A look at the history of U.S. health care and health insurance

Health insurance in the U.S. has some of its roots in the World War II shipyards of Henry J. Kaiser, who built 747 vessels for the Navy. The war made workers scarce, so Kaiser needed a way to attract them and, once there, keep them healthy. He couldn't pay them more because wages were frozen, so he offered them health care, which was provided by doctors at company clinics and hospitals. In turn, he asked employees to kick in 50 cents a week for the benefit. (Photo: Kaiser Shipyards in Richmond, Calif., courtesy of SanPedro.com/Permanente Metals Corporation)

"The war ended, the workers quit the shipyards, leaving behind hospitals and doctors but no patients," Bob Rosenblatt reports for the Los Angeles Times. "So the company decided to open the system to the public — and that's how generations of Californians who never heard of Kaiser shipyards have since gotten medical care."

Kaiser's story is just one example of how America's health insurance system developed, Rosenblatt writes. As at the shipyards, most people still get coverage through their jobs and, unlike the rest of the industrialized world, not from the government.

In fact, there has long been a fight against having the government in charge of providing care, Rosenblatt contends. In 1918, when California proposed a constitutional amendment that would have organized a state-run program, doctors said "compulsory social health insurance" was "a dangerous device invented in Germany." The amendment lost, but many presidents pursued the issue. Franklin D. Roosevelt "flirted with the idea but never threw political muscle behind it," Rosenblatt reports. Harry S. Truman asked Congress to provide national health insurance, but could not bring it to a vote.

It was the model exemplified in the shipyards that was adopted, and "health insurance became a standard feature in labor contracts," Rosenblatt writes.

Things changed in 1965, when President Lyndon B. Johnson pushed through a heavily Democratic Congress what Rosenblatt calls "a legislative three-layer cake:" Medicare Part A, Medicare Part B, and the federal-state Medicaid program. The legislation was controversial, with fears that doctors would refuse to see Medicare patients and hospitals would refuse to dismantle segregated wards. "The doctors didn't strike," Rosenblatt writes. "And the hospitals were immediately integrated without protest."

In 1993, President Bill Clinton wanted to extend national health insurance to everyone, but Rosenblatt says "Congress felt excluded and insulted, and the plan never came to a floor vote in the House or Senate."

President Obama did the opposite and relied on the congressional process. "Key to the plan was a mandate that everyone buy into the system; it was the best way to spread out the costs of illness," Rosenblatt writes. It's that mandate up for debate in the Supreme Court next month, but even if the Affordable Care Act is subsequently thrown out, "people already enjoy some benefits and won't want to give them up," Rosenblatt writes.

"It seems a safe bet that some provisions in the Affordable Care Act will stay on the law books," Rosenblatt concludes. "This places a few more patches on the national healthcare quilt. That's the American way." (Read more)