US Presidents have struggled with the complex politics of health care reform and universal health care since the beginning of the twentieth century.
The debate about the role of the federal government in the funding for avenues of healthcare for the country's citizens can be traced back to the end of the nineteenth century. The idea of populist reform can be seen in literary works like The Jungle
by Upton Sinclair, published in 1906, as well as in the movement for political reform led by suffragists and labor leaders such as Lucy Stone and Eugene Debs. The concept of government-sponsored public welfare developed simultaneously with the growing power given to the state as citizens looked for regulation of unsafe and unfair business practices. The idea was developed in detail in The Promise of an American Life
published by Herbert Croly in 1909 and manifested in the practices of nationalists like Theodore Roosevelt, who embraced the notion that the government should be a tool for progressive reform.
The platform of the Progressive Party, also known as the Bull Moose Party, which was founded by Roosevelt in 1912, was the first in American politics to include a plan to provide universal health insurance to all Americans. After Roosevelt lost the election to Woodrow Wilson the progressives made some efforts to try and get health care legislation passed by Congress, but without the support of the President, these efforts did not go far.
The question of public welfare was addressed directly again by Franklin D. Roosevelt, who as part of his "New Deal" platform signed the Social Security Act of 1935. The act provided a safety net for the old, sick and disabled Americans and the federal government's role of public welfare administration was firmly placed. After World War II (1939-1945), President Harry Truman's platform called the "Fair Deal" also advocated sweeping political and social reform and he even made the universal health care coverage part of the platform of the Democratic Party. Truman only managed to modestly expand the coverage of the Social Security Act, but his platform directly influenced Lyndon Johnson's "Great Society" policy.
Lyndon Johnson passed legislation which implemented Medicare and Medicaid and further expanded the federal government's role as a health care provider, but did not achieve Truman's goal of universal coverage. President Richard Nixon expanded the availability of the existing federal programs and took a stand for universal health insurance. However, the Nixon-Kennedy Healthcare plan of 1974 failed to pass through Congress because of the Watergate Scandal and the following economic difficulties in the country. At the beginning of the 1990s, President Bill Clinton also proposed a detailed plan to provide health care for all Americans, but was again defeated in Congress.
On March 21 2010, the Patient Protection and Affordable Care Act (PPACA) was passed by the House of Representatives. The new law included changes the way group health plan administrators and companies provide health insurance to their participants. The regulation envisioned a number of changes in employee benefit plan designs, costs and eligibilities over the course of four years.
The reform, which was considered the biggest reform of healthcare in the United States in 40 years, was made necessary by the high cost of the system before the changes. In 2007, spending on health care in the United States was equal to 16.2 percent of gross domestic product, which was almost two times the average of other countries in the Organization for Economic Co-operation and Development. The coverage of the previous system also caused problems. According to the US Census Bureau, there were 46.3 million uninsured people in America in 2008, out of a population of 300 million. There were also millions of Americans deemed "under-insured".
Before the PPACA, there were federally funded programs, with Medicaid and Medicare the biggest ones, but generally it was up to individual Americans to obtain health insurance. Most of them got coverage through their employers, but others signed up for private insurance schemes. Under the terms of most plans, regular premiums were paid, but people sometimes were required to pay part of the cost of their treatment (known as deductible) before the expense was covered by the insurer.
President Barack Obama said that under the PPACA, healthcare would become more affordable for Americans and health insurers would be more accountable. The changes under the new law would also help cut the federal deficit sharply by tackling fraud, waste and abuse.