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Health System Reform in American History Stephen Inrig, PhD Assistant Professor (Medical History) Division of Ethics & Hea...
Health System Reform in American History <ul><li>Pre-20 th  Century </li></ul><ul><ul><li>Hospitals for criminals/indigent...
Health System Reform in American History <ul><li>Early Efforts at Healthcare Reform (1910s) </li></ul><ul><ul><li>Payment ...
Health System Reform in American History <ul><li>Early Efforts at Healthcare Reform (1910s – 1920s) </li></ul><ul><ul><li>...
Health System Reform in American History <ul><li>Health Care reform and the Depression (1920s – 1930s) </li></ul><ul><ul><...
Health System Reform in American History <ul><li>The emergence of partial solutions (1920s – 1930s) </li></ul><ul><ul><li>...
Health System Reform in American History <ul><li>Period of medical expansion (1940s – 1950s) </li></ul><ul><ul><li>Increas...
Health System Reform in American History <ul><li>Changing funding mechanisms (1950s – 1960s) </li></ul><ul><ul><li>Failed ...
Health System Reform in American History <ul><li>Johnson, Kennedy, and the rise of Medicare/Medicaid (1965 – 1966) </li></...
Health System Reform in American History <ul><li>Nixon/Kennedy & Social/Health Security debate (1971 – 1974) </li></ul><ul...
Health System Reform in American History <ul><li>The Reagan-Era Pendulum (1980s) </li></ul><ul><ul><ul><li>Pay freezes and...
Health System Reform in American History <ul><li>The Clinton Plan (1993) </li></ul><ul><ul><ul><li>Brief Details </li></ul...
Health System Reform in American History <ul><li>The Bush Years (2003) </li></ul><ul><ul><li>The Medicare Prescription Dru...
Health System Reform in American History <ul><li>The Obama Years (2009 - 2010) </li></ul><ul><ul><li>Will we have a health...
Health System Reform in American History
Health System Reform in American History
Infant Mortality Rate Infant deaths per 1,000 live births,  International Comparison, 2004 Data: National and state—Nation...
Health System Reform in American History Medications Reviewed When Discharged from the Hospital, Among Sicker Adults, 2005...
Health System Reform in American History * Countries’ age-standardized death rates before age 75; including ischemic heart...
Health System Reform in American History
Health System Reform in American History
Health System Reform in American History
Health System Reform in American History
Health System Reform in American History
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  1. 1. Health System Reform in American History Stephen Inrig, PhD Assistant Professor (Medical History) Division of Ethics & Health Policy Department of Clinical Sciences UT Southwestern Medical Center 5323 Harry Hines Blvd. Dallas, TX 75390-9070 [email_address]
  2. 2. Health System Reform in American History <ul><li>Pre-20 th Century </li></ul><ul><ul><li>Hospitals for criminals/indigent/poor people </li></ul></ul><ul><ul><li>Medicine based on physician care </li></ul></ul><ul><ul><li>First US intervention in healthcare = 1798 </li></ul></ul><ul><li>End of 1800s </li></ul><ul><ul><li>First nationalized health insurance – Germany 1883. </li></ul></ul><ul><ul><li>Medical progress (Germ theory/science-based medicine) </li></ul></ul><ul><ul><li>Science-based public health </li></ul></ul>
  3. 3. Health System Reform in American History <ul><li>Early Efforts at Healthcare Reform (1910s) </li></ul><ul><ul><li>Payment = private affair between patient and doctor </li></ul></ul><ul><ul><li>In the 1910s, initial push was for “sickness insurance” tied to industry jobs. </li></ul></ul><ul><ul><li>Reformers concentrated on state-based systems of compulsory insurance. </li></ul></ul>
  4. 4. Health System Reform in American History <ul><li>Early Efforts at Healthcare Reform (1910s – 1920s) </li></ul><ul><ul><li>By 1920, “compulsory health insurance” efforts 15 states have largely died </li></ul></ul><ul><ul><li>AMA formally declares its opposition. </li></ul></ul><ul><ul><li>“ Socialized medicine” becomes the rallying cry of the opposition. </li></ul></ul>
  5. 5. Health System Reform in American History <ul><li>Health Care reform and the Depression (1920s – 1930s) </li></ul><ul><ul><li>Committee on Economic Security can’t get health insurance in 1935 SSA. </li></ul></ul><ul><ul><li>Technical Committee on Medical Care pushes a second time for national health insurance in 1938 </li></ul></ul><ul><ul><li>Southern Democrats & Republicans New Deal social reforms. </li></ul></ul>
  6. 6. Health System Reform in American History <ul><li>The emergence of partial solutions (1920s – 1930s) </li></ul><ul><ul><li>In the 1920s, the Committee on the Costs of Medical Care, proposed group medicine and voluntary insurance. </li></ul></ul><ul><ul><li>Hospital insurance </li></ul></ul><ul><ul><li>Group medicine/medical insurance </li></ul></ul><ul><ul><li>Impact of WWII on health insurance </li></ul></ul>
  7. 7. Health System Reform in American History <ul><li>Period of medical expansion (1940s – 1950s) </li></ul><ul><ul><li>Increased medical specialization </li></ul></ul><ul><ul><li>Increased hospital use and construction </li></ul></ul><ul><ul><li>Increased medical </li></ul></ul><ul><ul><li>research </li></ul></ul><ul><ul><li>Increased medical </li></ul></ul><ul><ul><li>regulation </li></ul></ul>
  8. 8. Health System Reform in American History <ul><li>Changing funding mechanisms (1950s – 1960s) </li></ul><ul><ul><li>Failed Truman Effort (1948/9) </li></ul></ul><ul><ul><li>1949 Court rules health insurance benefits = subject for collective bargaining </li></ul></ul><ul><ul><li>1954 – Congress determines health insurance non-taxable </li></ul></ul><ul><ul><li>Elderly Care </li></ul></ul>
  9. 9. Health System Reform in American History <ul><li>Johnson, Kennedy, and the rise of Medicare/Medicaid (1965 – 1966) </li></ul><ul><ul><ul><li>Medicare </li></ul></ul></ul><ul><ul><ul><li>Medicaid </li></ul></ul></ul>
  10. 10. Health System Reform in American History <ul><li>Nixon/Kennedy & Social/Health Security debate (1971 – 1974) </li></ul><ul><ul><li>Kennedy/Griffiths/Corman Health Security Act </li></ul></ul><ul><ul><li>Nixon Comprehensive Health Insurance Plan (CHIP) </li></ul></ul><ul><ul><li>Long-Ribicoff plan </li></ul></ul><ul><ul><li>Kennedy/Mill Compromise </li></ul></ul><ul><ul><li>HMO Act (1973) </li></ul></ul>
  11. 11. Health System Reform in American History <ul><li>The Reagan-Era Pendulum (1980s) </li></ul><ul><ul><ul><li>Pay freezes and shrinking reimbursements </li></ul></ul></ul><ul><ul><ul><li>COBRA/EMTALA (1986) </li></ul></ul></ul><ul><ul><ul><li>Medicare Catastrophic Coverage Act (1988) </li></ul></ul></ul>
  12. 12. Health System Reform in American History <ul><li>The Clinton Plan (1993) </li></ul><ul><ul><ul><li>Brief Details </li></ul></ul></ul><ul><ul><ul><li>Why it failed </li></ul></ul></ul><ul><ul><ul><li>Other issues </li></ul></ul></ul>
  13. 13. Health System Reform in American History <ul><li>The Bush Years (2003) </li></ul><ul><ul><li>The Medicare Prescription Drug, Improvement, and Modernization Act (2003) </li></ul></ul>
  14. 14. Health System Reform in American History <ul><li>The Obama Years (2009 - 2010) </li></ul><ul><ul><li>Will we have a healthcare bill? </li></ul></ul>
  15. 15. Health System Reform in American History
  16. 16. Health System Reform in American History
  17. 17. Infant Mortality Rate Infant deaths per 1,000 live births, International Comparison, 2004 Data: National and state—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2003, 2004, 2005, 2006, 2007a); international comparison—OECD Health Data 2007, Version 10/2007. Health System Reform in American History Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
  18. 18. Health System Reform in American History Medications Reviewed When Discharged from the Hospital, Among Sicker Adults, 2005 Note: Indicator was not updated due to lack of data. Baseline figures from Scorecard 2006 are presented. AUS=Australia; CAN=Canada; GER=Germany; NZ=New Zealand; UK=United Kingdom; US=United States. Data: 2005 Commonwealth Fund International Health Policy Survey. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
  19. 19. Health System Reform in American History * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. See report Appendix B for list of all conditions considered amenable to health care in the analysis. Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee 2008). Mortality Amenable to Health Care Deaths per 100,000 population* Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
  20. 20. Health System Reform in American History
  21. 21. Health System Reform in American History
  22. 22. Health System Reform in American History
  23. 23. Health System Reform in American History
  24. 24. Health System Reform in American History
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