Lyndon Johnson signing the Medicare bill, July 30, 1965. At left is former president Harry Truman. Credit: NARAA Century of American Healthcare ReformFor the first century of United States history, medical care was simple to access and relatively inexpensive. Services were, from a twenty-first century perspective, inadequate and primitive. Today the quality of care is far better, but Americans have to deal with a complex, confusing, and—by some standards—inefficient system, with terms like HMO, PPO, HSA, and FSA becoming household acronyms. Was it inevitable that the system become as convoluted as it is today, with health care costs passing 15% of GDP?1900-1920