Article

Health Care Reform

Stephen H. Gorin

in Social Work

ISBN: 9780195389678
Published online May 2012 | | DOI: http://dx.doi.org/10.1093/obo/9780195389678-0022
Health Care Reform

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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.

Article.  8558 words. 

Subjects: Social Work

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