Running head: History of US Health Care System: Final Project

History of US Health Care System: Final Project Antonio Abreu Nova Southeastern University BHS 3101 Professor Maryellen Antonetti MPH, PA-C

History of US Health Care System: Final Project

Health insurance in US Health care is arguably one of the most pressing concerns of governments all over the world. All developed countries are characterized by having elaborate healthcare systems which are in place to ensure that majority of the population has access to medical care when they need it. Arguably, health care insurance is a relatively new trend in the US. Before 1920, doctors and medical practitioners did not have many insights on diseases and curative techniques. As such, the cost of receiving medical care was relatively low and affordable to many Americans. However, as more discoveries were made and new techniques of delivering healthcare services emerged, the cost of receiving the medical treatment began to increase. As a result, many people could not afford quality care due to financial constraints. To this effect, private companies started offering health plans to their employees. However, the healthcare plans only covered against accidents related to travel by rail or water. However, these plans paved the way to more comprehensive covers that catered for other illnesses and injuries. In 1847, Massachusetts Health Insurance of Boston became the first company to offer group policies that gave comprehensive cover to its clients. Consequently, in 1890, insurance companies started offering individual disability and illness policies to their clients (Northern California Neurosurgery Medical Group, 2007). By 1929, group insurance coverage had gained prominence in the US. Baylor Hospital was the first organization to enter into a contract with a group of teachers from Dallas. This agreement aimed at ensuring that these teachers receive room, board and medical services from the hospital. The teachers on the other hand agreed to pay a monthly fee in exchange for these services. Soon after, several life insurance companies joined this seemingly lucrative field. A

History of US Health Care System: Final Project

precursor to future health care insurance schemes in America was Blue Cross which were the first to establish a health insurance similar to the modern model of the health care system in America today. This plan developed in 1930 advocated the payment of small premiums that would provide coverage for medical costs should one be hospitalized. The rationale behind this arrangement was that while huge medical bills were unaffordable to most people, little deductions over a long period of time were affordable to the majority of the population (Kooijman, 1999). This form of prepaid service were beneficial to both the hospital and the consumer especially in times of economic difficulties since neither party had to worry about the hospital bill being paid. During the Second World War, employers started offering insurance cover to their employees mostly as a way of attracting and retaining employees. However, this created a trend and became almost mandatory as strong trade unions started to negotiate for insurance packages for their employees. Northern California Neurosurgery Medical Group, (2007) notes that as of 1960, private health insurance was deeply imbedded into the American health care system and over 70% of the citizens had some form of health care coverage. In 1965, the U.S government created the Medicare and Medicaid programs with the aim of subsidizing the escalating cost of medical services (United States Department of Health and Human Services, 2009). This was mainly due to the fact that private sources catered for 75% of their medical costs (Moon, 2006). At this rate, many citizens could not cover their medical costs. However, these programs proved to be effective because as at 1995, individuals and companies enjoyed reduced costs since they only paid about half of their medical bills while the government covered the rest through these programs (United States Department of Health and Human Services, 2009).

History of US Health Care System: Final Project

History of Laser Eye Surgery

In the past few decades, inventions and breakthrough scientific discoveries in the biological field have resulted in the prevalence of access to sophisticated equipment and advanced diagnostic procedures that were once only in the realm of research institutes and few specialist hospitals. One of these technological advancements has been in the form of laser eye surgery. Documented evidence indicates that over the past one hundred years, there has been an increased interest in refractive surgery (Taylor, 2011). By 1898, Lans, a prominent professor of Ophthalmology had laid out the basic principles of radial keratotomy (Taylor, 2011). Before 1970, various eye specialists adopted different methods and techniques to treat eye related problems (Taylor, 2011). However, there were many complications regarding these techniques and in some cases, they made the situation worse. The most significant breakthrough was made in Russia in 1970s. This was in a case whereby Dr. Fyodorov was treating a boy whose glasses had broken and damaged his eyes (Taylor, 2011). This situation gave the doctor an opportunity to test the effectiveness of radial keratotomy. After the surgery, the doctor documented that the boys refractions were significantly less than they were before the injury. This discovery prompted him to do more research on the procedure. As a result, he came up with a formula that made refractive surgery more predictable than it was before (Taylor, 2011). It was not until 1978 that American ophthalmologist Dr. Leo Bores brought back the necessary technology for this surgery into America (Lasersurgeryforeyes.com, 2002). It should be noted that until 1970, lasers were primarily used to produce silicone computer chips in America (Lasersurgeryforeyes.com, 2002).

History of US Health Care System: Final Project

The mode of production was referred to as Excimer laser process (Lasersurgeryforeyes.com, 2002). After further research, it was discovered that the Excimer laser procedure could be used to remove damaged tissues without the risk of heat damaging the surrounding tissues (Dlxguard.com, 2009). This discovery was made in 1982 by three members of an IBM research team (Dlxguard.com, 2009). Soon after, this technique was applied in an array of medical procedures and treatments. However, it was not until 1982 that Dr. Steven Trokel, an American ophthalmologist based in New York first conducted the first eye surgery using this technique (Dlxguard.com, 2009). The following decade saw scientists and researchers devoting significant efforts towards perfecting the technique. It was not until 1996 that the government finally approved laser eye surgery in the US (Dlxguard.com, 2009). This approval led to a surge in eye treatment options. It should be noted that before this approval, some eye treatment options would leave the patient immobile for a long period of time (six or more weeks), and the surgeries were very risky. However, laser eye surgery presented practitioners and patients with a less risky, time saving, efficient and convenient option to correcting eye problems. Arguably, if you were among the 80% of Americans who require vision correction, the only option before the approval of laser eye surgery would have been either glasses or contact lenses. However, this is no longer the case since these techniques enable ophthalmologists to correct eye defects such as near or farsightedness effectively through radial keratotomy. More research is being carried out to improve the technique and facilitate better and safer eye correction services in the future.

History of US Health Care System: Final Project

Michael DeBakey: Father of cardiovascular surgery A life well lived is one that is lived in such a way that it makes a positive difference to others. Throughout history, different people have been credited for their works in regards to making a difference in the lives of others. Michael DeBakey is among such people in the medical arena. Born in 1908, in Los Angeles, this American surgeon helped develop various treatments and surgical procedures that have revolutionized the medical practice up to date (Notable Names Database, 2011). Before he died of natural causes in 2008, Michael DeBakey had performed heart operations in excess of 60,000 (Women's Internation Center, 2010). In addition, he had published more than 1,500 scientific publications that helped other practitioners understand and treat various medical phenomenons (Notable Names Database, 2011). His work has helped add decades of years to some of his patients in America and abroad. Similarly, he has trained many renowned surgeons across the world. Of his many achievements and contributions to medicine and health care, one of his major achievements included the invention of the roller-pump in 1932 (Notable Names Database, 2011). Twenty years later, this invention became an essential component during the development of the heart-lung machine which enabled cardiovascular surgeons to conduct openheart surgeries. NNDB (2011) further reports that in 1953, Michael DeBakey introduced improved Dacron and Dacron-velour artificial grafts to replace damaged arteries (Notable Names Database, 2011). He was among the leaders in the development of artificial arteries and introduced the concept of bypass surgery in the healthcare sector (Notable Names Database, 2011). He is also credited for the creation and development of the Mobile Army Surgical Hospitals (M.A.S.H) concept, which helped save many lives during the Korean and Vietnamese wars (Women's Internation Center, 2010). I personally was part of a group in Iraq that was

History of US Health Care System: Final Project

tasked with setting up mobile medical/battle aid station as we refer to them in the Navy; trust me when I say a lot of logistics goes into setting them up. Arguably, Michael DeBakey is best known for inventing the ventricular assist device (VAD) that is commonly referred to as the artificial heart. He invented this device in 1968 so that it would help patients whose hearts had weak cardiovascular muscles pump blood by assisting the main pumping chamber (Notable Names Database, 2011). It should be noted that this invention was never intended to replace the full heart but merely to offer assistance to weakened hearts. However, it paved way for more research and consequently, the first artificial heart was developed and implanted into a human being a year later (Notable Names Database, 2011). This operation was carried out in 1969 by Dr. Denton Cooley who was a former colleague of Michael DeBakey (Notable Names Database, 2011). In his pursuit for perfection, Michael DeBakey together with another colleague invented the Jarvik artificial heart (Notable Names Database, 2011). This heart was first fitted into a human being in 1982 (Notable Names Database, 2011). Later on in the 90s, Michael DeBakey in collaboration with NASA developed a miniaturized heart pump (Notable Names Database, 2011). This pump was so small that it could easily and comfortably be implanted in a child. These are among the key contributions that the renowned surgeon and physician made during his lifetime. Besides this, he was best known as being a Good Samaritan, a pioneer and a dedicated statesman who strived to ensure that every person had a chance to live a long and healthy life (Women's Internation Center, 2010). The WIC website states that Dacron arteries, arterial bypass operations, artificial hearts, heart pumps and heart transplants are common procedures in today's medicine, thanks to Dr. DeBakey (Women's Internation Center, 2010). This statement is true as has been elaborated in this essay.

History of US Health Care System: Final Project

Health care reforms in the U.S The US government has always taken a keen interest in the healthcare provision of its citizens. Kovner, Knickman and Jonas (2008) state that this idea of government involvement in the health concerns of the citizens can trace its existence from as far back as the 17th century (Koyner, Knickman, & Jonas, 2008). It is recorded that as early as the beginning of the 19th century, a majority of American citizens were worried about the affordability and availability of health care (Koyner, Knickman, & Jonas, 2008). It is for this reason that the public healthcare option was conceived in the late 1800s (Koyner, Knickman, & Jonas, 2008). However, it was in the era of President Theodore Roosevelt that health reforms took a definite shape. His monumental declaration that "Nothing can be more important to a state than its public health: the state's paramount concern should be the health of its people (Sebelius, 2009). Highlighted his dedication towards achieving a system that he perceived would afford the population the best opportunity to acquire health care. Roosevelts continuous commitment to a national health insurance plan through from 1912 was one of the key factors that shaped the public health insurance policies in the United States (Koyner, Knickman, & Jonas, 2008). Kooijman (1999), states that as of 1935, the efforts for national health insurance were greatly derailed by medical practitioners who were greatly opposed to the arrangement (Kooijman, 1999). This opposition stemmed from a misguided perception of what health insurance implied. The practitioners mistook the national health insurance for a socialistic system of medical practice whereby the government would limit the fee they received for their services (Kooijman, 1999). This widespread lack of support for the system led to the exclusion

History of US Health Care System: Final Project

of a national health insurance plan in the social security act thus dealing a great blow to the public option (Kooijman, 1999). In 1994, then, US President Clinton made a move to provide universal coverage through an employer mandate in 1994 (Singer, 2009). However, his administration was against a public insurance option which they deemed to be too expensive (Singer, 2009). President Bush also dealt a blow to the universal health care system by his move to veto a proposed health insurance program (Singer, 2009). He perceived the plan as a move towards a socialized health care system which would be unwanted since it would end up benefiting people who did not need any assistance (Singer, 2009). The public option received a new lease of life with the election of President Obama in 2008 (Singer, 2009). One of his major campaign policies was the wide spread reforms in the health care system. This has been perceived to be one of the major factors that led to his election. President Obama sees a shift towards a healthcare system that is both affordable and places value on quality service as the solution to the troubled system currently in place. His emphasis is on the affordability of health care for all American citizens through the adoption of a public option that would offer competitive prices to the people and therefore greatly regulate the health insurance market. However, his aim towards this has been marred by opposition from senators and financial institutions (Singer, 2009). Vaccination: A preventive measure for all ages Over the past few years there have been an increase in the number of diseases that affect human beings. As such, researchers and medical experts have dedicated most of the available resources to ensure that both preventive and curative measures are put in place in a bid to avoid

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further spread of the various diseases that pose a serious risk to the human race. The major challenge being faced globally is creating awareness of the diseases and controlling or containing their spread. Throughout history, vaccination has proven to be an effective strategy against many life threatening infections and ailments. In the United States, vaccines were used to eradicate life-threatening conditions such as polio and small pox. Arguably, the rise and fall of small pox is among the best feat when it comes to medical breakthroughs. The origin of the disease is not well known but it is believed to have originated from Africa and spread through other parts of the world. However, it was reported in most parts of America in the 17th and the 18th centuries. The fall of the scourge came through the realization that the people who survived the disease became immune for life. This knowledge led to the development of the process known as variolation (Brannon, 2004). This process involved infecting a healthy person with a mild form of small pox in the hope that he/she would develop some immunity against the disease in the future. The process worked and people underwent this process. Statistics indicate that 2-3% of people who underwent this process died of smallpox (Brannon, 2004). However, the majority survived and the number of people infected by this disease reduced significantly. Edward Jenner is credited for being the inventor of the first small pox vaccine (Brannon, 2004). The English physician observed that milkmaids who developed cowpox were less vulnerable to small pox. As a result, in 1796, the physician took a pustule sample of the cowpox infected maid and inoculated an 8 year old boy with it (Brannon, 2004). Six weeks later, Jenner exposed the subject to smallpox. To his own amazement, the boy did not show any symptoms of the disease. It is from this result that Jenner came up with the word vaccine. The word came from the Latin word vaca, which means cow (Brannon, 2004).

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Initially, many practitioners and people criticized his work but as his success rate increased; his method was rapidly adopted by other practitioners. Statistics indicate that at the wake of 1800, more than 100,000 people were already vaccinated against the disease. In America, the last outbreak of the disease was reported in 1949 (Brannon, 2004). The outbreak only affected eight people and claimed one life. However, the disease still claimed lives in other parts of the world. As a result, the world health organization initiated a campaign in 1967 (Brannon, 2004). The main purpose of this campaign was to promote awareness and eradicate smallpox in all regions of the world. This goal was realized in the ten years that followed. This was attributed to the massive vaccination efforts that ensued during that period (Brannon, 2004). Consequently, the last case of smallpox was reported in Somalia in 1977. However, measures were taken to ensure that everyone was vaccinated against the disease. Subsequently, in 1980, the World Health Assembly finally declared the world free from this killer disease (Brannon, 2004). It should be noted that by the year 1972, America had already vaccinated all its citizens but continued to vaccinate military personnel who were at risk of infection due to the nature of their job (Brannon, 2004). Vaccinations have been used to create immunity against other diseases. As a result, the infant mortality rate has decreased significantly across the world as compared to the situation a century ago.

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Reference: Brannon, H. (2004, September 25). Smallpoxhx: About.com. Retrieved August 5, 2011, from About Corporation Website: http://dermatology.about.com/cs/smallpox/a/smallpoxhx.htm Dlxguard.com. (2009). Retrieved August 5, 2011, from Dlxguard.com: http://www.dlxguard.com/history-laser-eye-surgery Kooijman, R. (1999). The Pursuit of National Health: the Incremental Strategy toward National Health Insurance in the United States of America. Atlanta: Rodopi Edition. Koyner, A., Knickman, J., & Jonas, S. (2008). Health Care Delivery in the United States. New York: Springer Publishing Company. Lasersurgeryforeyes.com. (2002). History: Laser Surgery for Eyes. Retrieved August 4, 2011, from Lasersurgeryforeyes Corporation: http://www.lasersurgeryforeyes.com/history.html Moon, M. M. (2006). Medicare: A policy primer. Washington: The Urban Institue Press. Northern California Neurosurgery Medical Group. (2007, October 11). Medical History and Ethics: History of Health Insurance in the United States. Retrieved August 5, 2011, from Neurosurgical: http://www.neurosurgical.com/medical_history_and_ethics/history/history_of_health_ins urance.htm Notable Names Database. (2011). People: Michael DeBakey. Retrieved Ausgust 4, 2011, from Notable Names Database Corporation Website: http://www.nndb.com/people/241/000027160/ Sebelius, K. (2009, August 15). healthcare.gov. Retrieved August 4, 2011, from Health Care Goverment Website: http://www.healthcare.gov/healthreform Singer, P. (2009, July 15). New York Times. Retrieved August 4, 2011, from Ney York Time Website: http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1 Taylor, J. (2011). Types: History. Retrieved August 04, 2011, from Laser Eye Surgery network: http://www.lasereyesurgery.net/Types/history.html United States Department of Health and Human Services. (2009). About: Health and Human Services History. Retrieved August 4, 2011, from U.S. Department of Health and Human Services: http://www.hhs.gov/about/hhshist.html Women's Internation Center. (2010). Bio: Debakey. Retrieved August 04, 2011, from Women's Internation Center Organization: http://www.wic.org/bio/debakey.htm