Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
There has been much discord as to the proper role of government in healthcare. Should the government purchase compulsory care for its population? Alternatively, should the government provide means-tested funds for individuals to purchase care and catastrophic insurance on the open market, making sure all have access? This would promote individuality along with the patient-physician relationship. It would be in society’s interest for ALL Americans to be as healthy and productive as possible thereby increasing gross domestic product and thus everyone’s standard of living.
For those wounded in our many wars there has been broad acceptance that the government should provide access to care. This has been provided in government facilities. Due to recent VA scandals, some veterans have been given funds to obtain care in private facilities.
The tax-exempt employer health benefit was introduced during World War II to attract workers into factories to augment their price-controlled salaries. The tax-exempt status was codified by Congress in 1954 and became a widespread benefit. It quickly morphed into pre-paid healthcare along with its huge bureaucracy and attendant inefficiencies.
In Congress, from 1943 till the passage of Medicare/Medicaid in 1965, various plans were submitted to provide healthcare to those in need that reflected different political philosophies. Some wanted all Americans covered by a mandatory government benefit through Social Security. Most nations after World War II adopted government-directed healthcare as a tax-supported benefit.
Others proposed a means-tested benefit to fund that care. The best chance of passage for this idea was in 1948; a coalition of Republicans and Southern Democrats championed the Hill-Aiken bill that planned to provide subsidies to the states for means-tested support for those in need to purchase private insurance. It stalled in committee because of President Harry Truman’s objections. In the early 1950’s a bill was signed providing federal funds for states to provide means-tested care for the poor, which in most states was poorly administered and ineffective. The problem festered due to the conflict between those who wanted an individual versus those who wanted a government directed solution.