Crisis, leadership, consensus

The past and future federal role in health

Research output: Contribution to journalArticle

Abstract

This paper touches on patterns of federal government involvement in the health sector since the late 18th century to the present and speculates on its role in the early decades of the 21st century. Throughout the history of the US, government involvement in the health sector came only in the face of crisis, only when there was widespread consensus, and only through sustained leadership. One of the first health-related acts of Congress came about as a matter of interstate commerce regarding the dilemma as to what to do about treating merchant seamen who had no affiliation with any state. Further federal actions were implemented to address epidemics, such as from yellow fever, that traveled from state to state through commercial ships. Each federal action was met with concern and resistance from states' rights advocates, who asserted that the health of the public was best left to the states and localities. It was not until the early part of the 20th century that a concern for social well-being, not merely commerce, drove the agenda for public health action. Two separate campaigns for national health insurance, as well as a rapid expansion of programs to serve the specific health needs of specific populations, led finally to the introduction of Medicaid and Medicare in the 1960s, the most dramatic example of government intervention in shaping the personal health care delivery system in the latter half of the 20th century. As health costs continued to rise and more and more Americans lacked adequate health insurance, a perceived crisis led President Clinton to launch his 1993 campaign to insure every American - the third attempt in this century to provide universal coverage. While the crisis was perceived by many, there was no consensus on action, and leadership outside government was missing. Today, the health care crisis still looms. Despite an economic boom, 1 million Americans lose their health insurance each year, with 41 million Americans, or 15% of the population, lacking coverage. Private premiums are going up again as federal programs are capped and the lack of a federal framework for quality assurance leads to growing problems of access and quality that will need to be addressed as we enter the 21st century. What role will government play?.

Original languageEnglish (US)
Pages (from-to)192-206
Number of pages15
JournalJournal of Urban Health
Volume76
Issue number2
DOIs
StatePublished - Jun 1 1999

Fingerprint

Consensus
leadership
Health
Health Insurance
health
Delivery of Health Care
health insurance
Public Health
Universal Coverage
Yellow Fever
commerce
Federal Government
Ships
Medicaid
National Health Programs
Medicare
campaign
coverage
Health Care Costs
Population

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Crisis, leadership, consensus : The past and future federal role in health. / Boufford, Jo Ivey Melville.

In: Journal of Urban Health, Vol. 76, No. 2, 01.06.1999, p. 192-206.

Research output: Contribution to journalArticle

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