History of Healthcare & Healthcare Reform [originally posted, 5/21/2013]

Jesus focused on the meaning of suffering and the healing of the whole person; little distinction is made between healing of the body, mind, and spirit. Emphasis is placed on the power of the thought life to affect health (Matthew 15:17-20). Early Christians believe that sickness, whether or not caused by sin, can be healed through prayer (James 5:14).

Physical healing does not become a dominant and widespread Christian practice until about the fourth or fifth century A. D. During the first three centuries, mainstream Christianity does not promise physical healing (as did the pagan healing cults) (Ferngren, 1992). “Caring for” rather than curing the sick is the chief ministry of the early Christian community. According to Ferngren (1992, pp. 13-14), caring for the sick was Christianity’s truly novel contribution to healthcare. At that time, pagans did not care for their sick in any organized fashion or on any widespread basis. The Jewish community provided care primarily to its own. The Christian Church, on the other hand, offered care not only to Christians but also to non-Christians.

Clement of Alexandria (150-215), one of the early church fathers who is well versed in Greek, argues that health by

Medicine has its origin in and its existence from God as well as resulting from human cooperation. He notes that the art of healing learned by human wisdom is from God. This view is reinforced by Origen (185-254), who notes that just as God allows trees to grow, so also does he give medical knowledge to humans.

Until the Christian era (after 350), there is no evidence of buildings (i.e., hospitals) devoted to the care and treatment of sick persons in the general population (Gran-shaw, 1993, p. 1181). Eastern Orthodox Christians, at the insistence of St. Basil, Bishop of Caesarea, establish the first great hospital in Asia Minor around 370. It is scattered among hotels, poorhouses, homes for the aged, buildings for diseases and a special hospital for lepers. This is done to honor the biblical obligation, in Matthew 25:36, 40, to clothe the poor and to heal the sick (Pollak, 1963, p. 74).

[Circa 400-550] There is great respect for physicians among Jews. The Jewish Talmud prohibits Jews from living in a city in which there is no physician (Dorff, 1998, p. 14). A hospital for the mentally ill is established in Jerusalem in 490 (Alexander, 1966).

[Circa 500-1200] The first period of medieval medicine is designated as “Monastic” or “Monastery” medicine, since it is practiced and taught under the direction of the Church (Pllak, 1963, p. 79).

[Circa 500-1000] Care for the poor and sick throughout this period is provided primarily by the Church (Amundsen, 1998, p. 83).

The Knights Hospitallers (equivalent to modern hospital physicians) are monks who operate hospitals in Jerusalem at the time of the crusades (Stevens, 1989). Clergy-operated monasteries continue as the primary institutions of healing. In medieval Europe, hospitals “were usually associated with a church or monastery, with religion defining life within them.” (Granshaw, 1993, p. 1182).

There is an intellectual awakening: Institutions of higher learning are reopened (1200-1300) and are largely supported by the Church. The word “doctor” is first used to indicate a learned person skilled in a profession. Science and the Church, however, begin to butt heads. The Church condemns Aristotelian empiricism, which incorporates the Greek scientific tradition and becomes widely popular between 1200-1240 (Kroll, 1973). The Theologian and philosopher Thomas Aquinas (1225-1274) synthesizes Christian faith and Aristotelian philosophy, which is finally accepted in the mid-fourteenth century (Kroll, 1973). Under Aquinas’ influence, medieval scientists begin to see their work as uncovering God’s plan. Aquinas writes about the importance of dreams and the workings of the unconscious (almost 700 years before Freud). The later period of medieval medicine is known as “The Age of Scholastic Medicine.” The relationship between religion and medicine undergoes a crucial shift that separates the two ever so slightly as doctors become certified by the state, rather than by the Church (Pollak, 1963, p. 91).

The greatest of the natural philosophers: Sir Isaac Newton composes his famous work Philosophiae Naturalis Frincipia Mathematica (1687), which sets up mathematical and mechanical systems of physiology and therapeutics to help guide a more scientific medicine. Newton argues that the entire universe can be explained in terms of physical laws. According to Eerdman’s Handbook to the History of Christianity, Newton “believed that his scientific discoveries were communicated to him by the Holy Spirit, and regarded the understanding of Scripture as more important than his scientific work.” (Dowley, 1982, p. 490)

In the late 1600s, the Church holds the position that secular methods of cure (medical or surgical) are God-given and work only through the exercise of God’s power.

The Sisters of Charity of St. Vincent de Paul organize Catholic nuns to serve both religious and secular hospitals. By 1789, there are 426 hospitals run by the Sisters of Charity in France alone (Porter, 1993, p. 1543). Not until the 1830s do Protestants have anything similar, when a Lutheran pastor starts a nursing school in Kaiserwerth, Germany, to train women (called “deaconesses“) for a life of service to the sick. Later, Florence Nightingale applies this concept to a secular setting to train the first “nurses” (Numbers & Amundsen, 1998, p. 2). For a more detailed history of the emergence of the nursing profession out of religious orders, see Nelson (1997).

Julien de LeMettrie (1709-1731) publishes L’Homme Machine (1749), which argues that humans are wholly material beings, that modern anatomy and physiology can find no evidence of a soul or spirit. Soon afterward, Denis Diderot (1713-1784) publishes his Reve d’Alemhert, which argues that human consciousness is entirely organic in origin. These works characterize the Enlightenment period (Porter, 1993, p. 1457).

Gamwell and Tomes (1995) note, “The rise of science in the eighteenth century slowly eroded the foundations of religion and ultimately led to the secular science of the modern world.” (p. 19).

The Wesleyan-Methodist tradition begins in England (as an offshoot of the Anglican tradition) with the work of John and Charles Wesley. John Wesley (1703-1791) writes extensively on health topics, including volumes such as Thoughts on Nervous Disorders (1784), The Duty and Advantage of Early Rising (1789), and his most famous work on the subject, Primitive Physick (1747). Primitive Physick becomes one of the most popular medical manuals of the eighteenth century.[1]

In 1765, the first medical school in North America is established at the College of Philadelphia, which later (1791) merges with the medical school of the University of Pennsylvania.

In the early 1800s, there are only three medical hospitals in the United States: the New York Hospital, the Pennsylvania Hospital, and the Massachusetts Hospital. The first official nursing organization in the United States is initiated in Emmetsburg by the Catholic Sisters of Charity in 1803, following a French model. The sisters perform home nursing as well as offer institutional care (Nelson, 1997).

The Second Great Awakening [1780-1830], a Protestant revival, sweeps the United States. Calvinistic teachings on man’s depraved nature are disputed, and some theologians shift from a doctrine of predestination to the doctrine of free will. It is possible, through good works and community volunteerism, for humans to influence their own salvation. This movement has great social force in America and helps prepare the country for a new approach to the treatment of mental illness (Taubes, 1998).

The American Medical Association is established in 1847.

One of the earliest health care proposals at the federal level was the 1854 Bill for the Benefit of the Indigent Insane, which would have established asylums for the indigent insane, as well as the blind, and deaf via federal land grants to the states. This bill was proposed by activist Dorothea Dix, which passed both houses of congress, but was vetoed by president Franklin Pierce.

Pierce argued that the federal government should not commit itself to social welfare, which he believed was properly the responsibility of the states.[1][2] After the Civil War, the federal government did establish the first system of national medical care in the South. Known as the Freedmen’s Bureau, the government constructed 40 hospitals, employed over 120 physicians, and treated well over one million sick and dying former slaves. The hospitals were short lived, lasting from 1865 to 1870. Freedmen’s Hospital in Washington, DC remained in operation until the late nineteenth-century before it became part of Howard University.[3][2]

The Progressive Era was a period of social activism and political reform in the United States that flourished from the 1890s to the 1920s.[1] One main goal of the Progressive movement was purification of government, as Progressives tried to eliminate corruption by exposing and undercutting political machines and bosses. Many (but not all) Progressives supported prohibition in order to destroy the political power of local bosses based in saloons.[2] At the same time, women’s suffrage was promoted to bring a “purer” female vote into the arena.[3] A second theme was building an Efficiency movement in every sector that could identify old ways that needed modernizing, and bring to bear scientific, medical and engineering solutions.

In 1932 Franklin Roosevelt (D) won the presidency, and the following year his administration began an aggressive program of economic and social intervention known as the “New Deal.” Many liberal Democrats expected some form of national health insurance to be a part of this program. Indeed, in 1933 Roosevelt’s Federal Emergency Relief Administration (FERA) declared healthcare to be a fundamental human right.

But during the war (WWII), a policy designed to keep inflation in check had an unintended consequence that was to shape the way most Americans would receive healthcare for the next seventy years. The federal government imposed strict price and wage controls on many industries, so companies found that they no longer could use competitive wages to attract talent. A growing number found that company-subsidized health insurance, then unregulated, fit this need.

In 1951 the IRS declared group premiums paid by employers as a tax-deductible business expense,[6] which solidified the third-party insurance companies’ place as primary providers of access to health care in the United States.

Medicaid was created by the Social Security Amendments of 1965 which added Title XIX to the Social Security Act. Medicaid was created as an entitlement program to help states provide medical coverage for low-income families and other categorically related individuals who meet eligibility requirements. Candidates include the blind, aged, disabled and pregnant women. In essence, Medicaid serves as the nation’s primary source of health insurance coverage for low-income populations. Each state administers its own Medicaid program, establishes their own eligibility standards, determines the scope and types of services they will cover, and sets the rate of payment. Benefits vary from state to state, and because someone qualifies for Medicaid in one state, it does not mean they will qualify in another.[6] The federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

In 1965, Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. Before Medicare’s creation, only half of older adults had health insurance, with coverage often unavailable or unaffordable to the other half, because older adults had half as much income as younger people and paid nearly three times as much for health insurance. Medicare also spurred the racial integration of thousands of waiting rooms, hospital floors, and physician practices by making payments to health care providers conditional on desegregation.[2]

In October 1972, President Nixon signed the Social Security Amendments of 1972 extending Medicare to those under 65 who have been severely disabled for over two years or have end stage renal disease (ESRD), and gradually raising the Medicare Part A payroll tax from 1.1% to 1.45% in 1986.[23] In November 1972, Nixon won re-election in a landslide over the only Democratic presidential nominee ever not endorsed by the AFL–CIO, Senator George McGovern (DSD),[24] who was a cosponsor of the Kennedy-Griffiths bill, but did not make national health insurance a major issue in his campaign.[25]

The HMO Act of 1973 created incentives for the formation of for-profit HMOs and introduced the managed care approach that would quickly come to dominate private insurance.

The Employee Retirement Income Security Act of 1974 (ERISA) (Pub.L. 93–406, 88 Stat. 829, enacted September 2, 1974, codified in part at 29 U.S.C. ch. 18) is a federal law which establishes minimum standards for pension plans in private industry and provides for extensive rules on the federal income tax effects of transactions associated with employee benefit plans. ERISA was enacted to protect the interests of employee benefit plan participants and their beneficiaries by:

  • Requiring the disclosure of financial and other information concerning the plan to beneficiaries;
  • Establishing standards of conduct for plan fiduciaries;
  • Providing for appropriate remedies and access to the federal courts.

The Age Discrimination Act of 1975 prohibits discrimination on the basis of age in programs and activities receiving federal financial assistance. The Act, which applies to all ages, permits the use of certain age distinctions and factors other than age that meet the Act’s requirements. The Age Discrimination Act is enforced by the Civil Rights Center.

The Age Discrimination in Employment Act of 1967 (ADEA) protects certain applicants and employees 40 years of age and older from discrimination on the basis of age in hiring, promotion, discharge, compensation, or terms, conditions or privileges of employment. The ADEA is enforced by the Equal Employment Opportunity Commission (EEOC).

Cafeteria Plans were added to the Internal Revenue Code in November 1978.[10] Internal Revenue Code Section 125 sets forth the requirements and tax treatment of cafeteria plans.[11] Section 125 has been amended multiple times since its enactment.[12]

The Cafeteria Benefits Plan was a result of the revelation that “one universal benefit program can no longer do the job,” said Thomas E. Wood of Hewitt Associates and chairman of the Corporate Board for the International Foundation of Employee Benefit Plans. Wood was the originator of flexible compensation due to the fact American corporations and households were becoming increasingly dynamic and globalized. As quoted in his chapter of the business publication, Business, Work, and Benefits: Adjusting to Change produced by the Employee Benefit Research Institute, “Wood’s framework creates a specific detailed picture. The concepts include the establishment of a basic “safety net” of benefits to cover financial hazards associated with old age, death and disability, and catastrophic medical expenses, with supplementary benefits offered on a defined contribution basis”. [9]

1980 [August] – Janice Osborne (Belue) began working in Greensboro, North Carolina Pilot Life Home Office.

1982 – Mark Belue – Graduates from the University of South Carolina, with a BS degree in Accounting, and goes to work for the Pilot Life Insurance Company, of Greensboro, NC in the Group Division in 1984.

The Consolidated Omnibus Budget Reconciliation Act of 1985 (or COBRA) is a law passed by the U.S. Congress on a reconciliation basis and signed by President Ronald Reagan that, among other things, mandates an insurance program giving terminating employees the ability to continue health insurance coverage after leaving employment. COBRA includes amendments to the Employee Retirement Income Security Act of 1974 (ERISA). The law deals with a great variety of subjects, such as tobacco price supports, railroads, private pension plans, emergency room treatment, disability insurance, and the postal service, but it is perhaps best known for Title X, which amends the Internal Revenue Code and the Public Health Service Act to deny income tax deductions to employers (generally those with 20 or more full-time equivalent employees) for contributions to a group health plan unless such plan meets certain continuing coverage requirements.

Section 89 of the IRC, enacted as part of the 1986 tax reform act, imposed qualification standards on healthcare and other welfare benefit plans. However, this controversial legislation proved to be too costly for companies to administer and it was repealed by Congress as part of the Omnibus Budget Reconciliation Act of 1989 (OBRA ’89). Section 89(k) qualifications standards, although repealed, remain very much alive in the qualification-type standards that continue to exist in the IRC and the ERISA. Courts still use these rules as ERISA guidelines.

1990 – Mark Belue moves to Charlotte, NC to open the Charlotte Sales Office of Mid-South Insurance Company of Fayetteville, NC as Regional Manager.

The Americans with Disabilities Act of 1990[1][2] (ADA) is a law that was enacted by the U.S. Congress in 1990. It was signed into law on July 26, 1990, by President George H. W. Bush, and later amended with changes effective January 1, 2009.[3]

The ADA is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability. It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964,[4] which made discrimination based on race, religion, sex, national origin, and other characteristics illegal. Disability is defined by the ADA as “…a physical or mental impairment that substantially limits a major life activity.” The determination of whether any particular condition is considered a disability is made on a case by case basis. Certain specific conditions are excluded as disabilities, such as current substance abuse and visual impairment that is correctable by prescription lenses.

President Bill Clinton had campaigned heavily on health care in the 1992 U.S. presidential election. The task force was created in January 1993, but its own processes were somewhat controversial and drew litigation. Its goal was to come up with a comprehensive plan to provide universal healthcare for all Americans, which was to be a cornerstone of the administration’s first-term agenda. A major healthcare speech was delivered by President Clinton to the U.S. Congress in September 1993. The core element of the proposed plan was an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely regulated health maintenance organizations.

In 1992, Bill Clinton (D) made his plan for universal health insurance a prominent part of his platform. Upon taking office, he appointed First Lady Hillary Rodham Clinton to head up a healthcare task force and made achieving universal healthcare legislation his principal first-term goal. The Clinton bill was met with concentrated opposition from conservatives and insurance industry groups. The bill, which would use a complex series of mechanisms, national boards, and rules to achieve universal coverage, was easy for opponents to demonize. Opponents contended that Clinton’s reforms would lead to the government’s deciding on Americans’ healthcare rather than their doctors.

The bill died in Congress, and its failure contributed to Republican victories in the mid-term elections in 1994, giving the GOP control of both houses for the first time since the 1950s. Clinton spent the rest of his presidency fighting for less ambitious healthcare reforms, including: the S-CHIP, a program which dramatically reduced the number of uninsured children; the Health Insurance Portability and Accountability Act, an initiative that helped some Americans maintain their health insurance after losing or changing jobs; and Medicare Advantage, which permitted Medicare recipients to receive insurance coverage (including an expanded list of benefits) through subsidized private insurance plans instead of traditional Medicare.

The Mental Health Parity Act (MHPA) is legislation signed into United States law on September 26, 1996 that requires that annual or lifetime dollar limits on mental health benefits be no lower than any such dollar limits for medical and surgical benefits offered by a group health plan or health insurance issuer offering coverage in connection with a group health plan. MHPA was largely superseded by the Paul Wellstone and Pete Domenici‘s Mental Health Parity and Addiction Equity Act (MHPAEA), which the 110th United States Congress passed as rider legislation on the Troubled Asset Relief Program (TARP), signed into law by President George W. Bush in October 2008. Prior to MHPA and similar legislation, insurers were not required to cover mental health care and as a result access to treatment was limited, underscoring the importance of the act.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191, 110 Stat. 1936, enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. It was sponsored by Sen. Nancy Kassebaum (RKan.).[1] Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.[2] This act gives the right to privacy to individuals from age 12 through 18. The provider must have a signed disclosure from the affected insured before giving out any information on provided health care to anyone, including parents.[3][4]

Mark & Jan Belue found, Belue & Associates, LLC in March of 1997.

The Medicare Prescription Drug, Improvement, and Modernization Act[1] (also called the Medicare Modernization Act or MMA) is a federal law of the United States, enacted in 2003.[2] It produced the largest overhaul of Medicare in the public health program’s 38-year history. Its most touted change is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies.

In the years since Medicare’s creation in 1965, the role of prescription drugs in U.S. patient care has significantly increased. As new and expensive drugs have come into use, patients, particularly senior citizens for whom Medicare was designed, have found prescriptions harder to afford. The MMA is meant to address this problem.

The MMA created a new Health Savings Account statute that replaced and expanded the previous Medical Savings Account law by expanding allowable contributions and employer participation. After the first 10 years over 12 million Americans were enrolled in HSAs (AHIP; EBRI).

“Economic Survey of the United States 2008: Health Care Reform” by the Organization for Economic Co-operation and Development, published in December 2008, said that:[58]

  • Tax benefits of employer-based insurances should be abolished.
  • The resulting tax revenues should be used to subsidize the purchase of insurance by individuals.
  • These subsidies, “which could take many forms, such as direct subsidies or refundable tax credits, would improve the current situation in at least two ways: they would reach those who do not now receive the benefit of the tax exclusion; and they would encourage more cost-conscious purchase of health insurance plans and health care services as, in contrast to the uncapped tax exclusion, such subsidies would reduce the incentive to purchase health plans with little cost sharing.”

When Barack Obama (D) became president in 2009, his large Democratic majorities in both houses of Congress offered the opportunity to achieve the substantial expansion and reform of healthcare in the United States long envisioned by Democrats. Compromises made to accommodate Democrats from conservative states and districts, however, led to an intra-party fight over the legislation, with more liberal Democrats championing a public option similar to Nixon’s proposal in 1974. Obama said he personally favored the public option, but in the end agreed to a deal taking it off the table, and the Affordable Care Act, which was designed to dramatically reduce the number of uninsured Americans, was signed into law in March, 2010, with most of the changes staggered over the following four years. Going into the 2010 mid-term election Republicans vowed to campaign against the reform and repeal it if they regained control of Congress. Due to the complexity of the law and its massive impact on the group and individual markets, a summary is not possible, here. Living in this fallen world, under the curse due to man’s sin, with steady degradation of creation from sin towards death, is a struggle. Treating and caring for the sick and injured is a gift of God from the Great Physician, Himself. Belue & Associates, LLC is dedicated to witnessing the love and care of Jesus Christ of Nazareth and hold Him up as our model for selflessly serving our clients. We regard our agency as actively participating in the financing of the healing ministry of Yeshua the Messiah. By God’s grace, we are faithful He will impart to us the knowledge and wisdom to properly care for and advise our clients that He has given us for whatever changes and developments may come, as He has already done, to date.                                               

[1] Harold G. Koenig, M. D., Handbook of Religion and Health (Oxford University Press, Oxford, NY) Pages 31-47. Most references from the first 2 pages of this paper where taken directly from these referenced pages. Dr. Koenig is the Director of Center for Spirituality, Theology, and Health, a Professor of Psychiatry & Behavioral Sciences, and an Associate Professor of Medicine.

[2]Most of the following references and information containing hyper-links were taken from Wikipedia and some other media websites.

Posted in

Belue & Associates, LLC.