As U.S. lawmakers consider possible paths forward in reshaping health care and health insurance, UMBC’s Christy Ford Chapin has published detailed analysis of historical health care models to inform today’s discussions. Chapin, assistant professor of history, is the author of the award-winning book Ensuring America’s Health: The Public Creation of the Corporate Health Insurance System. Since its publication, she has commented in numerous media outlets on the history of health insurance and factors to consider in developing effective reform.
In a New York Times op-ed, published just ahead of Senate Republican’s release of proposed new health care legislation, Chapin suggests that both Republicans and Democrats “have stumbled to enact comprehensive health care reform because they insist on patching up a rickety, malfunctioning model.” The Democrats’ Affordable Care Act only “added a cracked support beam or two,” and a Republican bill recently passed by the House “will knock those out to focus on spackling other dilapidated parts of the system,” she writes.
But Chapin’s piece isn’t just a critique. She also offers fresh ideas for consideration, based on often forgotten historical models. Reflecting on the perspective she brings to the conversation, Chapin notes, “Historians can use narrative to explain seemingly complex issues, add nuance to national conversations, and highlight overlooked facts.”
Chapin explains that in the early 20th century, a variety of models to organize and pay for health care existed in the U.S. “Unfortunately,” however, “the leaders of the American Medical Association (AMA) saw early health care models…as a threat,” and, she suggests, exercised their power with hospitals and on state licensing boards to retaliate against physicians who participated in them.
After World Word II, President Harry Truman proposed a government-managed universal health care system, similar to some in post-war Europe. In response, writes Chapin, “AMA officials decided that the best way to keep the government out of their industry was to design a private sector model: the insurance company model.”
Chapin argues in the Times that over the years, “because of the perceived threat of reform, insurers weathered rapidly rising medical costs and unfavorable financial conditions to expand coverage from about a quarter of the population in 1945 to about 80 percent in 1965. However, she writes in a related piece for Dissent, “Despite the extraordinary growth of private insurance, high policy costs prevented insurance companies from extending protection to a politically satisfactory percentage of the elderly.” In response, the federal government introduced Medicare in 1965.
Medicare was also designed around the insurance company model, because at the time “the private health care sector had far more capacity to manage a large, complex program than did the government,” writes Chapin in the Times. With more seniors insured, demand for health services spiked. This led insurance companies to introduce cost-containment efforts like standardizing which procedures would be covered for which health conditions, and “shaping the practice of medicine”—exactly what the AMA originally feared would result from government involvement.
Chapin contends in the Times that “to actually bring down costs, legislators must roll back regulations to allow market innovation outside the insurance company model.” In Dissent she further argues, “Only fundamental reforms that reduce corporate influence over health care can make generous universal coverage possible.”
Looking toward the future, Chapin points out that innovative plans are starting to re-emerge in pockets of the country, though they are limited by insurance regulations designed to prevent such practices. Rather than piecemeal workarounds across the country, she suggests a “universal system that grants individuals subsidies to purchase coverage from any medical plan—not just insurance companies.”
“It’s a simple plan for universal care,” Chapin suggests in Dissent. “But it’s also a plan that will drastically reduce costs, encourage doctors to find innovative health care solutions, and liberate the system from corporate control.”
Chapin’s ideas have already sparked conversations across the country, with her New York Times op-ed quickly climbing to top spot as the paper’s most-shared article on its publication day. Learn more about Christy Chapin’s historically-informed perspective on health insurance in The New York Times, Dissent, Forbes, Process, on WYPR, and on EconTalk, one of the nation’s most popular academic podcasts. Read her response to a critique of her work at NewsMax.
Image: Christy Ford Chapin gives a presentation about her work. Photo by Marlayna Demond ’11 for UMBC.