A crisis is defined by Merriam-Webster as: “an unstable or crucial time or state of affairs in which a decisive change is impending”. There is no definition that better sums up the condition of the American health care system that started largely in the 1970s and continues to present day 2017. To say our health care system is a mess is, well, accurate. Everyday we hear talk of reform: scrap this provision, add more of that, eliminate the waste, etc. etc. Healthcare is incredibly tricky and the United States has been trying to get it right ever since it became professionalized around the 1920s. The last 4 decades have seen the largest push, more aptly a struggle, to get our system right, never really getting to the finish line though. So has our healthcare system gotten better, or worse, over the last forty years, and are we finally getting close to adequate solution? Let’s see where almost 50 years of health reform have gotten us.
I say President Nixon, you say….Social Security Amendments of 1972? You were thinking Watergate, weren’t you? Gotcha. This amendment, which extended Medicare to people under 65 that have had severe disabilities for a minimum of 2 years. This seems like Nixon’s attempt to do something, anything, during this time when American medicine is seen as going through a “crisis”. Unfortunately, while a well-meaning addition, it only further exacerbated the problems facing our medical system. Skyrocketing healthcare costs (thanks largely in part to rising medicare costs ), expansion of hospitals and their increase of costs as well as a plethora of medical advancements (vaccination for chickenpox, rubella, pneumonia & meningitis!!!) all contributed to the crisis, which pushed on through the 80’s
Women in Medicine
Ok so this isn’t reform related at all, but still, in my opinion, important. The 1970s were a great time for women in medicine. This time period saw one of the greatest rises in women in medical fields ever. At the beginning of the decade just 9% of medical students were women and less than ten years later that number had jumped to over 25%. Among those entering medical school in 1978 was the daughter of Betty Friedan, author of the 1963 book, The Feminine Mystique. It is speculated that Betty’s’ feminist revolution has some part to play in women being encouraged to seek out a career in medicine.
Ahh the 80s, the decade I was born (and so the best decade in my opinion). This time period saw a wide expansion of medicare, which only added to the rising costs of health care. This was the first significant expansion since medicare’s inception in 1965. What’s ironic about this is that before the program was ever passed into law Reagan warned against it. Reagan’s expansion expansion was later repealed by the first Bush president because it contained such things such as outlandish taxes to provide or its increased cover.
Mental Health Care
Perhaps one of the worst things to come out of the 80s and Reagan’s presidency was his deinstitutionalization of the mentally ill. The Mental Health Systems Act of 1980, which was signed into law just before Reagan took office, was landmark legislation in mental health care policy that provided rehabilitation, mental health support systems, general health and mental care as well as social support services. During the first year of his presidency, Reagan signed the Omnibus Budget Reconciliation Act of 1981 and thus repealing almost all of the Mental Health Systems Act. Furthermore, Reagan began the systematic closure of mental hospitals, releasing patients in critical need of care back into the community. In doing all this, Reagan essentially created a national epidemic of homelessness we still see in force today.