Until the mid-19th century, no Americans had any form of health insurance. If a person got sick and could afford to go to the doctor, they paid directly for services rendered. Starting in the 1860s, insurance companies started offering plans to insure against accidents from travel by rail or steamboat; perhaps the opportunity to make some money on people's fears was just too good to pass up. However, the process of selling health insurance opened the door for selling more comprehensive health plans covering other types of illnesses and injuries.

Group health insurance plans got a boost with a program in Dallas, Texas. In 1929, a group of teachers made a deal with Baylor Hospital for room, board, and medical services in exchange for a monthly fee. Shortly after this, other insurance companies began offering health policies, the best known of which was the Blue Cross and Blue Shield plan that was first offered in 1932. Blue Cross and Blue Shield was a nonprofit organization that grouped people who needed services. They promised volume business and prompt payment to physicians and hospitals and, in return, the organization received discounted health rates.

In the 1940s, an increasing number of companies offered health plans. The government imposed wage freezes because of World War II (1939-45), and many companies also froze wages. They found that offering health care benefits permitted them to win over the more desirable workers. In the 1950s, unions bargained for better benefit packages and the process grew.

In the late 1950s and 1960s, the government began to expand its programs to cover health care costs. In 1954, disability benefits (payment for workers who become disabled and are no longer able to work) were added to social security coverage for the first time. Then in 1965 the government created Medicare and Medicaid.

During the last two decades of the 20th century, the cost of health care in America grew quickly, and this has forced companies that were facing ever-increasing insurance premiums to figure out different programs to offer their employees. In the process, companies have been pushing their employees into more affordable health maintenance organizations or in some cases dropping the health program altogether. By 1995, individuals and companies only paid for about half of health care; the government took responsibility for the other half. . .

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