After I opened my mail and plowed through 10 pages of Medicare maze, I failed to see how anyone needed that many pages. I felt badly for all those trees that made that paper. It is said Medicare will remain what it has been. Others are straining to understand what might be the best and most economical plan in the Affordable Care Act.

Providing for the health care of all our citizens is a more complex attempt now than preceding attempts in history. Always in the background was the thought (or threat) of compulsory governmental health insurance. As early as 1883, Germany instituted mandatory sickness insurance for workers. Austria, Hungary, Norway, Britain, Russia and the Netherlands also instituted forms of social insurance, which later became national insurance through 1912. Subsidies for mutual benefit societies organized by workers were prevalent in other European countries. These programs were to maintain income and protect against loss of wages due to sickness, but also used for political power.

A 1919 state of Illinois study reported the loss of wages because of sickness was four times greater than the medical cost of treatment. Most people did not want health insurance and instead purchased "sickness insurance." Comparable to disability insurance it provided replacement of income if ill and not able to work. Most illness was treated in the person's home. The role of bacteria, antisepsis and immunology were not recognized nor in general use until well into the 1900s. Medical technology was not what it is today; hospitalization was seen as a threat to well-being and generally avoided.

Commercial insurance companies did not believe that health was an insurable commodity. It was seen as hazardous, difficult to calculate and subject to fraud. Death was easily defined; loss of health justifying insurance compensation was difficult. A large part of the insurance business was burial insurance which would be excluded if compulsory national health insurance was instituted. Physicians and pharmacists opposed compulsory health insurance fearing government intervention might limit control of their practices. Popular support was low.

As time marched on, the lives of Americans changed. Urban population increased. Homes were smaller and ability less to care for ill family. In 1904, requirements for physician licensure were standardized and physicians required increased education. Technology advanced with better medical care. In 1913, the American College of Surgeons was founded requiring stricter standards, facilities and accreditation.

In 1929, studies revealed the average American family's medical expenses totaled $108 with hospital charges of 14 percent. Costs rose as families began to demand increased medical care and by 1934, hospital costs rose to nearly 40 percent of a family's medical bill. A group of teachers in Dallas joined the Baylor University Hospital plan, which provided 21 days hospitalization for a $6 pre-payment. This plan became the precursor for Blue Cross. During the Great Depression, incomes fell but hospital bills were paid by the plan. When private hospital occupancy and financial status was drastically low, the American Hospital Association designed Blue Cross guidelines for a prepayment plan. Legislation allowed this plan to act as nonprofit corporations, tax-exempt, and free of insurance company regulations. Underwritten by hospitals, these plans were considered to be in society's interest, assisting low-income individuals with benefits for hospitalization. Blue Cross succeeded but did not include physician payment.

In 1934, the American Medical Association instituted ten principles to ensure that voluntary health insurance would be under physician supervision, not controlled by non- physicians. Legislation also allowed these plans to be nonprofit, tax-exempt and free from insurance regulations. Local medical societies could form their own plans thus retaining physician autonomy and interests. These plans later affiliated and, in 1946, they became known as Blue Shield.

With the success of BCBS, health insurance became commercial, technology advanced and business boomed. Commercial insurance companies, governmental legislation, tax benefits for employee insurance plans, union intervention and other administrative rulings -- all this and more influenced the increase in health insurance through the 1950s. By 1958, nearly 75 percent of Americans had some type of health insurance.

Along came the 1960s. Medicare came about with controversy as to whether this could be afforded. As an RN working in an acute care hospital, I experienced the increase of dear older patients who without insurance would have just "toughed it out" and not sought needed care. Many benefits came with this legislation.

The race continues in 2013 to provide health care through the mandated Affordable Care Act. If you thought the previous years were confusing, you are correct. What is now upon us is a "challenge" to phrase it nicely. There is much information and disinformation available but it requires careful examination. There are persons who can assist in determining the best plans to sign into but this requires careful scrutiny. The Area Agency on Aging and Disability has knowledgeable persons who can assist. There was an informational meeting today at the fairgrounds. On Thursday, the AARP has information at their summit at Fanchon Ballroom. For this, it is good to call for reservation to Millie Karlin at (785) 625-9463.

It is regrettable that the Affordable Care Plan was passed by Congress before they even knew what was in it. Time will tell.

I really do admire and thank Sandy Praeger, our Kansas insurance commissioner. I believe she has admirably served us all rather than seeking her own political benefit. She truly has been nonpartisan in helping to provide helpful information.

Will the Affordable Care Act be able to meet its projected goals? We pray that it will do what works the best for the good of all Americans.

God bless America.

Ruth Moriarity is a member of The Hays Daily News Generations advisory group.