1950's
At the start of the decade, national health care expenditures are 4.5 percent of the Gross National Product. Many more medications are available now to treat a range of diseases, including infections, glaucoma, and arthritis, and new vaccines become available that prevent dreaded childhood diseases, including polio. The first successful organ transplant is performed.
1960's
Over 700 insurance companies are selling health insurance. Concern about a "doctor shortage" and the need for more "health manpower" leads to federal measures to expand education in the health professions. Major medical insurance endorses high-cost medicine. President Lyndon Johnson signs Medicare and Medicaid into law in 1965. Costs immediately begin to accelerate.
1970's
President Richard Nixon renames prepaid group health care plans as health maintenance organizations (HMOs), with legislation that provides federal endorsement, certification, and assistance. Healthcare costs are escalating rapidly, partially due to unexpectedly high Medicare expenditures, rapid inflation in the economy, expansion of hospital expenses and profits, and changes in medical care including greater use of technology, medications, and conservative approaches to treatment. American medicine is now seen as in crisis.
1980's
Corporations begin to integrate the hospital system (previously a decentralized structure), enter many other healthcare-related businesses, and consolidate control. Overall, there is a shift toward privatization and corporatization of healthcare. Under President Reagan, Medicare shifts to payment by diagnosis (DRG) instead of by treatment. Private plans quickly follow suit. There are growing complaints by insurance companies that the traditional fee-for-service method of payment to doctors is being exploited. Corporate profits trump care. Charitable non-profit hospitals are driven out of the market.
1990's
Health care costs rise at double the rate of inflation. Expansion of managed care helps to moderate increases in health care costs. Federal health care reform legislation fails again to pass in the U.S. Congress. By the end of the decade there are 44 million Americans, 16% of the nation, with no health insurance at all. The long-term viability of Medicare and Medicaid is ignored by Congress.
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