Public Policy Issue: U.S. Health Care Reform History

Healthcare in the United States has come a long way since the American Medical Association (AMA) organized to establish control over physician services in 1901.

President Franklin Roosevelt’s “drafts of the legislation for the Social Security Act from 1935 included language that would have created a compulsory national health insurance” modeled on a single-payer system, but concerns with “overburdening the Social Security Act” and issues with the economy pushed the proposal aside (Tim Foley, Change.org).

President Harry Truman proposed a new national health care program to Congress on 19 November 1945 to “improve the state of healthcare” by addressing “the lack of doctors, dentists, nurses, and other health professionals in many rural or otherwise lower-income areas of the United States” (Harry S. Truman Library and Museum) Part of his proposal involved instituting an optional national health insurance plan. President Truman’s proposal, however was shot down by the American Medical Association, whose members:

characterized the bill as "socialized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line". (Harry S. Truman Library and Museum)

In 1961, right after his election, President John Kennedy rallied for the Medicare plan as “an attachment to the Social Security Act” to popular support, but “private insurers . . . resisted the plan along with the AMA and the plan failed to pass the Senate.


President Lyndon Johnson passed Medicare plan in 1965 despite protests from private insurance companies and the AMA.

On 6 February 1974, President Richard Nixon announced his Comprehensive Health Insurance Plan (CHIP) to Congress.


Nixon's plan proposed the following:

1. it offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;
2. it will cost no American more than he can afford to pay;
3. it builds on the strength and diversity of our existing public and private systems of health financing and harmonizes them into an overall system;
4. it uses public funds only where needed and requires no new Federal taxes;
5. it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.
6. it encourages more effective use of our health care resources;
7. And finally, it is organized so that all parties would have a direct stake in making the system work--consumer, provider, insurer, State governments and the Federal Government.

(From “Nixon's Plan For Health Reform, In His Own Words,” KHN)

Nixon’s plan came the closest to being passed of any American president since President Obama, but he did not have time to convince the opposition parties to pass the bill before he resigned on 8 August 1974.

In 1997, President Bill Clinton was able to sign into law the State Children’s Health Insurance Program (SCHIP) program, which was “created out of a partnership between Sen. Kennedy and Sen. Orrin Hatch with support from Hillary Clinton. . . . [T]he program used money from tax on tobacco to provide coverage for 6 million children” (Tim Foley, Change.org).

When President Barack Obama took office, he increased the coverage of SCHIP to “an additional 4 million children” (Tim Foley, Change.org). President Obama has made passing a comprehensive national system health insurance a central priority of his adminstration. On 7 November 2009, in a well publicized event, the House approved an overhaul of the nation’s healthcare system. On December 24th, the Senate approved $871 billion for the plan. Now, the fate of the new plan lies in agreement among the House and Senate in the details of the bill. Republican Scott Brown’s recent Senate seat victory in Massachusetts may problematize the trajectory of the bill.