In part one of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, provides a look at the state of healthcare in America from the 1930s through the 1960s.

1. A Brief History of Health
Care Reform
Part 1: All Americans Were Uninsured
John J. Dalton, FHFMA
Senior Advisor Emeritus

2. 1930s
• US economy struggles to recover from the Great
Depression; Franklin Delano Roosevelt is elected
President in 1932.
• FDR follows cousin Teddy’s lead and proposes to include
publicly funded health care programs as part of his Social
Security legislation.
• Roosevelt removes the health care provisions from the
bill in 1935 in the face of strong opposition to
“compulsory health insurance” from the American
Medical Association and its state and local affiliates.
• Groups of hospitals began offering insurance programs
that soon evolve into not-for-profit Blue Cross plans.

3. 1940s
• Kaiser Steel, Fontana, CA – first steel plant west of
the Rockies.
• WWII – wage and price controls; major labor shortages.
• How to recruit workers to work in a sparsely populated
desert?
• Birth of employer-sponsored health care.
• 1949 - President Harry Truman calls for universal
health care as a part of his Fair Deal program, but
drops it in the face of fierce opposition from the
AMA et al.

4. 1950s
• “I like Ike;” Dwight D. Eisenhower elected
President in 1952.
• Ends Korean “police action,” followed by
eight years of relative peace, prosperity
and the growth of the interstate highway
system.
• Collective bargaining agreements expand
employer-based health care; “first dollar
coverage” becomes commonplace with
low deductibles and co-pays.

5. 1960s
• Following President Kennedy’s 1963 assassination,
Lyndon B. Johnson aggressively advances the “New
Frontier” agenda, gaining passage of the Civil Rights
Act, the War on Poverty and access to healthcare for
the poor and elderly.
• Title XVIII – Medicare (named for Canada’s program
of health care access for all) passes, assuring health
care services for the elderly when they most need it;
and
• Title XIX – Medicaid enacted as a joint federal-state
program to expand coverage for the working poor.
• The first Medicare hospital claim is processed by
Horizon Blue Cross and delivered to Jack Farmer,
CFO of East Orange General Hospital; it made the
five o’clock news.

6. Contact Information
BESLER Consulting
3 Independence Way, Suite 201
Princeton, New Jersey 08540
Phone: 609.514.1400
Toll Free: 877.4BESLER
Fax: 609.514.1410
www.besler.com