Introduction to US Healthcare - Part 2

By | October 25, 2013

Go back to Part 1

Here are the main historical events (categorized by presidents) that occurred with respect to US Healthcare.


  • occupied by challenges of depression and world war 2


  • announced conversion program after word war 2 to shift into peace
  • part of these initiatives was a national health 5 point program
  • he advocated for an insurance program for the middle class, although republicans saw this as socialized medicine
  • Truman set the stage for the health care debate that exists today


  • private insurance became more ubiquitous
    • problems: expensive, low coverage
  • set up Medicare for the elderly
    • was met with opposition from the American Medical Association and from congress
    • had helpful support from Reagan
    • Kennedy thought Medicare was a logical extension of social security
    • after being knocked down, Medicare shifted in the hands of Johnson


  • as part of his 1964 campaign, Johnson continued the Medicare plan
  • Johnson was a renowned legislative negotiation
  • with the support of Democrats and Republicans, Medicare and Medicaid was established in July 1965
  • Truman was given the first Medicare card in honor of his efforts towards reform


  • drafted a Nixon healthcare plan for the 1972 election
  • Americans were concerned with healthcare costs
  • Nixon's plan was different from Kennedy's plan
    • mandate that employers have insurance for their employees
    • ensures the poor were covered
    • his version of the right plan: one based on partnership; one in which doctors worked for patients and not for the government
  • Nixon resigned from Watergate and his plan was not enacted


  • when Ford took office, he made clear that universal healthcare would not be affordable but that the private insurance system should be used to expand coverage for middle class families


  • made campaign promises for reforming the health care system
  • commitment to national health insurance
  • Democrat Senator Kennedy (advocating healthcare for all) and Republican Carter (incremental program) were in disagreement and produced a rupture between Democrats and Republicans
  • proposed a National Health Plan
    • expanded coverage

Neither Nixon, Ford, or Carter's different health plans took to action as did Medicare and Medicaid


  • Medicare reform, expansion
  • enacted fee for service to standardize Medicare fees to bring down costs
  • if hospitals can provide the service for less than what the government paid, then they kept the difference

GHW Bush

  • wanted to reform healthcare to save costs
  • wanted to harness the potential of health information technology for better healthcare consumers
  • wanted to extend a tax credit to low income families to purchase insurance
  • suggested a tax deduction for middle class families
  • emphasis on prevention
  • he did not achieve significant reform but the plan was set for Clinton


  • set healthcare reform as a priority
  • Clinton Health Security Act
    • plan to give all Americans a minimum set of healthcare protection services
    • along with Hillary, Clinton went on a series of tours to promote his plan
  • opposition to his plan grew in Congress, particularly requiring employers to provide for their employees
  • the Health Security Act was never brought to the floor for a vote until Clinton's second term
  • SCHIP - state children's health insurance program: provided insurance for many children

There were still many problems to address. For example, 1/3 of all seniors did not have prescription medication care.

GW Bush

  • by 2003, Medicare reform was a priority for Bush, such as a mandated drug prescription component (Medicare part D)
  • Democrats seized control and as SCHIP was set to expire, the Bush administration vetoed the reauthorization of SCHIP


  • signed into authorization of SCHIP
  • framed the need for system wide healthcare reform
  • Obama thought healthcare problems were a major threat financially
  • although Obama emphasized the expensive problems healthcare would cause, he faced opposition because of lack of details
  • Obama's Plan
    • if you like your insurance, you can keep it; no dropped coverage when you're sick; no cap on the coverage each year
    • if you don't have insurance, quality affordable choices for all americans via a new marketplace where small business can shop for competitive insurance plans and tax credits as needed; a public health insurance option
    • establishment of medical experts to identify waste and fraud
  • the House and Senate approved two different versions of the Bill in 2009
    • Obama formed bipartisan committees to find common ground and rallied support
  • the House and Senate then approved the Affordable Care Act 
  • opposition arose from the Supreme Court
    • claims of unconstitutionality
    • declaring that some states were exempt
    • the law will be implemented in different ways for each state

Many presidents have tried to reform the healthcare system, mostly focusing on expanding coverage and hindering rise in cost. There is still concern that even with the ACA, many individuals will remain uninsured.

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