Archive for October, 2009
Free to do whatever on halloween…
~ mahalo to DM
Health insurance in the USA is a modern invention—and by modern, we mean only 80 years ago. So, what did people do before that?
“Bring Out Your Dead”
Many historians trace health insurance back to ancient civilizations like Greece and Rome. Imagine, for instance, you lived in Roman times. You might join a collegium—a society, usually with both a joining fee and a maintenance fee, that existed for the benefit of its members. Of course, little could be done for you if you became seriously ill. But when you died, your collegium would ensure that you had a decent burial.
Collegia were precursors to the medieval guilds, which operated along similar principles. Like-minded people, sharing a craft, profession, or religion, formed a guild. Guilds influenced the politics of town life and the prices of goods, but one personal benefit of belonging to a guild was that if you died, your guild would bury you and take care of your family.
Are you seeing a trend here? Health insurance was not a concern, because medicine was not very advanced. People who became seriously ill in ancient or medieval times were more likely to die than recover. So, collegia and guilds basically offered burial insurance, not health insurance.
“The Doctor Will See You Now”
Now fast-forward a few hundred years to the end of the 19th century. Medical knowledge had advanced, but if you fell ill, you were almost certain to be cared for at home by your family. In the United States and Europe, most people still lived on farms. There was no way to contact a doctor, no local hospital, and probably still no cure for your illness. In 1900, the average life expectancy in the United States was only 47 years.
But the world was modernizing. By the turn of the century, the telephone and the automobile had been invented. People were moving from farm to town and from town to city. This meant more people had access to doctors and even hospitals, which were improving rapidly.
In 1904, the American Medical Association created the Council of Medical Education to standardize medical school admission and to ensure that medical training was uniform, including two years of clinical rotation at a teaching hospital. By the 1910s, state licensing boards were also enforcing regulations. American doctors were starting to professionalize.
“Do You Have Insurance?”
Even so, your biggest worry around the turn of the century was not the bill from your doctor. It was your lost wages from missing work due to illness. So, after 1890, there was a growing demand for “sickness” insurance. It wouldn’t pay your doctor’s fee, which was still low, but it would pay some of your lost wages if you were laid up. By 1911, the employees of Montgomery Ward had joined the first group “sickness” plan.
Before too long, progressives—including former president Theodore Roosevelt—sounded the call for national insurance. In 1912, Roosevelt ran for a third (non-consecutive) presidential term on the Progressive, or “Bull Moose,” ticket. At the Progressive National Convention, he said, “the hazards of sickness, accident, invalidism, involuntary unemployment, and old age should be provided for through insurance.”
The official Progressive platform called for “the protection of home life against the hazards of sickness, irregular employment, and old age through the adoption of a system of social insurance adapted to American use.” But obviously, it did not come to pass. Roosevelt lost the election to Woodrow Wilson, and World War I put warfare ahead of health care.