Health Care Reform in the U.S.: History and Challenges

Introduction

For quite some time, the debate on health care reform has centered on a number of key issues. These include whether there is an essential right to health care, who should have access to it, the circumstances that grant such access, the method of government support for health care, the quality achieved relative to the money spent, the sustainability of expenditures, and the role of the federal government in bringing about change.

Given that health care in the United States is offered by many separate legal entities, health care facilities are mostly owned and managed by the private sector. Apart from programs such as Medicaid, Medicare, TRICARE, the Children's Health Insurance Program, and the Veterans Health Administration, health insurance is primarily provided by the private sector. In 2001, it was estimated that approximately 15% of the United States population was entirely uninsured, while an additional 21% was underinsured. This means that up to 36% of the country's population was unable to cover the costs of their medical needs.

Within the same year, statistics revealed that 62% of all personal bankruptcies in the United States stemmed from medical debts. Notably, the number of uninsured and underinsured Americans has increased since then. As a result, more money per person is spent on health care in the United States than in any other country in the world — a greater percentage of the country's total income goes toward health care than anywhere else. Nevertheless, many argue that the health care system does not deliver equivalent value for the money spent. There is therefore a great need for health care reform that will ensure the right to health care, along with efficiency, access, cost-effectiveness, fairness, and quality.

History of Health Care Reform

The concept of acquiring insurance to protect against illness emerged in the early twentieth century, driven by advancements in the medical field that placed greater demand on medical services. Though these services were available, they were beyond the reach of many, and this problem intensified greatly with the onset of the Great Depression. In an effort to address this disparity, the Committee on the Costs of Medical Care was formed to conduct a five-year study. In 1932, the committee concluded that the heaviest medical expenses were concentrated among a small group of people with the most serious health problems. The commission recommended the establishment of a system relying on collective responsibility through the creation of health insurance.

During the same period, European countries faced similar questions and settled on a remedy involving government intervention. This approach successfully spread financial risk across the whole population and treated health care as a right rather than a privilege. In the United States, fears of communism, despotism, and Nazism stirred opposition to government involvement in the economy, and the private sector blocked any near-term possibility of universal health care. Harry Truman's attempt at national health insurance in the 1940s was supported by some labor unions; however, those unions were ultimately satisfied by their ability to include health care in collective bargaining agreements, which allowed them to negotiate low standard premium rates for all members.

Though it became a name that invited ridicule, Blue Cross/Blue Shield was the first private entity to apply the concept of insurance widely, establishing a community rate that allowed all group members to pay the same amount for equal benefits. The organization also practiced a form of guaranteed issue, meaning it accepted coverage for anyone willing to pay the premiums, regardless of their medical conditions. It was a nonprofit, benevolent organization and was granted tax exemptions by the government in recognition of its work on behalf of the elderly and the needy.

The Medicare-Medicaid Bill was enacted into law by President Johnson in 1965, though it initially covered only hospitalization. The bill served to expand insurance rolls significantly, with costs rapidly exceeding initial projections, while also playing a role in reducing poverty (Kakasuleff par. 15). The rapid increase beyond projected costs was partly attributable to the program's success in bringing more elderly and poor Americans into the mainstream health care system.

Since the early 1970s, there have been sustained efforts to establish comprehensive health insurance. Health care reform has been a major concern for successive U.S. administrations and a prominent issue in presidential campaigns. While some administrations achieved significant changes to the health care system, others fell short. For instance, though health care reform was a central concern of the Clinton administration, the 1993 Clinton health care plan — proposed by a task force headed by First Lady Hillary Clinton — was never enacted into law.

During the 2004 presidential election, both George W. Bush and John Kerry presented health care proposals. As president, George W. Bush signed into law the Medicare Prescription Drug, Improvement and Modernization Act, which included a prescription drug plan for elderly and disabled Americans. By the 2008 presidential campaign, health care reform had become a top issue, given that health care costs appeared uncontrollable even as 46 million Americans remained uninsured.

Political Affiliations as a Challenge

Throughout the years, American citizens have generally supported the need for reform of the health care system. Although many have believed the country to be on the brink of national health care reform, the United States has found itself in that position many times before without producing fundamental change. Despite proposing significant changes to the health care system, President Obama found it difficult to enact these proposals into law for several reasons, the first of which is political affiliation.

Political affiliation has been one of the major obstacles to health care reform throughout American history. Despite broad public support for reform, Americans are divided on the method of reform based on party lines. For example, a 2008 poll asked Americans how the country's health care system compared to those of other nations. The results revealed stark partisan differences: 68% of Republicans believed the U.S. system was the best in the world, compared to 40% of Independents and 32% of Democrats. The same poll found that over half of Democrats would support a presidential candidate who advocated for reform, compared to 37% of Independents and only 19% of Republicans. These divisions emerged as a direct challenge to President Obama, as Republicans remained skeptical while Democrats were relentless in their pursuit of reform (Iglehart par. 1).

While Obama's proposals attracted the support of a sizable majority of Democrats, Republicans opted for skepticism. The push for reform devolved into a political battle, with the prospects of Democratic passage increasing only if members could agree on approach. Democrats broadly favored a stronger government role in health care, though they were divided among themselves, while Republicans favored more market-based solutions. Republicans also feared that government management of health care choices represented the first step toward controlling citizens' lives more broadly.

Conclusion

For a long time, American citizens have needed reform of the health care system. The current system is increasingly inaccessible to many poor, lower-class, and middle-class people, and the United States continues to spend more per capita on health care than any other nation in the world. The reforms proposed by the Obama administration held significant promise for expanding access to health care and reducing government expenditure in the long term. However, the president encountered serious difficulties because of the underlying political, ideological, and policy challenges that must be resolved before meaningful change can be enacted.

For further context on the structure of U.S. health insurance and public program coverage, the Centers for Medicare and Medicaid Services provides authoritative information on federal health program administration and reform initiatives.

Works Cited

Iglehart, John K. "The Struggle for Reform: Challenges and Hopes for Comprehensive Health Care Legislation." The New England Journal of Medicine. Massachusetts Medical Society, 23 Apr. 2009. Web. 14 Apr. 2010.

Kakasuleff, Jenny. "Health Care Reform Series: A History of Health in the U.S. Part 1." Examiner.com. Clarity Digital Group LLC, 30 June 2009. Web. 14 Apr. 2010.

"Why Are Republicans against Healthcare Reform as Outlined by Obama?" Answers.com. Answers Corporation. Web. 14 Apr. 2010.