Health Care Reform

by

Stephen H. Gorin

• LAST REVIEWED: 23 May 2012
• LAST MODIFIED: 23 May 2012
• DOI: 10.1093/obo/9780195389678-0022

Introduction

Efforts to expand access to health care in the United States date back to at least 1798, when Congress enacted legislation for “the relief of sick and disabled Seamen.” Modern reform efforts began during the first two decades of the 20th century, largely through the efforts of the American Association for Labor Legislation, an organization of academics and other professionals, political figures, and business and labor officials. In 1912 Theodore Roosevelt’s Progressive Party called for “adoption of a system of social insurance,” including the “protection of home life against the hazards of sickness.” Despite this, national health insurance (NHI) failed to achieve broad public support. During World War I opponents of NHI succeeded in linking it with Germany and later the Soviet Union. These developments put reform advocates on the defensive, and by 1920, efforts for NHI had waned. The issue reemerged during the 1930s, when FDR’s Committee on Economic Security debated adding NHI to the Social Security Act. Strong opposition from the American Medical Association and others convinced Roosevelt not to include it. After Roosevelt’s death, Harry S Truman advocated NHI, but this effort was also unsuccessful. During the 1950s many advocates of NHI began advocating government coverage for older adults, who were then the most vulnerable segment of the population. In 1965 this effort culminated in the enactment of Medicare and, to the surprise of many, Medicaid. During the 1970s the escalation of health-care inflation forced reformers to begin addressing the issue of health-care costs. Employers and government officials increasingly turned to managed care as an alternative to the traditional fee-for-service system. The spread of managed care, in turn, raised questions and concerns about the quality of care. With the failure of President Clinton’s Health Security Act, which tried to combine competition, managed care, and government regulation, reform efforts again largely waned. The battle between Hillary Clinton and Barack Obama for the Democratic presidential nomination in 2008 again brought reform to the fore. Without support from Republicans, Congress in 2010 enacted the Affordable Care Act (ACA). This entry focuses on the history, background, and current status of three aspects of health care reform—coverage, cost, and quality. It also addresses the contentious debate over the future of the ACA, Medicaid, and Medicare.

General Overviews

Discussion of the history of health-care reform can be found in a wide range of sources, including work by social workers, sociologists, economists, political scientists, physicians, and others. Corning 1969 provides a detailed examination of the background and development of Medicare. Starr 1982, a Pulitzer Prize–winning analysis of the development of the medical profession, includes valuable material on reform efforts through the 1970s, and Mizrahi and Gorin 2008 presents an overview of reform efforts since the early 1900s, with emphasis on the role of social workers in formulating, developing, and advocating for social policies. Quadagno 2006 provides a historical and theoretical discussion of why the United States lacks national health insurance: the author particularly focuses on how powerful interest groups have mobilized to undermine public support for reform. Birn, et al. 2003; Hoffman 2003; and Hoffman 2009 offer three unique perspectives on the history of reform efforts. Moniz and Gorin 2010 presents an overview of development and current status of health and mental health policy in the United States.

• Birn, A. E., T. M. Brown, E. Fee, and W. J. Lear. 2003. Struggles for national health reform in the United States. American Journal of Public Health 93.1: 86–91.

  DOI: 10.2105/AJPH.93.1.86

  Overview of popular efforts to achieve health-care reform.

• Corning, P. A. 1969. The evolution of Medicare. . . from idea to law. Woodlawn, MD: Social Security Administration.

  Insightful discussion of the origins and development of Medicare, commissioned by the Social Security Administration. Available online.

• Hoffman, B. 2003. Health care reform and social movements in the United States. American Journal of Public Health 93.1: 75–85.

  DOI: 10.2105/AJPH.93.1.75

  History of the role of social movements in broadening struggles for health-care reform; concludes with a valuable discussion of recent organizational reform efforts.

• Hoffman, C. 2009. National health insurance—a brief history of reform efforts in the U.S. Menlo Park, CA: Henry J. Kaiser Family Foundation.

  Succinct overview of reform efforts from 1934 to 2011, including discussion of economic and political factors, supporters and opponents of reform efforts, and reasons for the success and failure of each effort.

• Mizrahi, T., and S. H. Gorin. 2008. Health care reform. In Encyclopedia of social work. Edited by T. Mizrahi and L. E. Davis, 340–348. New York: Oxford Univ. Press .

  Discussion of reform efforts through 2008, with a particular emphasis on the role played by social workers.

• Moniz, C., and S. Gorin. 2010. Health and mental health care policy. Boston: Allyn and Bacon.

  Broad overview of health- and mental health–care policy and reform; includes content on role of social work in health- and mental health–care policy practice.

• Quadagno, J. S. 2006. One nation, uninsured: Why the U.S. has no national health insurance. New York: Oxford Univ. Press.

  A detailed analysis by a leading theorist of the long effort to enact national health insurance in the United States. The author stresses the role of “shareholder mobilization” and organizational structure.

• Starr, Paul. 1982. The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. New York: Basic Books.

  Pulitzer Prize–winning account of the development of the medical profession in the United States. Book Two of this work examines modern efforts to expand coverage and address the growing problem of costs.