Diabetes Management in the Age of National Health Reform

National health care policy is a relatively new concept in the U.S. with a rather tortured and painful past (1). President Theodore Roosevelt's initial efforts to establish national health insurance in 1912 failed. Twenty-three years later, his cousin Franklin Roosevelt incorporated Maternal and Child Health Grants into the original Social Security Act passed in 1935 in the midst of the New Deal. His successor, Harry Truman, attempted to extend medical care to the poor through grant authorization to the states, but met opposition from the American Medical Association, and both Senate and House versions of the bill foundered. Until recently, the Medicare and Medicaid programs signed into law by Lyndon Johnson in 1965 were the most significant legislation addressing health care delivery and financing in the U.S.—extending care to the elderly, the disabled, and the poor. Since then, many have tried to establish national coverage, but neither the Republicans nor the Democrats have had success. Richard Nixon's Comprehensive Health Insurance Plan in 1972 was very much like the Obama Plan presented in 2009, but was considered inadequate to meet the national needs by the Democratic opposition. The Clinton administration's attempt to introduce the Health Security Act was met with bipartisan opposition so fierce that the bill was never brought to the floor of either chamber for a vote. The Patient Protection and Affordable Care Act (PPACA) of 2010 is clearly the most sweeping revision of health care delivery and finance since the introduction of Medicare and Medicaid. The questions surrounding it are numerous, and its impact remains to be seen; however, it is worthwhile to examine why health reform is necessary. Independent of the source of payment, per capita health care expenditures in the U.S. rose over the last 30 years from approximately $1,000 to $7,000 (adjusted for inflation) (Fig. …