Before the late 19th century, U.S. health care was basically an agreement between the physician and patients. Prices were determined by what the patient 's ability to pay was and diagnosis, treatments, and fees were considered confidential (2). On May 7th, 1847 two hundred and fifty-eight delegates from twenty-eight states met together to create the American Medical Association (AMA). The goal of the AMA was to establish unilateral standards for education, training, and conduct (3). They battled to maintain the "the old relations of perfect freedom between physicians and patients, with separate compensation for each service (2)." At this meeting, a national code of ethics in the medical profession was created and continues to be the ethics guide for practicing physicians (3).
Health reform in the United States continued to be the topic of political debate into the late 19th, early 20th centuries. The 1854 Bill for the Benefit of the Indigent Insane, was created to establish asylums for the indigent was one of the earliest health care proposals at the federal level. Passed by both houses, this bill was proposed by activist Dorothea Dix but then vetoed by President Franklin Pierce. Pierce argued that social welfare was the responsibility of the states and not the federal government(7). However, after the Civil War, the Freedman 's Bureau was established as in the South as one of the first systems of national medical care. Although the Freedmen 's Bureau was short lived, 1865 to 1870, the government did employ over 120 physicians, constructed 40 hospitals and treated over one million sick and dying former slaves. Up until the late nineteenth century, The Freedmen 's Hospital in ...
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... 's) were derived from HMO 's models but instead were organized by physicians and hospitals. With decreasing popularity of HMO 's, by 2002 PPO 's had upwards of 50% of covered employees.
Still a hot topic of political debate, many presidential campaigns centered on healthcare reform and it was not surprising that within his first year in office, President Obama released a white paper entitled, "A Call to Action: Health Reform 2009," on November 12, 2008. This paper outlined goals to reform the U.S. healthcare by improving the quality of care, affordability, and control costs. Taking several years of a bitter partisan battle and political maneuvering, the Patient Protection and ACA of 2010 (PPACA) was signed into law on March 23, 2010. The Affordable Care Act was created to increase quality and affordability of insurance coverage and expand Medicaid and Medicare.
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