American Public University

History of Health Care Reform in America

August 22, 2010

William R Cox
4075725
Dr. Mark Bowles
HIST 557, K001, Spring 2010
 On March 23, 2010, surrounded by members of Congress, aides and citizens who

lacked health insurance coverage, President Obama signed into law the Patient Protection

and Affordable Care Act. The act mandates that by 2014 most individuals obtain and

carry health insurance coverage or pay a financial penalty. The legislation establishes

directives for the creation of Health Insurance Exchanges that will offer a marketplace for

individuals and small businesses to purchase affordable coverage and realize certain

premium subsidies offered by the federal government based upon income levels. It also

establishes tax credits and penalties to encourage businesses to provide their employees

with health insurance, as well as, expands Medicaid, the existing state based health

coverage for the poor.1 During the signing ceremony President Obama remarked that the

Patient Protection and Affordable Care Act would enshrine “the core principle that

everybody should have some basic security when it comes to their health care.”2 The

Patient Protection and Affordable Care Act, true to President Obama’s remarks,

established as its goal to provide affordable health care to all Americans and specifically

to reduce the number of uninsured in America by thirty two million over the first nine

years, thereby eliminating a major threat to the financial security of many.

Detractors of the Patient Protection and Affordable Care Act readily point out the

drawbacks and potential flaws in the plan. The first issue obtaining great opposition is

the cost of nearly a trillion dollars in the midst of mind boggling federal budget deficits.
1
The Henry J. Kaiser Family Foundation, "Focus on Health Reform," Kaiser Family
Foundation, Kaiser Family Foundation, April 28, 2010,
http://www.kff.org/healthreform/upload/8023-R.pdf (accessed 15 2010, July ).
2
President Barack Obama, "The White House Blog: "On Behalf of My Mother"," The
White House, Jesse Lee, March 23, 2010,
http://www.whitehouse.gov/blog/2010/03/23/behalf-my-mother (accessed August 15,
2010).

2
Secondly, the Act establishes punitive annual fines of up to $2000 per employee for

employers who fail to provide their employees coverage, yet most businesses are

struggling, due to the poor economic climate (a climate featuring over nine percent

unemployment), to maintain revenues to meet payroll much less add benefits. Insurance

companies are targeted in the act as well. The plan mandates that insurance contracts

must cover certain specified preventative services at zero cost to the insured, that by 2014

no one can be denied coverage regardless of preexisting conditions, that health insurance

premiums may only be based on age not medical conditions, and that insurance plan

premium increases will be subject to review and at least eighty percent of premiums

collected must fund medical claims.3

Finally, and perhaps the most dangerous flaw to the successful implementation of

the plan, is the constitutionality of the Federal government mandating that individuals

purchase a particular consumer product. The same day that President Obama signed the

act into law fourteen states attorneys general filed suit in federal court arguing that the

law was unconstitutional. Attorney General of Florida Bill McCollum argued that,

“there’s no provision in the Constitution that allows for anybody to be forced to do

something when there’s no commerce, no action,” further arguing that the federal

mandates within the law also violated the sovereignty of the states.4 The State of

Virginia filed a separate suit in federal court due to a state law specifically blocking such

mandates from the federal government. The Virginia suit survived its first legal

roadblock on August 2, 2010, when the Obama administration petitioned a federal judge

3
The Henry J. Kaiser Family Foundation, "Focus on Health Reform.”
4
Ariane de Vouge and Devin Dwyer, "ABC News," States Launch Legal Challenge to
Health Care Law, ABC News, March 23, 2010, http://abcnews.go.com/print?
id=10178015 (accessed August 17, 2010).

3
to dismiss the suit. Federal District Judge Henry Hudson ruled that, “unquestionably, this

regulation radically changes the landscape of health insurance coverage in America” and

ordered the matter to move forward to a hearing in October of 2010.5

Those who support the Patient Protection and Affordable Care Act correctly point

out that Congress maintains authority to regulate health insurance under the commerce

clause of the Constitution. Both proponents and detractors of the Act will likely pursue

their side of the cause all the way to the Supreme Court; however, historically Congress

has received great leeway from the Court when it concerns the commerce clause. In fact

from 1937 to 1995 the court did not overturn any acts of congress that were based on the

commerce clause; however, the Robert’s court may prove to be less content with

congressional authority when it comes to something as intimate as health care.6 Only

time will tell, which side in the health care debate will prevail; however, the ideological

argument over the Patient Protection and Affordable Care Act, is seen as early as the

Progressive movement of the first two decades of the twentieth century and has continued

throughout the century.

The ideological debate over health care has raged throughout the twentieth

century and has consisted in the simplest terms as a contest that pitted individual

responsibility versus the general societal desire for an adequate social safety net;

however, over the last three decades the debate has come to represent America’s desire to

have less government while at the same time having more government services. We

5
Michael Felberbaum, "The Associated Press: Va. Health Care Reform Lawsuit Clears
First Hurdle ," Google News: The Associated Press, August 2, 2010,
http://www.google.com/hostednews/ap/article/ALeqM5jIYk-
9I_3l_9vZpcpalaAhOGdUdgD9HBHHH00 (accessed August 20, 2010).
6
Linda R Monk, The Words We Live By: Your Annotated Guide to the Constitution (New
York: Hyperion , 2003), 196.

4
want the government to guarantee our health care, yet we refuse to allow the government

to enter health care.

The history of this debate, in many ways, has shaped the culture of America

during the last century. The progress of the American health care system has provided

untold societal benefits from improvements in life expectancy, to increased quality of

life, to the freedom and opportunity to experience cosmetic changes; however, as

American health care has improved and progressed with society, the cost of the system

has become devastatingly expensive. In 1897, the first year of its operation, St. Francis

Hospital in Hartford Connecticut charged an average of fifteen dollars per week to treat

patients.7 In comparison, a 2000 University of Michigan medical center study of 12,365

patients revealed an average total cost of $17,734 for hospital services.8 Health care

spending has spiraled out of control over the last half of the twentieth century increasing

from around five percent of American gross domestic product in 1960 to almost fifteen

percent by 2002, or $1.6 trillion.9 Americans revel in the benefits of a rapidly advancing

health care system; however, its costs leave most terrified and asking the question, “What

if I lose my insurance?” This is the context within which we must examine the history of

health care financing in America, specifically the attempts that have been made to reform

the financing system, set the stage for the 2010 Patient Protection and Affordable Care

Act.

7
Mark Bowles, Saint Francis Hospital and Medical Center: Our Healing Mission
(Cleveland, OH: History Enterprises, 2003), 14.
8
National Center for Policy Analysis, "Daily Policy Digest: Length of Stay and Hosptial
Cost," Daily Policy Digest, NCPA, October 9, 2000,
http://www.ncpa.org/sub/dpd/index.php?Article_ID=9413 (accessed August 19, 2010).
9
Cathy Cowan, Aaron Catlin, Cynthia Smith and Arthur Sensenig, "National Health
Expenditures, 2002," Health Care Financing Review (Centers for Medicare and Medicaid
Services) 25, no. 4 (Summer 2004).

5
 The history of health care financing emerges in the years prior to the Great

Depression in the form of the Progressives. The Progressives emerged into their

professional lives where they viewed it as their responsibility to accomplish “the

reconciliation of democratic ideals with the political, social, and economic realities of the

new urban and industrialized America.”10 The generation known by the label

Progressives attempted to bring order to the chaos that surround a society dominated by

industrial monopolies with names like Heinz, Swift, and Singer. They sought justice,

equality and economic opportunity, not only for themselves, but also for future

generations of Americans.

The Presidential election of 1912 featured a Progressive Party Platform, on which

Theodore Roosevelt sought election, that castigated the chaotic nature of the new

unrestrained industrial economy stating “this country belongs to the people who inhabit

it” and “its resources, its businesses, its institutions and its laws should be utilized,

maintained or altered in whatever manner will best promote the general interest” in short,

“it is time to set public welfare in the first place.”11 One of the methods for setting the

public welfare first was pledging to “work unceasingly in State and Nation for . . . the

protection of home life against the hazards of sickness, irregular employment and old age

through the adoption of a system of social insurance adapted to American use.”12 The

Progressive party did not win the election and therefore did not have an opportunity to

implement its program of Social Insurance; however, they would see many of their other

10
Ernst Breisach, Historiography Ancient, Medieval, and Modern, 3rd Edition (Chicago,
IL: University of Chicago Press, 2007), 313.
11
Progressive Party 1912, "Progressive Party Platform 1912," The American Presidency
Project, John Woolley and Gerhard Peters, November 5, 1912,
http://www.presidency.ucsb.edu/ws/index.php?pid=29617 (accessed July 8, 2010).
12
Ibid.

6
concerns addressed to one degree or another by the new President, Democrat Woodrow

Wilson, who being very politically astute, offered every incentive for the Progressives to

follow him.13 Wilson negotiated the enactment of his New Freedom plan that included

social provisions such as workers compensation programs for any government work and

labor legislation that stipulated an eight-hour workday, giving labor unions a long

anticipated victory.14 Government in the Progressive era was bringing order to society

and establishing that it had a role in the economic and social life of America.

Although the Wilson Presidency did not enact national health insurance, a group

known as, the American Association for Labor Legislation, notably comprised of future

Supreme Court Justice Louis Brandeis among others, began an investigation into the

possibility of compulsory health insurance. The committee studied the issue of national

health insurance in conjunction with several other groups, most notably the American

Medical Association, and after two years they drafted a bill for compulsory sickness

insurance that would become known as the Standard Bill and would be introduced and

studied by more than twelve states within two years. The movement for national

compulsory health insurance collapsed by 1920 seeing the opposition of insurance

companies, organized labor and the American Medical Association.15 The proponents of

the Standard Bill were influenced and encouraged by Europeans, specifically, Great

Britain who had adopted the National Insurance Act of 1911, “which brought government

sponsored health insurance to five sixths of the families in the nation and established the

13
James Cooper, Pivotal Decades: The United States 1900-1920 (New York: W.W.
Norton, 1990), 218.
14
Ibid., 214-215.
15
Joseph Hirsh, "The Compulsory Health Insurance Movement in the United States,"
Social Forces (The University of North Carolina Press) 18, no. 1 (October 1939): 106-
108.

7
precedent of state concern for the physical welfare of the individual citizen.”16 On the

eve of America entering World War I, following years of reform from President

Theodore Roosevelt and President Woodrow Wilson, Americans were not ready for that

level of government involvement in their lives, and in reality the demand for health

insurance was low because the prices of medical care were to that point, reasonable. The

greatest cost associated with injury and illness during this period was being unable to

work. The Bureau of Labor Statistics studied 211 families in Ohio in 1918 and

discovered that “only seven point six percent of their average medical expenditures” were

for hospital care. Americans were suspect of compulsory insurance and some, albeit with

a vested interest, like Frederick Hoffman, an executive of Prudential Insurance, called

national health insurance “un-American.”17 With such a small economic incentive for

reform, proponents of national health insurance would have to wait; however, the

economic crisis just around the corner would offer President Franklin Roosevelt an

opportunity to secure American society from illness and injury.18

By 1929, the American health care system had completed its transformation into

an industry based on science and business principles. For certain curing illness and

recovery from sickness remained the goals; however, the increased demand for medical

services during the previous decades necessitated great expansion of facilities and with

that expansion and technological advance, came larger and larger expenses that were

passed on to the patients. The first International Hospital Congress meeting in June of
16
Bentley Gilbert, "The British National Insurance Act of 1911 and the Commercial
Insurance Lobby," The Journal of British Studies (The University of Chicago Press) 4,
no. 2 (May 1965): 127-148.
17
Hirsh, "The Compulsory Health Insurance Movement in the United States," 106-108.
18
Melissa Thompson, "Health Insurance in the United States," Economic History
Services, April 17, 2003, http://eh.net/encyclopedia/article/thomasson.insurance.health.us
(accessed August 5, 2010).

8
1929 offered a chance for European hospital staffs and Americans to compare notes.

Guenter Risse, in Mending Bodies, Saving Souls, points out the European observations

that, even though subject to competition, “both administrative and care cost were much

higher in America,” that there was pressure to create semi private and private rooms in

American hospitals, that “American hospital staffs were also found to be, on average, 10

times larger than those serving comparable European Establishments,” that “in the eyes

of European administrators, the amount of paperwork generated in American hospitals

was truly staggering,” and “in America, food, furnishings, and service resembled those of

first-class hotels.19” By this time many of the Europeans had operated under compulsory

national health insurance for years. In the context of hospitals being seen by Europeans

as luxury hotels, the 1930 American Hospital Association convention speaker Julius

Rosenwald, offered a prophetic vision of the future of health care finance when he stated

that considering the current economic conditions, “free care was to be curtailed further in

favor of fee for service,” “the pay as you go method of medical care was more in accord

with current American ideals,” and that “for those who could not afford medical services,

either the state would have to assume this responsibility or interested individuals and

groups had to find other ways to provide good medical care at a fair price.”20 As

Rosenwald suggested a group of Dallas teachers working with Baylor University

Hospital developed another way to obtain good medical care at a fair price.

The Baylor University Plan was the first prepaid hospital plan that emerged

during the Great Depression. The plan stipulated that for a fixed payment amount the

hospital agreed to provide a certain number of days hospitalization. Plans like the Baylor
19
Risse Guenter, Mending Bodies, Saving Souls: A History of Hospitals (Cary, NC:
Oxford University Press, 1999), 472-474.
20
Guenter, Mending Bodies, Saving Souls, 475.

9
plan grew during the Depression as a way for individuals to pay their bills, arguing that

most people could afford a few cents a day all year but not a large bill after being

hospitalized. The American Hospital Association would encourage other hospitals to

adopt similar payment schemes and ultimately organize them under the association to

become what we know today as Blue Cross. Doctors would eventually adopt their own

prepayment service out of fear that they could lose the revenue stream of prepayment to

the hospitals if they developed a prepayment plan for doctors’ services. The plan for

doctors was also developed out of a fear of potential compulsory health insurance from

the Roosevelt administration, which had successfully implemented social security. The

physicians ultimately followed the example of the American Hospital Association and the

American Medical Association established Blue Shield in 1946.21

The Roosevelt administration faced unprecedented problems and offered

imaginative, and on occasion unbelievable, solutions from the Works Progress

Administration, to the Wagner Act, to the Lend Lease Act. Faced with the economic

catastrophe of the Great Depression Roosevelt implemented many programs designed to

ease the plight of the poor and unemployed in America. Certainly the most famous

legislative achievement of the administration occurred in 1935 with the passage and

implementation of the Social Security Act. Congress created it as “an act to provide for

the general welfare by establishing a system of Federal old-age benefits, and by enabling

the several States to make more adequate provision for aged persons” and funded the

measure with over forty nine million dollars the same year.22 The implementation of

21
Thompson, "Health Insurance in the United States."
22
Congress of the United States, "Transcript of Social Security Act (1935)," Our
Documents, 1935, http://www.ourdocuments.gov/doc.php?
flash=true&doc=68&page=transcript (accessed August 4, 2010).

10
Social Security represented a new era where the government recognized that it had a

responsibility in providing a social safety net.23 Neither the Social Security Act nor the

Committee on Economic Security specifically mentioned health insurance, since passage

of the financial insurance for the aged was the primary purpose; however, Roosevelt did

form the Interdepartmental Committee, and tasked them to examine public health issues

in America. The Committee eventually conducted health surveys of the country and

established the Technical Committee of Medical Care and in 1938 published its report, A

National Health Program. In 1939 Senator Wagner proposed a National Health Bill;

however, the bill never left the committee level, meanwhile the modern Department of

Health and Human Services was created to unify all the federal agencies that dealt with

health, welfare and social insurance programs.24 The creation of additional social

programs by the Roosevelt administration was interrupted by World War II; however,

due to wage and price controls implemented during the war many employers indirectly

increased their employees net benefit from employment by providing employer

sponsored health benefits. The Wage Labor Board ruled the practice of providing health

benefits appropriate in 1943, thereby; firmly establishing employer provided health care

as a norm in American economic life. With D-Day looming in less than six months, in

his state of the Union message to congress, Roosevelt called for them to establish an

American “economic bill of rights” that included “the right to adequate medical care and

the opportunity to achieve and enjoy good health” and “the right to adequate protection

from economic fears of old age, sickness, accident and unemployment.”25 The President
23
Alonzo Hamby, Liberalism and Its Challengers: From F.D.R. to Bush (New York:
Oxford Univeristy Press, 1992), 24.
24
The Henry J. Kaiser Family Foundation, "Focus on Health Reform."
25
Franklin D. Roosevelt, "State of the Union Message to Congress: January 11, 1944,"
The American Presidency Project, John Woolley and Gerhard Peters, January 11, 1944,

11
urged congress to “explore the means of implementing” these rights, because “all of these

rights spell security” and “after this war is won we must be prepared to move forward . . .

to new goals of human happiness and well being.”26

Once the war was won, the veterans returned home to put the nation on a path to

world wide economic hegemony while creating a society that with the highest standard of

living in the world. America during the Truman and Eisenhower administrations faced

the threat of communist expansion and nuclear catastrophe yet national health insurance

lurked in the background as an issue both would address. Truman, in some measure to

complete Roosevelt’s legacy, attempted to revive the goal outlined in the economic bill of

rights to provide adequate health security by introducing the Wagner-Murray-Dingell bill

that sought to provide funding for states to provide medical care for the poor in 1946 and

in 1947 he sent another message congress asking for a reintroduction of the bill. In 1954,

President Eisenhower proposed a fund to help private insurers offer coverage to groups

they had so far refused to cover and he signed the Revenue Act, which excluded from

income any employer contributions towards employee health plans.27 This provision of

the tax code provided employers with an incentive to provide better benefits to

employees and it incentivized employees to accept benefits rather than taxable cash. In

1956, a preview occurred for national health care with the adoption of programs that

provided government health insurance for the dependents of those serving in the Armed

forces.28

America moved incrementally closer to national health insurance in 1965 when

http://www.presidency.ucsb.edu/ws/index.php?pid=16518 (accessed August 15, 2010).

26
Ibid.
27
The Henry J. Kaiser Family Foundation, "Focus on Health Reform."
28
Ibid.

12
the Social Security Act was amended to include Medicare, health insurance for the aged,

and Medicaid, health insurance for the poor. Medicare, which is seen as one of the

crowning achievements of President Johnson, originated under President Kennedy as a

program for medical care of the aged. President Kennedy and ultimately President

Johnson faced an uphill battle from opposition forces some who, lamented the plan would

“sap the individual self-reliance of Americans.”29 Kennedy rebutted the critics in a New

York speech in 1962 stating that, “the fact of the matter is that what we are now talking

about doing, what most of the countries of Europe did years ago” and that the

“cooperation between an alert and Progressive citizen and a progressive Government is

what has made this country great—and we shall continue as long as we have the

opportunity to do so.”30 President Johnson “having lived on the fringes of poverty

himself, . . . felt a deep empathy for the poor,” and he used his skill as a legislator to

secure the passage of the Economic Security Act of 1964, the Civil Rights Bill and the

legislation to establish Medicare and Medicaid.31 Johnson’s empathy for the poor and his

vision of government having a social responsibility contrasted sharply to his Republican

opponent Barry Goldwater who “espoused an aggressive frontier individualism.”32

Johnson expressed the wonders of his Great Society as outlined in the bill during the

signing ceremony on July 30, 1965 in Independence, MO alongside former President

Truman, stating “the benefits under the law are as varied and broad as the marvelous

modern medicine itself . . . no longer will older Americans be denied the healing miracle
29
John F Kennedy, "Address at a New York Rally in Support of the President's Program
of Medical Care for the Aged," The American Presidency Project, John Woolley and
Gerhard Peters, May 20, 1962, http://www.presidency.ucsb.edu/ws/index.php?
pid=8669&st=&st1 (accessed August 5, 2010).
30
Ibid.
31
Hamby, Liberalism and Its Challengers, 258.
32
Ibid., 259.

13
of modern medicine” and “no longer will illness crush and destroy the savings . . . put

away over a lifetime.”33 Barry Goldwater lost the election to Johnson; however, a new

politician was waiting in the wings that purported the same individualism, Ronald

Reagan.

The years between the Johnson and Reagan Presidencies experienced rampant

inflation with the cost of living increasing at an average annual rate of over eight percent.

The large-scale inflation, a result of increased government spending during the Vietnam

War, pent up consumer demand and a middle-eastern oil crisis resulted in economic

terror for many Americans. These decades also saw bracket creep for many Americans

and the enactment of Proposition 13 in California, which mandated a two-thirds vote by

the state legislature on all tax increases, signaled that progressivism had reached too far

in American society.34 These decades also treated Americans to the further expansion of

government into health care with the expansion of Medicare to cover those with long-

term disabilities, the enactment of Employee Retirement Income Security Act, and the

establishment of, the Health Care Financing Administration.35 Ronald Reagan took

advantage of America’s growing distrust, dislike, and suspicion in 1980 with a campaign

that focused on the competent individualism of the American citizen and the equality of

opportunity afford to all.

Reagan summarized the feeling of many Americans in his first inaugural address

33
Lyndon Johnson, "Remarks with President Truman at the Signing in Independence of
the Medicare Bill," Lyndon Baines Johnson Library and Museum, Lyndon Baines
Johnson Library and Museum, July 30, 1965,
http://www.lbjlibrary.org/collections/seelctied-speeches/1965/07-30-1965.html (accessed
August 2010).
34
James Patterson, Restless Giants; The United States From Watergate to Bush V. Gore,
ed. David Kennedy (New York: Oxford University Press, 2005), 65-66.
35
The Henry J. Kaiser Family Foundation, "Focus on Health Reform."

14
when he addressed the growing place of government in society stating that, “in this

present crisis, government is not the solution to our problem; government is the

problem.”36 America entered an era of political ideology that was dominated by a

growing number of conservative citizens who placed an ideological emphasis on their

individual capabilities; however, in reality the government continued to expand,

especially in realm of health care. During the Reagan administration, the political

rhetoric focused on the cause of a small government, yet Medicaid expanded three

different times, in 1986 the Emergency Medical Treatment and Active Labor Act, which

mandated that hospitals must treat emergency patients regardless of ability to pay, and the

Consolidated Omnibus Budget Reconciliation Act (COBRA) was signed into law,

allowing employees to continue their employer sponsored health insurance for up to

eighteen months after they left a job.37 The era of small government did not apply to

health care reform and the government became more intimately involved in the regulation

of health care through COBRA than perhaps anytime since the 1960’s. Americans had

developed an unhealthy trend, they desired less government intervention and intrusion;

however, they demanded more government services and safety nets.

This ideological contradiction continued into the Clinton administration where

within the first weeks of his Presidency a task force was created to develop a plan of

health care reform. The Clinton administration ran on a platform that espoused the value

of government in American society, stating that the administration would work at

“putting government back on the side of working men and women,” and that the party

36
Ronald Reagan, "Inaugural Address January 20, 1981," The American Presidency
Project, John Wolley and Gerhard Peters, January 20, 1981,
http://www.presidency.ucsb.edu/ws/index.php?pid=43130 (accessed July 16, 2010).
37
The Henry J. Kaiser Family Foundation, "Focus on Health Reform.”

15
believed in “an activist government;” however, the party contradictorily stated the desire

to restore “the basic American values that built this country and will always make it

great: personal responsibility” and “individual liberty.”38 Regardless of party platform

positions, the political rhetoric illustrated the reality, that Americans wanted less

government yet more services. The Clinton administration’s Health Security Act was

plagued by poor political calculations and was never implemented; however, due to rising

medical cost and possibly in response to the threat of nationalized health care most

insurers adopted managed care business models.39 The adoption of managed care slowed

the rapid growth in insurance premiums throughout the Clinton years and reduced the

growth of hospital expenditures significantly to less than four percent between 1993 and

1998. Ironically, a by product of managed care was a decrease in out of pocket expenses

for individuals, this decrease in out of pocket expenses eliminated any consumer restraint

in utilization of medical services thereby increasing the demand and ultimately prices.

The consumer was insulated from this increase in medical inflation due to the limited out

of pocket expenses offered under managed care. This ticking time bomb was set to

explode by the late 2000’s.

The premium cost for the Baylor plan was a fixed six-dollar payment for a benefit

of twenty-one days per year of hospitalization in 1929.40 Eighty years later the average

cost for a family to purchase private health insurance coverage was $13,375 per year.41

38
Democratic Party, "Democatic Party Platform of 1992," The American Presidency
Project, John Woolley and Gerhard Peters, July 13, 1992,
http://www.presidency.ucsb.edu/ws/index.php?pid=29610 (accessed August 20, 2010).
39
The Henry J. Kaiser Family Foundation, "Focus on Health Reform."
40
Thompson, "Health Insurance in the United States."
41
The Henry J Kaiser Family Foundation, "Employer Health Benefits 2009 Annual
Survey," The Kaiser Family Foundation, The Kaiser Family Foundation, 2009,
http://ehbs.kff.org/?page=charts&id=2&sn=16&p=1 (accessed August 20, 2010).

16
The health care debate has continued throughout the last century and initially focused on

individual responsibility versus the progressive societal concern for providing an

adequate safety net; however, an ideological shift has taken place over the last three

decades that places American’s in a contradictory position of wanting more for less. The

Progressive party of 1912 offered Americans “protection of home life against sickness,”

Franklin Roosevelt offered an economic bill of rights, and President Johnson finally

provided protection for the aged. Americans a century later are seeking a solution to the

nightmare of, “What if I lose my insurance?” However, the proponents and detractors

remain, almost six months after President Obama signed the Patient Protection and

Affordable Care Act the country remains almost equally divided between those who

favor compulsory health insurance and those who oppose it.42 The debate will continue

all the way to the Supreme Court by way of the ballot box in November.

42
Opinion Reseach Corporation, "CNN Opinion Research ," CNN Opinion Research ,
August 2010, http://i2.cdn.turner.com/cnn/2010/images/08/19/rel11g.pdf (accessed
August 20, 2010).

17
Bibliography
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Cleveland, OH: History Enterprises, 2003.

Congress of the United States. "Transcript of Social Security Act (1935)." Our
Documents. 1935. http://www.ourdocuments.gov/doc.php?
flash=true&doc=68&page=transcript (accessed August 4, 2010).

Cooper, James. Pivotal Decades: The United States 1900-1920. New York: W.W.
Norton, 1990.

Cowan, Cathy, Aaron Catlin, Cynthia Smith, and Arthur Sensenig. "National Health
Expenditures, 2002." Health Care Financing Review (Centers for Medicare and Medicaid
Services) 25, no. 4 (Summer 2004).

de Vouge, Ariane, and Devin Dwyer. "ABC News." States Launch Legal Challenge to
Health Care Law. ABC News. March 23, 2010. http://abcnews.go.com/print?
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Democratic Party. "Democatic Party Platform of 1992." The American Presidency

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http://www.presidency.ucsb.edu/ws/index.php?pid=29610 (accessed August 20, 2010).

Felberbaum, Michael. "The Associated Press: Va. Health Care Reform Lawsuit Clears
First Hurdle ." Google News: The Associated Press. August 2, 2010.
http://www.google.com/hostednews/ap/article/ALeqM5jIYk-
9I_3l_9vZpcpalaAhOGdUdgD9HBHHH00 (accessed August 20, 2010).

Gilbert, Bentley. "The British National Insurance Act of 1911 and the Commercial
Insurance Lobby." The Journal of British Studies (The University of Chicago Press) 4,
no. 2 (May 1965): 127-148.

Guenter, Risse. Mending Bodies, Saving Souls: A History of Hospitals. Cary, NC: Oxford
University Press, 1999.

Hamby, Alonzo. Liberalism and Its Challengers: From F.D.R. to Bush. New York:
Oxford Univeristy Press, 1992.

Hirsh, Joseph. "The Compulsory Health Insurance Movement in the United States."
Social Forces (The University of North Carolina Press) 18, no. 1 (October 1939): 106-
108.

18
Johnson, Lyndon. "Remarks with President Truman at the Signing in Independence of the
Medicare Bill." Lyndon Baines Johnson Library and Museum. Lyndon Baines Johnson
Library and Museum. July 30, 1965. http://www.lbjlibrary.org/collections/seelctied-
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