THE U.S.

HEALTH CARE SYSTEM

 AMERICA’S HEALTH CARE SYSTEM
America spends the most on health care in the
world, both in absolute terms and as share per
of GPD

America’s health care system ranks as the worst

of the industrialised nations in the world

It has no universal health care system, and might

never have one. Why?
 AMERICA’S HEALTH CARE SYSTEM
Currently, the US spends two to three times as much per capita on health care
as most industrialized countries.

Per capita spending in healthcare

United States 9,451
Norway 6,567
Netherlands 5,343
Germany 5,267
Sweden 5,228
Ireland 5,131
Austria 5,016
Denmark 4,943
Belgium 4,611
Canada 4,608
Australia 4,420
France 4,407
Japan 4,150
United Kingdom 4,003
New Zealand 3,590
Italy 3,272
Spain 3,153
 AMERICA’S HEALTH CARE SYSTEM
Of this health care spending, an estimated two thirds falls on the
government’s shoulders, when one accounts for entitlements (Medicare and
Medicaid), the cost of health insurance for government workers, and tax
credits that subsidize private insurance plans for other people.

US health care is divided into private, public and voluntary sectors.

Hospitals and clinics are largely operated as private businesses, although
some are community-and volunteer-run and owned by the local
government.
Quality and availability of healthcare is variable, depending on wealth,
gender, ethnicity, location, age and insurance coverage of patients. Most
Americans have publicly funded health care, either in full or in part.

The government spends much more than other countries, but it’s an opaque
system. The government’s role is mostly to subsidize the astronomical costs
set by the for-profit market.
MEDICARE
Medicare is a federally funded programme available to most U.S.
citizens and permanent legal residents who have lived continuously in
the country for five years or more and are age 65 or older.
People younger than 65 may also be eligible for Medicare if they have
certain chronic illnesses.
To qualify for premium-free Medicare Part A, you or your spouse need
to have worked at least 10 years and paid Medicare payroll taxes while
working. Medicare Part B has a premium that most people pay. To
cover additional costs or provide more health-care services, you may
enroll into a Medicare Prescription Drug Plan (Part D) or a Medicare
Advantage plan (Part C). Medicare Advantage plans and Medicare
Prescription Drug Plans are offered by private Medicare-approved
insurance companies, and costs, coverage details, and availability may
vary among plans.
MEDICAID
Medicaid is jointly funded at the state and federal levels.
Medicaid supports low-income individuals and families by covering
costs associated with both medical and long-term custodial care for
those who qualify. Some of the benefits covered under Medicaid
overlap with Medicare, such as inpatient and outpatient hospital care
and doctor services.
However, depending on the state, Medicaid may also offer coverage
that is not included under Original Medicare, such as personal care,
optometry services, and dental services.
Also, the service providers (such as hospitals and doctors) available to
people using Medicaid are often different than those available to
people using Medicare.
OBAMACARE
The Affordable Care Act (ACA) is the comprehensive health care reform
signed into law by President Barack Obama in March 2010. Formally
known as the Patient Protection and Affordable Care Act—and simply
Obamacare—the law includes a list of health-related provisions
intended to extend health-insurance coverage to millions of uninsured
Americans.
The Act expanded Medicaid eligibility, created health insurance
exchanges, and prevents insurance companies from denying coverage
(or charging more) due to pre-existing conditions. It also allows
children to remain on their parents' insurance plan until age 26.
When did the country diverge from other
industrialised nations and, rather than
offering universal health coverage, built up
a system that relied on private insurance?
THE ROOT OF NO UNIVERSAL HEALTHCARE
The root of the current system can be found in World War II. In 1943 president
Franklin D. Roosevelt imposed an effective freeze on labour wages, and
companies started offering health and pension benefits as a way to retain
workers instead.
This was the beginning of employer-sponsored health care, though there was
no government mandate to offer it (except in Hawaii). Unions began
negotiating the benefits as part of what they could obtain for workers.
The rest of the population wasn’t covered, but it meant the unions didn’t put
pressure on the government to create a public health system.
THE ROOT OF NO UNIVERSAL HEALTHCARE

Another turning point was an exceptionally successful campaign that

opposed California governor Earl Warren’s 1944 plan to introduce
compulsory health insurance in the state, paid for through Social Security.

“Political medicine is bad medicine,” was used to lobby newspapers and the
population against government intervention in matters of health.

People were reminded of what was called “socialized medicine” was a

German invention—it came from the same country American soldiers were
fighting abroad.
THE ROOT OF NO UNIVERSAL HEALTHCARE
The same campaign strategy was used to block president Truman’s 1949
proposal of a public health plan.

The campaign, which included riding anti-communist sentiment to terrorize

people against the spectre of “socialized medicine” and “convincing the
people of the superior advantages of private medicine, as practised in
America, over the State-dominated medical systems of other countries”
successfully turned popular support against Truman’s plan.
THE ROOT OF NO UNIVERSAL HEALTHCARE
This rejection of universal health coverage as a form of “collectivization” or
“bolshevization,” had begun several decades before. In the 1910s, right-wing
politicians, medical professionals, and representatives of the medical industry
opposed attempts to broaden national health coverage on the grounds that it
was a Soviet-inspired concept—an objection that gained force after the
Russian revolution.

This sentiment is may be still felt in America today.

THE ROOT OF NO UNIVERSAL HEALTHCARE

Despite knowing very well that a single-payer healthcare system is the

only sustainable long-term solution for creating broader coverage
without skyrocketing prices, it is considered politically unfeasible.

The result is that American doctors and the medical industry benefit
from a system that pays them significantly more than doctors
elsewhere—although, taking into account the cost of medical studies in
the US, their standard of living isn’t necessarily that much higher.
ORIGIN OF UNIVERSAL HEALTH IN UK

Contrast this with Britain, which in 1948, as the country was patching itself up
from World War II, introduced the National Health Service (NHS). The reform
was proposed during the war, and was based on the principle that healthcare
for salaried workers and their dependents needed to be provided by the
state, as it wasn’t coming from businesses. This request, led by the Labour
Party, found an ally in the UK’s need to guarantee the survival of a number of
voluntary hospitals that had been opened during the war and risked failing
without government support.
 THE LABOUR PARTY?
It seems there could be another overarching explanation for why the US doesn’t
have universal healthcare, there hasn’t been a labour party in the US that
represents the working class.

The Democratic party has ties with unions and includes those who believe in
European-style welfare policies. But it always had a strong pro-business soul
which prevented it from focusing primarily on the needs of the working class.
One reason no true labour party has emerged is that no large portion of US
society considers itself “working class.”

“In the United States, everyone self identifies as middle class.” Therefore, the
labour movement isn’t large enough to demand welfare reforms such as
universal health coverage.
NO LUCK WITH PROGRESSIVE GOVERNMENTS

Even in the progressive eras of presidents Kennedy and Carter, while

there were some attempts to pass universal health care, none were
successful. They were blocked by the American middle class’s
association of public programs with charity, as well the by-then
powerful insurance and medical lobbies dedicated to opposing not-for-
profit care.
INEQUALITY IN US HEALTH CARE
Inequality and segregation have also played a role. The lack of universal
healthcare coverage tends to be hardest on racial minorities who, being
more likely to be poor, are more likely to be on welfare.
The battle for black civil rights and access to health care have historically
been close; the introduction in 1965 of Medicare and Medicaid (government
insurance for the poor and the elderly, respectively) struck a powerful
blow against segregation, since it channeled federal funds to hospitals and
thus, under the Civil Rights Act passed a year earlier, banned them from
discriminating on the grounds of race.
However, African Americans are still the most likely to be uninsured.
In 2015, 12% of the black population and 17% of Hispanics were uninsured,
compared to 8% of whites.
TOO MUCH POWER IN THE FEW
Despite the evidence that a single-payer system would be a more
efficient and cheaper choice, introducing it in the US is not a serious
option.
Trying to dismantle the current system would be a mammoth task. For
one thing, it would cost a great many jobs: health- and life-insurance
companies employ some 800,000 people, with yet more employed by
the medical industry just to deal with insurance companies.
Though the savings from eliminating them could be invested in
retraining those people for other professions, it would be difficult for
any party to convince voters that it’s a necessary step.
TOO MUCH POWER IN THE FEW
And with a market worth more than $3 trillion, drug firms, medical
providers, and health technology companies have an incentive to
maintain a system that lets them set prices instead of negotiating with
a single government payer.
Both the Republican party and the Democratic party are under the
influence of the medical-industrial complex: In 2016, hospitals and
nursing homes contributed over $95 million to electoral campaigns in
the US, and the pharmaceutical sector gave nearly $250 mjillion.
 UNIVERSAL HEALTH CARE THE
WAY FORWARD, BUT A BIG LEAP

The Republicans’ failure to pass their health-care law seems to confirm

a prediction made early in the Trump administration: that once people
had had a taste of increased health-care security with Obamacare, they
wouldn’t easily forget it.

Too many variables in the American system make universal healthcare a

distant dream for many, the power of the country is in the hands of the
few. Quite a contradiction to the philosophy of the U.S. Constitution.