The US healthcare system is a large and complex organism

Policy: Early attempts at national health insurance (e.g., Teddy Roosevelt in 1912) failed due to political opposition and the decentralization of medicine.

Mid-20th Century (1930s-1960s): The Insurance Era

System: Employer-sponsored health insurance took root, propelled by the Great Depression (which strained hospital finances) and World War II wage freezes (employers offered benefits instead of raises). This created the employment-based coverage foundation of the modern US system.

Policy: The Social Security Act of 1935 provided federal grants for maternal and child health but famously omitted national health insurance.

The Great Society Era (1960s): Government Intervention

System: The elderly, poor, and disabled were largely left uninsured by the private market, creating a strong political need for government action.

Policy: 1965 saw the creation of Medicare (federal insurance for people aged 65 and older, regardless of income) and Medicaid (a federal-state program for low-income individuals and families), marking the government's major entry as a payer.

Sample Answer

🇺🇸 Evolution of the US Healthcare System: Policy, Expenditure, and Economics

The US healthcare system's evolution is a dynamic, fragmented process marked by a shift from a private, decentralized model to a complex system heavily influenced by government policy and exponentially increasing costs.

Key Phases of Evolution and Major Policy Shifts

The history can be divided into distinct periods, each driven by economic conditions and social pressure:

Early 20th Century (Pre-1930s): Private and Charitable Era

System: Healthcare was primarily a private transaction between a physician and patient (fee-for-service), with payments made out-of-pocket. Hospitals were mostly charitable institutions or places for the poor.