Health 1

Timeline of American Healthcare - 6

1758: First Hospital founded in Philadelphia, PA by Benjamin Franklin

1849: American medical Association founded

1929: Blue Cross Blue Shield

1958: First Organ Transplant

1996: HIPPA

2010: Affordable Care Act (obamacare)

Colonial America

Since immigrants included few classically trained physicians, healthcare was often provided by women, and it was mostly reserved for childbirth

What was colonial healthcare like? - 3

No government regulation

No emphasis on public health (all individualized come as you go)

No preventative medicine

Early American Medical Advancements

Continental Army and smallpox vaccine - first public health

Civil war

2X as many soldiers died due to disease than battle

We begin to see that healthcare is becoming more organized, hospitals became larger, medical education becomes more formal, and public health becomes increasingly important.

Perhaps the most important thing is that medicine begins to move towards a scientific model.

Smallpox disparagingly affected African Americans (7X)

Advances include: Aseptic technique, sterilization techniques (1860), and antiseptic surgery (1965)

Army hospitals

Under USSG Alexander Hammond and medical director Letterman, an ambulance and hospital system was developed

Industrial revolution

urbanization = bigger need for public health

labor unions negotiated for members to receive healthcare benefits

Physicians gained professional sovereignty and resisted socialized medicine

Due to the need for specialization and technology, the hospital because the core of delivery of services

Universal medical licenses became commonplace

tremendous educational reform = AMA took over control of medical education

The Great War (WWI)

70% of amputations were due to gas gangrene because teams had no antiseptic

Henry Dakin: Protein/amino acid specialist who sought an antiseptic that could kill bacteria without damaging human tissue or white blood cells.

• Existing antiseptics such as *iodine and peroxide** killed bacteria but also damaged human cells and were quickly inactivated by amino acids.

Alexis Carrel: Prominent surgeon and Dakin's colleague who recruited Dakin to develop a better wound antiseptic.

• Together they developed *Dakin’s solution** = Sodium hypochlorite + boric acid + water.

• Boric acid: Buffers the solution to approximately pH 9–10, reducing tissue irritation, while also providing mild antiseptic activity.

Agatha Hodgins

Adopted technique using N₂O in a blend with O₂ that became the standard of surgical care

Also helped design the monovalve, which was the precursor to the modern gas machine

Founded the first school of anesthesia

Agatha was not simply to produce unconsciousness. Her technique was designed to provide anesthesia while avoiding excessive physiological compromise.

Rise of private insurance

The Baylor Plan (1929) - a Prepaid plan

• birth of private insurance

1939, the California Medical Association started the Blue Shield plan

The Great Depression

• Great Depression: Many people could no longer afford healthcare.

• Key pattern: Government involvement expands when private systems cannot adequately meet population needs.

Social Security Act of 1935 – signed by FDR as part of “New Deal”

• Social security, which decreased poverty among the elderly

• Unemployment insurance

• Aid to Dependent Children – assistance for children of single mothers

Post-world war 2

Discovery of antibiotics was revolutionary

• 1945 – Florey and Fleming shared Nobel Prize for penicillin

Blood transfusions, medical specializations, improvements in anesthesia

Increase in employer-sponsored health insurance

1960’s

Advances in science and technology, as well as specialized training in medicine and surgery led to many groundbreaking advances in healthcare and rise in $$$

Expansion of Social Security Act of 1935, leading to the Social Security Act of 1965 → laid the groundwork for Medicare and Medicaid

1980’s

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

• COBRA: Allows eligible employees to temporarily continue employer-sponsored health insurance after leaving a job.

• The individual generally pays much more of the premium, making it expensive.

• Major benefit: prevents an immediate gap in health insurance coverage between jobs.

HIV awareness pushed more Public Health

1990’s

• Health Security Act (1993) — Clinton

  • Address rising healthcare costs

  • Protect preexisting conditions

  • Require employer-sponsored insurance for full-time employees

  • ❌ Did not pass Congress

• HIPAA (1996)

• CHIP

  • Health coverage for uninsured children <19

  • Targets families earning too much for Medicaid

  • Important correction: CHIP did not expand Medicare; it created/expanded coverage alongside Medicaid for children.

  • Bridging the gap for Medicaid ineligibility

2000s

• Medicare Modernization Act (2003) created Medicare Part D

  • Voluntary prescription drug coverage

• Affordable Care Act (ACA) — 2010

  • Major U.S. healthcare reform

  • Expanded access to health insurance

  • Required many employers to offer coverage

  • Established an individual coverage mandate

  • Prohibited denial of coverage due to preexisting conditions

Current

• U.S. healthcare spending

  • Higher administrative costs than other wealthy countries

  • Lower spending on long-term care

• Mental health & substance use disorders

  • Affect patients across all healthcare settings

  • Inadequate behavioral healthcare contributes to:

    • Substance abuse & overdose

    • Chronic and psychiatric illness

    • Medication interactions

    • Poor treatment adherence