<P> After the Civil War, the federal government established the first system of medical care in the South, known as the Freedmen's Bureau . The government constructed 40 hospitals, employed over 120 physicians, and treated well over one million sick and dying former slaves . The hospitals were short lived, lasting from 1865 to 1870 . Freedmen's Hospital in Washington, D.C. remained in operation until the late nineteenth century, when it became part of Howard University . </P> <P> The next major initiative came in the New Deal legislation of the 1930s, in the context of the Great Depression . </P> <P> In the first 10--15 years of the 20th century Progressivism was influencing both Europe and the United States . Many European countries were passing the first social welfare acts and forming the basis for compulsory government - run or voluntary subsidized health care programs . The United Kingdom passed the National Insurance Act of 1911 that provided medical care and replacement of some lost wages if a worker became ill . It did not, however, cover spouses or dependents . U.S. efforts to achieve universal coverage began with progressive health care reformers who supported Theodore Roosevelt for President in 1912, though he was defeated . Progressives campaigned unsuccessfully for sickness insurance guaranteed by the states . A unique American history of decentralization in government, limited government, and a tradition of classical liberalism are all possible explanations for the suspicion around the idea of compulsory government - run insurance . The American Medical Association (AMA) was also deeply and vocally opposed to the idea, which it labeled "socialized medicine". In addition, many urban US workers already had access to sickness insurance through employer - based sickness funds . </P> <P> Early industrial sickness insurance purchased through employers was one influential economic origin of the current American health care system . These late - 19th - century and early - 20th - century sickness insurance schemes were generally inexpensive for workers: their small scale and local administration kept overhead low, and because the people who purchased insurance were all employees of the same company, that prevented people who were already ill from buying in . The presence of employer - based sickness funds may have contributed to why the idea of government - based insurance did not take hold in the United States at the same time that the United Kingdom and the rest of Europe was moving toward socialized schemes like the UK National Insurance Act of 1911 . Thus, at the beginning of the 20th century, Americans were used to associating insurance with employers, which paved the way for the beginning of third - party health insurance in the 1930s . </P>

When was the idea of national health care insurance first debated in the united states