The American health care system is unique because, for most of us, it is tied to our jobs rather than to our government. For many Americans, the system seems natural, but few know that it originated not as a well-thought-out plan to provide for Americans' health, but as a way to circumvent a quirk in wartime wage regulations that had nothing to do with health.
As far back as the 1920s, a few big employers had offered health insurance plans to some of their workers. But only a few: By 1935, only about 2 million people were covered by private health insurance, and on the eve of World War II, there were only 48 job-based health plans in the entire country.
The rise of unions in the 1930s and 1940s led to the first great expansion of health care for Americans. But ironically, it did not produce a national plan providing health care to all, like those in virtually all other developed countries. Instead, the special conditions of World War II produced the system of job-based health benefits we know today.