The post-Civil War expansion into businesses and manufacturing efforts of all types led to an increase in work-related injuries, and Americans began to realize that it was morally wrong for a worker to often lose his job because his injury prevented him from working, and then to also be responsible for the medical bills himself.

The governments in England and Germany had enacted laws that protected the worker, and in 1908, President Theodore Roosevelt pushed through a Federal Employer's Liability act to protect certain federal workers, stressing that that the burden of care following a work-related accident should not fall on the worker or his family. In 1911 Wisconsin was the first state to adopt a "workmen's compensation" law, but it took until 1949 before all states had passed some form of this law to protect workers.

Government-provided health care benefits have been equally slow in coming. Though young people today assume that Medicare (health benefits for senior citizens) has always been around, it has actually existed for a very short time, and even with Medicare, which senior citizens now swear by, it took prodding and pushing to get anything through Congress.

The first time a government health insurance bill was introduced in Congress was in 1935. Later, Harry Truman became the first sitting president to endorse national health insurance. There was a huge outcry about the dangers of "socialized medicine," but eventually lawmakers began discussing the idea of a program to provide medical insurance to Social Security beneficiaries.

Progress on this slowed during the late 1940s and 1950s. Employee benefits such as health insurance began to be provided during World War II when the government imposed a wage freeze but permitted various benefits to be added to enhance employee compensation packages. Companies began to use these added benefits as a way to attract good employees, and the movement grew during the 1950s.

In 1961 President John F. Kennedy recommended to Congress the passage of a bill providing health insurance for the elderly. Finally in 1965 Lyndon Johnson was able to get through Congress provisions for medical benefits for the elderly and under-privileged, and on July 30, 1965 he signed into law provisions for Medicare (for senior citizens) and Medicaid, a federal-state partnership that provides health insurance coverage for the poor.

Since 1965 there have been numerous changes to Medicare and Medicaid, expanding and extending coverage in many ways. As early as 1972, coverage was extended to people with disabilities and end-stage renal disease. More recently, George W. Bush signed into law the "Medicare Modernization Act." In addition, the State Children's Health Insurance Program continues to be expanded to meet an increasing need, with each state receiving some federal funds for their program.

As we look toward Congressional action for 2010, we hope for passage of a "good enough" bill--not a perfect bill--that can be tinkered with as lawmakers and health care administrators note what will serve us well over time.

Happy New Year to all.