Physician Leadership Journal
Resuscitating Healthcare: 80 Years of Federal Laws, Financing, and Future Forecast
This analysis traces U.S. healthcare policy from the 1798 Marine Hospital Act to today's value-based care, highlighting key laws like Medicare and Medicaid. It explores spending growth and future sustainability challenges.
May/June 2026 Vol. 13, No. 3 pp. 53–58 DOI: 10.55834/plj.8288784457
Abstract
This comprehensive examination traces the evolution of U.S. healthcare policy from its origins in the 1798 Marine Hospital Act through present-day value-based care initiatives. Drawing on presidential addresses and historical literature, the analysis explores how federal legislation shaped healthcare spending — from under half a trillion dollars in 1970 to $5.3 trillion today. The article examines pivotal developments, including the Social Security Act, Medicare and Medicaid implementation, DRG-based hospital reimbursement, and the resource-based relative value scale (RBRVS) for physician payment. Looking forward, the convergence of artificial intelligence, accelerated innovation, and aging demographics will necessitate sophisticated risk-sharing arrangements and integrated care systems to address sustainability challenges as healthcare approaches 20% of GDP.
