would be shuttered, rendered impractical following the formation of
Medicare.
Medicare is the single largest payer for health care in the United States;
and it just celebrated its 50th birthday. If Medicare were human, it just
reached eligibility for AARP. Once a senior citizen begins receiving Social
Security benefits, she is automatically enrolled in Medicare Part A. One is
“entitled” to receive Medicare benefits as a United States citizen; one
most opt to forego all of their Social Security benefits to not be enrolled in
Medicare. Hence, the term, “entitlement” spending when considering
Medicare benefits. This type of “compulsory” health insurance began in
late 19th century Germany, where the philosophy of “social insurance”
was introduced by the leadership team of Chancellor Otto von Bismarck.^1
The German Sickness Insurance Act was passed into law in 1883 (the year
after Robert Koch discovered the bacteria that causes tuberculosis),
establishing a compulsory health care system financed by employer and
employee contributions, in which the wealthy contributed more than the
poor.^2
Many European countries adopted similar forms of compulsory health
coverage, including Great Britain in 1911. The British National Health
Service was later formed in 1948, ensuring health care coverage for all
Brits (emulated in Canada in 1968). The social insurance program initially
constructed in Britain in 1911 was no doubt inspirational to American
intellectuals, including the leader of the Progressive (Bull Moose) Party,
Theodore Roosevelt.
Roosevelt’s politics had morphed from a strict, conservative “blue
blood” Republican agenda to progressive, social equality initiative
orientation, and national health insurance was a party platform for the
Progressive Party in 1912. Both Roosevelt (Progressive) and Taft
(Republican) lost the 1912 election, with Democrat Woodrow Wilson
securing the presidency from 1913 to 1921. While national health
insurance had been an issue of some interest in 1912, the momentum for
its passage was stalled by World War I.^3 Decades would pass until a form
of national health insurance would become a political possibility.
Justin Ford Kimball, a native Texan, had graduated from Baylor
University and law school at the University of Michigan, and started his
career as a high school teacher and principal in small Texas and Louisiana
towns. Successful at every turn, he became a school superintendent before