We’ve been trying to deal with health care in the US for a long time. Starting about 100 years ago with Teddy Roosevelt we’ve been debating the best way to provide access to affordable health care for the American citizen. Health care doesn’t like to change. It’s slow to change because many times the incentives to change are pointed in the opposite direction. Over the years health care delivery has changed- but mainly in a “piecemeal” way to deal with a specific issue. These are the four major changes in health care that have really influenced where we are today.
1. 1939: Introduction of group health insurance as an employee benefit and (in the 1940s) exempting the employer/employee premium from federal taxes. This set the stage for the development of the group health insurance market. The tax exempt status of health insurance premiums remains in effect today.
2. 1966: Introduction of Medicare and Medicaid. The government was now in the health insurance business big-time and created the entitlement programs that now contribute significantly to our deficit.
3. The HMO Act of 1974. Managed care was introduced as the “savior” to address the rising health care costs in the country. It worked for awhile, but not so much any more.
4. 2010: The enactment of the Patient Protection and Affordable Care Act (PPACA); While we still don’t know the final outcome- the legislation was a wake-up call for the country and an attempt to shake-up the unsustainable health care system we have in place today.
While many other changes have occurred politically, clinically, and economically, these four “health care resets” changed the way health care works and created the challenges we are facing today.
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