How Health Care Became A Hot Mess
The health care system didn’t get this way overnight. It took a century of advancements in science, medicine, technology, and attempts by many presidents to ensure everyone could afford care.
If you were sick, you’d call a doctor to come to your house and pay him a few bucks. Since doctor bills weren’t that high then, and there weren’t many meds available, there was no need for health insurance.
As hospitals got fancier (read: clean) and more sophisticated medications were developed, costs went up. Businesses started to pick up the tab for employees as a perk—mainly because they wanted their staff healthy so they could get back to work. Some politicians, including Presidents Roosevelt and Truman, thought everyone should have this benefit, so they sent bills to Congress with provisions for universal health care. “No can do,” said Congress. Too expensive. Since ending World War II was a bigger priority for these leaders, they gave up on health care.
World War II had a massive impact on medicine, and by the time it ended, penicillin, morphine, and many life-saving techniques had been developed. Health care became a big business, which made medical bills bigger, too. Insurance companies got in the game by charging a monthly fee to cover costs.
It was becoming difficult for poor, old, and disabled people to pay their medical bills, so President Johnson passed the Medicare and Medicaid Act of 1965. It was the largest health care reform ever, but they didn’t bother to crunch the numbers to see how much it would cost Americans in the long run. (Spoiler alert: A lot.)
Health care got really, really expensive and by the end of the century, sixteen percent of the population didn’t have health insurance and sure as hell couldn’t pay for medical care without it. There was a lot of shady stuff going down, like people being refused insurance because they had a “pre-existing condition” such as depression or asthma. In 1996, President Clinton signed the Health Insurance Portability and Accountability Act, aka HIPAA. You probably think of HIPAA as that extra form you have to sign at the doc’s office saying they’ll keep your stuff confidential, but it’s about more than privacy. HIPAA made it illegal for insurers to deny you coverage if you have a pre-existing condition.
President Bush signed the Mental Health Parity and Addiction Equity Act of 2008, which was kind of like an equal-rights bill for people dealing with mental illness and addiction. It forced insurers to cover those conditions just as they would any physical illness or disability.
There were more people without insurance than ever before. President Obama made passing a blockbuster health care reform bill his number-one priority, and he pulled it off. In 2010, he signed the Patient Protection and Affordable Care Act (ACA), which everyone calls Obamacare. There is a debate on just how “affordable” it is, but it did expand Medicaid, let kids stay on their parents’ plan until age twenty-six, and gave everyone else the chance to buy insurance on the Health Insurance Marketplace. Once the ACA became law, if you decided not to buy health care, you had to pay an annual fee. This pissed a lot of people off, but the Supreme Court said it was legit.
The ACA was a big win for people with mental health issues. It recognized that mental health care is an essential health benefit, and made sure that all insurance plans covered it. Depression and alcohol misuse screening was added to the list of preventive care services that everyone should have access to, just like getting your blood pressure taken.
President Trump and the Republican-led House and Senate put repealing the ACA at the top of their to-do list. It proved to be a harder bill to take down than expected, but they did manage to get rid of the insurance mandate so that people who decide not to have coverage don’t have to pay a fine.
Let me be your guide to getting the best health insurance for your budget so you can get quality care for your mind and body. Order Everything Is Going to Be OK: A Real Talk Guide to Living Well with Mental Illness.