Army nurses.
After the war she created the first generation of mental asylums.
She proposed the Bill for the Benefit of the Indigent Insane.
It would have provided federal land grants to the states for the creation of asylums
for the insane, as well as facilities for those who were blind and deaf.
The bill passed both houses of Congress and appeared to be on its way to becoming law.
President Franklin Pierce vetoed it, stating that the federal government should not be
in the business of social welfare.
After the Civil War, attitudes in the US government shifted concerning social welfare, though
only for specific individuals and for a limited time.
A system of medical care in the south known as the Freedmen’s Bureau was established.
Several hospitals were built to treat over one million former slaves, many of whom were
sick or dying.
This program only lasted from 1865 to 1870, then it was back to business as usual.
The next notable attempt to enact universal health care was in 1912.
Theodore Roosevelt ran for a third Presidential term as a member of the Progressive Party.
He lost, but the party continued advocating for a form of health insurance provided by
the states.
The initiative failed, at least partially because the American Medical Association was
completely opposed to the idea.
It called any attempt at public health care “socialized medicine”, with the understanding
that all things socialist were bad.
While advocates in the late 19th and early 20th century pushed for some form of universal
healthcare, the framework of modern private insurance was just getting started.
Some employers, starting in the 19th century, provided industrial sickness insurance to
employees.
The overhead was low for companies because the plans were self managed.
Most importantly, only employees were allowed on the plan.
If somebody was too sick to work, then they couldn’t access the insurance.
By making sure only productive, healthy employees joined the plan costs were kept low.
As an added bonus for companies, workers in the US became accustomed to having their health
care provided by employers.
When the world economy crashed in 1929, and the Great Depression was in full effect, another
attempt was made to implement a universal health care plan.
In 1933, while working on Social Security legislation, Franklin Roosevelt wanted it
to contain provisions for publicly funded health care options.
He had to remove these provisions in order to get the final bill passed.
The American Medical Association attacked this plan as well, claiming it was “compulsory
health insurance”.
In the late 1930s, individual hospitals began offering their own insurance programs.
The first was provided by groups of hospitals, and was called Blue Cross.
Another was offered by groups of physicians, and was called Blue Shield.
In the 1940s, Congress passed legislation to support these third party insurers, which
in turn led directly to the private insurance scheme that is standard in the United States
today.
The private insurance industry achieved another milestone in growth during World War 2.
During the war, the Federal government implemented wage and price controls.
Companies managed to attract talent anyway by offering health insurance benefits instead
of increased pay.
This system is still in place today.
Its defining characteristic is its tendency to use third parties instead of letting patients
pay doctors and hospitals directly.
After the war, Harry Truman wanted to continue with reforms introduced during Roosevelt’s
New Deal legislation.
Truman referred to this as the Fair Deal, and wanted universal health care to be an
important part of it.
As usual, opposition managed to stop any progress.
In 1951 the IRS ruled that group insurance premiums paid by employers were a tax deductible
expense.
This ruling made sure that third-party insurance companies became the primary, and sometimes
the only way that people could access affordable healthcare.
In the 1960s and 1970s, public opinion changed slightly.
The plight of elderly without health insurance became a national concern.
President Lyndon Johnson proposed medicare and medicaid, a social insurance program administered
by the government which provided coverage mostly to those over 65.
The American Medical Association and private insurance companies all opposed the program.
The opponents said it would increase costs, represented socialized medicine, and was generally
unAmerican.
Johnson was able to get the bills passed despite their objections, making sure they became
law in 1965.
Richard Nixon was the next President to oversee an expansion of public health care, meager
though it was.
He signed the Social Security Amendments of 1972 bill, which extended medicare coverage
to those under 65 who were disabled.
Over the next 37 years, various attempts were made to reform health care but they all failed.
Occasionally bills were passed to help with certain details, but there was no major legislation
which affected private insurance or controlled costs.
This changed when the Patient Protection and Affordable Care Act (sometimes referred to
as Obamacare) was signed into law in 2010.
The new law tried to ensure that health insurance was available to everyone.
Part of how it did this was forcing insurance companies to cover people with pre-existing
conditions.
Also, a mandate was included which required people to purchase insurance.
Furthermore, insurance companies had to offer plans that were affordable to individuals.
Various parts of this bill have been challenged in the years since, but the law is still in
effect.
Clearly the US Federal government is not going to reform healthcare again anytime soon.
But, it doesn’t prevent the states from doing it.
As a result, some states have taken it upon themselves to implement universal health care,
or at least take steps in that direction.
Minnesota, Massachusetts, and Connecticut all have plans that provide healthcare to
residents of those states.
Unfortunately, this has led to an influx of uninsured people moving to states that offer
coverage.
Overcrowded waiting rooms and overworked physicians are the inevitable result.
Many states, like California and Oregon, have tried to pass single payer health care in
the past.
Those attempts have failed, with the exception of Vermont.
In May 2011, Vermont became the first state to pass legislation establishing universal
healthcare.
This would seem to be progress.
But, in December 2014, the Governor of Vermont suspended implementation of the plan due to
its high cost.
So how well does the current private insurance system work in the US?
The unfortunate answer is that it works very well for the insurance companies, but not
so well for the patients.
In 2011, the Census Bureau reported that 60% of Americans have health coverage via an employer.
This of course means that almost half of the population has no insurance at all, at least
at that time.
And although hospital Emergency Rooms will perform life saving procedures on anyone in
need, any care beyond that usually requires private insurance.
Millions of people, then, simply do not have access to medical professionals.
Or if they do, bankruptcy may be the end result.
In 2019, the average premiums paid out for health insurance for a single individual was
$7,188.
For an entire family, it was $20,576.
The family premium has increased 54% since 2009, and 22% since 2014.
The cost of insurance premiums has increased so fast that many households dedicate 20%
of their income or more just to paying these premiums.
Any additional co-pays, or bills which insurance doesn’t pay, have to be paid in addition
to the premiums.
The number of insurance plans and what they cover is so insanely complicated that it can’t
be discussed in sufficient detail here.
But, in general, most plans require patients to pay a deductible.
The deductible is an out of pocket amount that a patient must pay before insurance pays
anything.
Additionally, many insurance plans will only pay 100% for doctors that are considered in
network.
This means that the company has a list of doctors and facilities that are covered.
Anything out of network will usually be paid at a lesser percentage, leaving the patient
to pay the remainder.
To add to the confusion, it is quite possible for a patient to go to a hospital that is
in network, and then be treated by a doctor that is not in network.
So even when attempting to follow rules specified by the insurance company, it is entirely possible
to incur charges that could not be avoided or anticipated beforehand.
As if the private insurance market in the US wasn’t confusing enough, 97% of the health
insurance plans do not cover dental work.
Dental insurance is entirely separate.
Even when a patient has a dental policy, it often only pays a small percentage for procedures.
Thus, Americans pay significant out of pocket expenses for dental work in addition to other
health care expenses.
Here is a short list of some of the more insane health care costs that are commonplace in
the US:
1.
Ambulance rides can cost as much as $1200.
Health insurance only covers this if it’s absolutely necessary, which means most of
the time it isn’t covered.
Also, the patient is responsible for the bill even if he or she didn’t want the ambulance
in the first place.
2.
If a patient needs to be evacuated by helicopter, that can range from $12,000 to $25,000.
As with an ambulance, most of the time insurance doesn’t cover it unless it meets a narrow
definition of being medically necessary.
3.
A visit to the Emergency Room by someone who is uninsured is typically several thousand
dollars at a minimum.
4.
137 million Americans are currently in medical debt due to being uninsured, or having expenses
not covered by insurance
Healthcare in the United States is clearly a broken system.
The costs are increasing each year faster than the average household can increase income
to compensate.
And for those who can’t afford the premiums, healthcare is simply not an option in most
cases.
The unfortunate result is that while politicians and lobbyists argue about socialism, people
die from preventable causes.
At what point does practicality take precedence over ideology?
Thus far, the answer is rarely if ever.
How do you feel about universal health care?
Please let us know in the comments.
And as always, thanks for watching Bad Things in History.