Hey uh, this became a lot longer than it had to be. I think I have written an abridged version of United States healthcare history.

e: I was wrong about FDR's and Nixon's intentions with healthcare as a mod pointed out.

Tldr: yes hospital bills in 1969 could sink a middle class family into crippling debt. Hospital bills were always expensive and rise as healthcare providers and insurers kept gaining more power to get more money.

I'm not a historian but I did study for a master's degree in healthcare administration so I can offer some insight. You probably already found out this answer but maybe other people will ask this question so I can copy and paste it. That said, I don't know how I can talk about healthcare in the United States without inserting politics, so of course I will talk about politics in this answer.

prior to the 1900's, a doctor was not a very educated field. They didn't know about how washing hands decreased surgery mortality rates because they did not know about the existence of germs. Many doctors were called quacks, and many of them did not have any formal education. Instead they went around selling fake cures for various illnesses, and this is where the term "snake oil" comes from as many doctors did sell literal snake oil as a miracle cure. Being an educated doctor was pretty much a job consisting only of prescribing laudanum (an opiate) telling people they were going to die and chopping limbs off.

At this time period many doctors were more like door-to-door salesmen. Soon however, big name universities such as Princeton or Harvard would attempt to create a standard for medical care, which also lead to an increase in prestige for doctors from their schools and in general, which also lead to an increase in the cost of healthcare. Hospitals influenced by the teachings of Florence Nightingale used "advanced techniques" such as not keeping a bunch of sick people in closer proximity. These techniques led to fewer deaths, more prestige for hospitals who then consolidated into taking care of greater populations.

In these big populations, we also saw the rise of insurance and insurance companies. Insurance companies and employers made deals with hospitals and providers to provide them with steady income so long as they took care of their insured customers at a discount. (Side note, as employers were the ones who initiated the move to provide insurance rather than government, this became a foundation for powerful private insurance systems rather than a single public one).

However these advancements did not occur everywhere in the United States, and the advancements insurance were not even adequate to give a person the care they needed. For example, early 1920's insurance programs were designed to help disabled workers with wages lost during time they could not work. This excluded healthcare such as medicine, disability benefits.

To this day there are several cities often in the Midwest who suffer from a lack of healthcare benefits. This is due to the fact that lower population means lower demand for doctors. New doctors then do not choose to live in the Midwest because of the lack of prestige and opportunities to make money, they choose to live in California or New York where they can make a fortune working every day with the latest technology and prestigious coworkers. This means that people living in Appalachia need to spend more on healthcare to satisfy demand, they need to spend more to even travel to a doctor because there might not be one available for fifty miles.

Previously there were some attempts to lower healthcare costs for sick people, pregnant women and children but these were thwarted by the now powerful American Medical Association and by Private insurers who were afraid of having their business taken away by a government program. Blue shield an organization that seeks to give aid to financially struggling patients was founded. Private insurers imitated their practice in a way to get steady income from middle class families.

Famously, during the great depression a large number of veterans post world war 1 marched on capital hill demanding aid but were met with firehoses from the national guard. Even after FDR enacted his great new deal, he did not pursue health insurance as he felt that there was no great interest in it. He was content to let private insurers, employers and providers work out the details on their own.

During/post World War 2, insurance demands skyrocketed. With a diminished and competitive supply of workers, Employers competed with each other by offering workers bigger benefits such as better healthcare insurance. Furthermore, advancements in healthcare such as the invention of penicillin led to an increase of the cost of healthcare. However, disabled people did not receive insurance.

In America there were quite a lot of poor, illiterate people in addition to Immigrants and minorities. These people perhaps did not qualify for insurance as they were not Americans, or they did not seek it out because they were afraid of discrimination or perhaps fear that they would be found out as an illegal alien, they did not understand how to qualify for insurance, they did not want insurance so they could become more attractive to an employer, or an employer tried to deny them insurance to save money or to discriminate against their employees on basis of culture, class, race etc.

Many American citizens could not afford insurance. in 1965 it was officially determined that 44% of American citizens did not have insurance. Factoring the number of illegal aliens, the number of uninsured people in America was far greater. Therefore, if one family member suffered a life threatening injury, the out of pocket cost could definitely sink their family. This was the year that Medicaid and Medicare was passed

The way Insurance works is that healthy people pool a little bit of money in case one of them gets sick and requires a lot of that money in the pool. If more people who are at risk for sickness or injury join the pool, there is a higher probability that the safety net of the pool of money will be decreased. This is what is referred to as a 'Moral Hazard.' Insurance companies then discriminated and excluded high risk individuals and their family members by denying them insurance.

Here are some factors of healthcare that can absolutely skyrocket the cost of healthcare to sink a middle class family or at least raise premiums.

-medicine/equipment required to treat illness is owned by a private company with an exorbitant cost (i.e Martin Shkreli rises the price of his brand of insulin to 800 dollars or a hospital with expensive technology to treat an acute illness such as those suffered by Ashkenazi Jews raises prices on said technology to make up for lack of demand, or cancer treatment)

- insurance company will raise premiums on a person or deny them insurance because they have a family history of illness or a genetic disposition to illness (Barack Obama however signed a bill in 2008 to prevent insurance discrimination based on genetic makeup).

-if you have any history of drug use or hospital history. (It is however illegal for employers and insurance companies to discriminate based on previous conditions).

- a person is uninsured and is carried to the ER after an accident, the hospital is forced to treat this person but also charge them exorbitant fees to make up for the sunk cost of taking the time to treat an uninsured person instead of an insured person.

Lyndon Johnson passed Medicare and Medicaid in 1965 to help the elderly, poor and disabled. Many in congress decried these bills as pro communist, yet the elderly care provided by Medicare remain extremely popular policies. When Reagan tried to reverse Medicare he was met with great pushback. Previous to Reagan, Nixon even tried to expand healthcare, contrary to popular expectations at the time. In 1969 he declared that healthcare was a crisis and proposed drastic attempts to cut costs and improve quality. Then Watergate happened and Nixon's plans fell to the wayside along with his credibility.

Any other attempts to make healthcare affordable failed as they were decried as communist. Or they were decried of only helping people who would abuse the system i.e "welfare queens" who don't contribute to society but keep leeching off the taxes of hardworking middle class citizens. People of color and poor people were particularly called out as the benefactors of healthcare expansion. Attacking these vulnerable people was very politically motivated.

So people often were poor but not poor enough to qualify for Medicaid.

In the 1970's a bill was passed to force every hospital with an Emergency room to treat patients. This bill did not address the idea of the Moral Hazard however, therefore skyrocketing the cost of medical care even more. Poor families who can not pay for primary care go into Emergency rooms, taking up resources without offering any way to pay. This means that hospitals charge patients even more to make up for the lost time and resources. Some hospitals have even closed down their Emergency rooms.