History of Health Insurance in America


There has been a long history of inaction concerning universal health care in America. While Europe was busy implementing a social insurance system, the US was not.

It has been documented that President Theodore Roosevelt supported universal health care based on his awareness of both British and German programs and his well known belief that no country could be strong whose people were sick and poor. But the political momentum of the day was against the idea, and so the debate on health care slowly came to a grinding halt for the next twenty years or so. And no further action was action was taken.

The Universal Health Care Debate, the AALL, the AFL, and the AMA

Plans did looked good in the beginning, though, as, according to the history of health care section of the Physicians for a National Health Program (PNHP) website, in 1912, the American Association of Labor Legislation (AALL), a progressive group whose aim was to reform capitalism, created a committee to focus on health care issues. In 1915, the committee drafted a health care bill, which, essentially, covered the working class and all others who earned less than $1200 a year, including dependents.

The upshot was that physicians were consulted and even the American Medical Association (AMA) ended up supporting the proposal. For a while, the AMA and AALL worked together like long-lost cousins at a family barbecue, but eventually the sides fell into disagreement on how to pay physicians. Shortly thereafter, the AMA retracted all support for the proposal and, later, the AALL altogether.

To muddy the waters further, the then president of the American Federation of Labor (AFL) repeatedly denounced compulsory health insurance on the shortsighted basis that looking out for American people’s health was not the Government’s responsibility but the Union’s.

The Origins and History of Universal or Social Health Insurance Overseas

In Europe it was a different story entirely, as “social insurance” was being implemented across many countries. The first plan was reportedly adopted in Germany in 1883, with other countries – Austria, Hungary, Norway, Britain, Russia, and the Netherlands – soon following suit. Interestingly, a handful of European countries even subsidized the social health societies bubbling up in support of worker benefits across the political landscape.

The refreshingly progressive notion that had been driving all of this had come from the idea that a happy and healthy workforce would incur less medical expense and sick time, increase productivity and profit, and lead to, in the long run, thriving, more robust nations. And far from being seen as a burden on government spending, both British and German health care systems were developed during primarily conservative administrations.

The History of Blue Cross and the Origins of American Health Care

In America, the first detectable indications of health insurance at all came in the form of a prepaid hospital plan. In 1929, teachers at Baylor University in Dallas, Texas signed an agreement with the nearby hospital that they would pay an incremental stipend in return for full hospital care.

The plan, according to the BCBC website, established by Justin Ford Kimball, would grow from 1,300 covered lives to 3 million in just ten years, and the company that grew up from it would become known as Blue Cross (Blue Shield). But the Baylor agreement was just a start, and a report on the PBS website attempts to identify some major events in shaping health care today:

  • The National Labor Relations Act would required management to bargain with labor over “wages and conditions” and became the catalyst for employer-based health benefits.
  • Wartime (1939-1945) government wage freezes would increase the demand for group health care, as, unable by law to attract workers by paying more, employers focused on improving benefit packages.
  • Government programs to cover health care costs began to expand during the 1950s and 1960s, and disability benefits would come to be included in social security coverage for the first time in 1954.
  • During the 1980’s and 1990’s, the cost of health care would rise rapidly, and the majority of employer-sponsored group insurance plans switched from “fee-for-service” plans to the cheaper “managed care plans.”

Managed care is how most Americans know health care now, and the rest of the U.S. is either not fully covered, not covered at all, or can afford so-called “Cadillac plans.” Various Acts of Congress have been passed to ensure that insurance is not lost between jobs, but this primarily puts the burden on businesses and does nothing to evaluate the quality of coverage.

If history is any indicator, even with the current debate underway, it seems unlikely that the Government will change the basis of the current health care system in any meaningful way (without the addition of a true nation-wide “public option”).