Health in America
Health in America
Health in America

Health Insurance

1950s advertisement for Blue Cross and Blue Shield companies, which provide health insurance for millions of Americans.

Exorbitant medical bills are a relatively new problem for families. One hundred years ago, health insurance didn't exist and most families treated routine illness with home remedies. The problem of paying medical bills began in the early 20th century when doctors became better at curing disease and hospitals changed their focus from charity to patients who could pay.

Employers and unions alleviated health care costs by providing group insurance and hospitals created the Blue Cross system to cover hospital care. In the 1930s and 40s, liberals and unions pushed for national health insurance, but were defeated by an alliance of conservatives, anti-Communists and the American Medical Association. Access increased in 1965 with the passage of Medicare for the elderly and Medicaid for the poor. The federal government also became a significant player in supporting medical and pharmaceutical research.

Your Social Security – poster issued in 1968 to advertise the availability of Medicare.

Just as we spend more today on a gallon of milk than we did 20 years ago, we spend more for the same medical services than in years past. But medical price inflation is outpacing general inflation and is driving 51 percent of the growth in health care spending. Increasing numbers of patients challenged by obesity, smoking, drug abuse, poor nutrition and physical inactivity contribute to an increase in the use of, and cost of health care. More than 75% of health care costs are due to chronic diseases, such as heart disease, cancer, stroke, diabetes and arthritis.

But these diseases are not caused simply by personal choices. As a Centers for Disease Control report notes, the social determinants of inequalities in health, "such as community design, housing, employment, access to health care, access to healthy foods, environmental pollutants and occupational safety" contribute greatly to the personal choices that lead to chronic disease. Industries, such as fast food, asbestos, tobacco and lead, are also responsible for rising costs. Sky-rocketing medical bills have also resulted from the cost of prescription drugs - particularly specialty drugs; government mandates; fraud and abuse; "defensive medicine" and, preventable medical errors.

Employers, union benefits funds and private health insurance plans have struggled to cover these costs. Today, health costs are the leading cause of bankruptcy. In an attempt to expand insurance coverage, Congress passed the Patient Protection and Affordable Care Act in 2010. This federal health care reform is intended to increase the number of Americans who are insured by expanding Medicaid and providing subsidies to eligible individuals so they can afford to purchase private insurance.

President Obama’s signature on the Patient Protection and Affordability Act, 2010.
AIDS support group ACT UP protests against New York’s health care crisis.
Illustration showing how health insurance protected families against destitution and sickness, appeared in the American Labor Legislation Review, 1919.