My five choices for the Health Museum are
1. The great depression and birth of blue cross
2. The dominant influence of Government
3. Efforts at planning and quality control
4. Managed care organizations
5. The Reagan communication
#1 (The great depression and birth of blue cross)
The Depression of 1929 shook the financial security of both physicians and hospitals. Physician incomes and hospital receipts and admission rates dropped precipitously. As the situation grew worse, hospitals began experimenting with insurance plans. The Baylor University Hospital plan was not the first, but it became the most influential of those insurance experiments.
By enrolling 1,250 public school teachers at 50 cents a month for a guaranteed 21 days of hospital care, Baylor created the model for, and is credited with, the genesis of Blue Cross Hospital Insurance. Baylor started a trend that developed into multihospital plans that included all the hospitals in a given area. By 1937, there were 26 plans with more than 600,000 members, and the American Hospital Association (AHA) started approving the plans. Physicians were pleased with the increased availability of hospital care and the cooperative manner in which their bills were paid. The AMA, however, was characteristically hostile and called the plans “economically Unsound, unethical, and inimical to the public interest.”
#2 (The dominant influenced government)
Although the health insurance industry contributed significantly to the spiraling costs of health care in the decades after World War II, it was only one of several influences.
The federal government’s coverage of health care for special populations played a prominent role. Over the years, the U.S. government developed, revised, and otherwise adjusted a host of categorical or disease-specific programs designed to address needs not otherwise met by state or local administrations or the private sector.
Federally sponsored programs account for about 40 percent of this country’s personal health care expenditures. Most physicians and other health professionals are trained at public expense, the government provides almost 6 percent of the funds available for research and development, and most not-for-profit hospitals have been built or expanded with government support. State and local governments also contribute, but in much smaller amounts.
#3 (Efforts at planning and quality control)
The federal government did not ignore the issues of cost and quality; the efforts to address those concerns were essentially doomed to be ineffectual by their very designs. To get legislation passed that might alter the existing constellation of health care services or that would scrutinize how well clinicians actually practiced, the powerful medical and hospital lobbies had to be accommodated. This meant the legislation had to be “provider friendly,” allowing physicians, hospital administrators, and other health professionals to maintain control over how the legislation was interpreted and enforced.
#4 (Managed Care Organizations)
In 1973 the Health Maintenance Organization Act supported the development of health maintenance organizations (HMOs) through grants for federal demonstration projects. An HMO is an organization responsible for the financing and delivery of comprehensive health services to an enrolled population for a prepaid, fixed fee. HMOs were expected to hold down costs by changing the profit incentive from fee for service to promoting health and preventing illness.
The concept was accepted widely, and between 1992 and 1999,
HMOs and other types of managed care organizations experienced phenomenal growth, accounting for more than half of all privately insured persons
#5 (The Reagan Administration)
Beginning with the Reagan administration and continuing to this day are attempts, some successful, to undo or shrink the federally supported programs begun in the 1960s and 1970s. Unlike Nixon and Ford, Reagan succeeded in implementing New Federalism policies that were all but stymied in previous administrations. A significant reduction in government expenditures for social programs occurred.