The System Wasn’t Designed—It Evolved

Understanding Health Care Reform

Michael Koriwchak, MD

People assume that U.S. health care financing was designed – by somebody, somewhere.

It wasn’t.

It evolved – mostly by accident.

A hundred years ago, “health insurance” wasn’t even about health care.

Because there was very little health care to be had.

Medicine was, in many ways, a spectator sport.

The real need was income protection:

* death
* disability

Then something changed.

We began to actually diagnose and treat disease.

* insulin
* antibiotics
* modern surgery

For the first time, medicine could effectively intervene.

But those interventions were only reactive—
responses to major adverse events:

* heart attack
* cancer
* severe infection

And that’s where the financing model took shape.

In 1929, the first modern health insurance plan emerged in Dallas.

A hospital partnered with a group of schoolteachers.

The offer:
Up to 2 weeks of hospital care…
for 50 cents a month.

Simple. Predictable. Effective.