Health Insurance: Past and Present Day

I like to watch an old television show, The Fugitive, via Youtube.   The television show ran on ABC from 1963-1967.  The show’s  plot was really a borrowing  from the  classic novel, Les Miserables, by French writer Victor Hugo.  The plot:  a man convicted of a murder he didn’t commit, having escaped from a trip to the death house, trying to find the man he suspects really murdered his wife, all the while dodging in and out of the shadows to avoid the relentless police lieutenant pursuing him to bring him back to face his punishment.   I’ve been enjoying the well-written show, with interesting storylines, plus seeing the work of some  famous actors and actresses of today who guest starred, when they were young, starving artists, so to speak.

The Fugitive

A recent episode  got me to pondering about health care and health insurance in the US.    The show’s protagonist, Dr. Richard Kimble(David Janssen) was  working for a wealthy family, under an alias; as their estate’s new gardener/caretaker.  The family’s son, age 9, was walking on top of a high garden wall, despite being told not to walk on it, and he fell to the sidewalk, hurting his arm.  Kimble  knew  the boy needed medical help.  He convinced the boy’s mother, and they  drove  the boy  to the family’s doctor.  I sat incredulously watching as Kimble carried  the boy with  the boy’s mother right behind him into the clinic.  They  walked  to the  receptionist’s desk and told her  that the child had injured his arm and  needed an x-ray.  Then they   just kept on walking  back to the examining rooms where the doctor was!  Not one peep from the receptionist about insurance, no forms to fill out, nothing!  The added kicker, for me, was  when the doctor announced that after the x-rays were negative for a broken bone, he felt the child needed some extra care at the hospital for the injured arm and he said he’d drive the child there himself!!!  No ambulance called for transport, the doctor did the driving!

When did housecalls go the way of the dinosaur and why?

When did housecalls go the way of the dinosaur and why?

When was the last time your doctor offered to drive you to the hospital?  When have you ever been able to walk right in to the doctor’s office, be seen immediately, and not have to produce insurance information, pay a co-pay upfront, and not have forms to fill out or update?   This depiction of healthcare in the U.S. from The Fugitive, circa 1963, led me to wonder when did health insurance arrive in the US, and what has it’s impact been on those who provide health care services?

From what I’ve read, health insurance as we know it, didn’t really exist in the same format when it began in 1850.  Prior to 1850, people who needed a doctor’s services paid the costs out of their own pockets.  In Massachussetts, the Franklin Health Assurance Company, which began operating  in 1850, offered  Accident insurance to employees who worked for the railroads and steamboats.  The idea caught on and by 1866, there were 60 different organizations offering Accident insurance in the US.   Jumping forward to 1911, the first employer-sponsored disability policy was issued, but only for covering lost wages due to sickness causing an employee being unable to work.  This plan didn’t cover medical costs.

In the 1920s, some hospitals began to offer pre-paid  services to their patients.  That led to the creation of the Blue Cross companies in the 1930s.    Teachers in Dallas, TX successfully created the first employer-sponsored health care plan which only covered the member teachers’ medical expenses and only at one specific hospital.

medical prac. cartoon

Jumping to the 1940s and WWII, the government had put into place price and wage controls: workers were fewer, demand for products was high, and this caused a very tight labor market.  To appease the workers with no wage increases happening, many manufacturers began offering benefits-health care, especially, since the War Labor Board had decided that benefits to employees wouldn’t contribute to a wage increase.   President Truman wanted to pass public health insurance, a program that would be open to all who wanted to participate in it, but participation would be optional, not mandated or forced.  His plan was shot down by the Chamber of Commerce, the American Hospital Association, and the American Medical Association.  Labor Unions had liked Truman’s plan but decided to put all of their might behind employer-offered health insurance and by 1958, 75% of Americans had some form of health insurance.

In 1965, President Johnson signed into law Medicare and Medicaid, government run health insurance for the elderly and the poor and in 2010 the Affordable Care Act(Obamacare) was signed into law.

2010-President Obama signing the Affordable Care Act bill into law.

2010-President Obama signing the Affordable Care Act bill into law.

1965-President Johnson signing the Medicare bill into law as President Truman looks on.

1965-President Johnson signing the Medicare bill into law as President Truman looks on.

So that’s the history of health insurance in the US, but has it always been a boon for the health care providers?   I was at a Candidate’s Forum Monday night, in Rolla, to listen to the various Judges present themselves to we, the voters, for the upcoming election.  I also heard the two candidates speak, who are running for the Clerk of Courts office.  One of those candidates is a doctor and something she said I thought was very true, and very telling. She said that as much as she has loved being a doctor, she went into medicine to serve others, to help others, and increasingly in the medical profession, she has seen that old saying come true, He who pays the Piper calls the tune.  In her meaning, since the Federal Government is increasingly paying the doctors, the hospitals, and in turn through the hospitals, the nurses and other employees, the Federal Government can increasingly dictate to all in the medical field how everything should be run, and should be done.

Health care in the US still is fraught with problems and perhaps, sometime in the future, common sense methods can be used to take away or create better solutions to  some of those problems.  Gone are the days of health care as it was   depicted in that 1963 The Fugitive episode, but ease in obtaining affordable health  insurance,  ease in seeing a doctor that one has  chosen, is that too  much to ask for  and hope for?

Information for this blog was found through  the following:

“How did America end up with this health care system?”, Bill Toland, Pittsburgh Post-Gazette, April 27, 2014.



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