Health Insurance in the United States
Posted Mon, 2010-02-01 18:21 by Anonymous
Melissa Thomasson, Miami University
This article describes the development of the U.S. health insurance system and its growth in the twentieth century. It examines the roles of important factors including medical technology, hospitals and physicians, and government policy culminating in the development of Medicare and Medicaid.

1900-1920: Sickness Insurance versus Health Insurance
Prior to 1920, the state of medical technology generally meant that very little could be done for many patients, and that most patients were treated in their homes. Table 1 provides a list of pioneering early advances in medicine. Hospitals did not assume their modern form until after the turn of the century when antiseptic methods were well established. Even then, surgery was often performed in private homes until the 1920s.

Table 1: Milestones in Medical Technology

1850-1870: Louis Pasteur, Joseph Lister and others develop understanding of bacteriology, antisepsis, and immunology.
1870-1910: Identification of various infectious agents including spirochaeta pallida (syphilis), typhus, pneumococcus, and malaria. Diphtheria antitoxin developed. Surgery fatality rates fall.
1887: S.S.K. von Basch invents instrument to measure blood pressure.
1895: Wilhelm Roentgen develops X-rays.
1910: Salvarsan (for syphilis) proves to be first drug treatment that destroys disease without injuring patient.
1920-1946: Insulin isolated (1922), sulfa developed (1935), large-scale production of synthetic penicillin begins (1946).
1955: Jonas Salk announces development of vaccine for polio.
Medical Expenditures Initially Low

Given the rudimentary state of medical technology before 1920, most people had very low medical expenditures. A 1918 Bureau of Labor Statistics survey of 211 families living in Columbus,