National Health Care

• Author: Jeffrey Lehman, Shirelle Phelps

Page 180

The development of a national system of HEALTH CARE in the United States has remained a major topic of debate throughout the United States, especially since the 1980s. Healthcare costs in the United States have risen dramatically during the past 40 years, due in part to longer average life spans, which give rise to greater costs because older citizens require greater care, and the employment of technologies that extend the life of patients, which generally results in greater spending. Insurance costs have likewise increased dramatically, and a relatively large percentage of U.S. citizens and other residents are uninsured or underinsured. According to information from the CENSUS BUREAU in 2001, 41.2 million Americans, constituting 14.2 percent of the population, did not have HEALTH INSURANCE.

The healthcare system is largely controlled by the free market, which is believed to provide limitations on how much physicians and other specialists can charge to their patients. However, many critics of the current system, including organizations composed of physicians, note that the system has become largely bureaucratic and that cost-cutting measures and pressures caused by competition and the need for profit have reduced the effectiveness of medical practice. Despite these problems, many commentators have not been able to agree as to the proper level of control that state or federal governments should have over health care.

Following WORLD WAR II, the number of Americans that had private insurance policies grew dramatically. In 1965, Congress approved the development of MEDICARE and MEDICAID to assist the elderly and the poor in being able to afford medical care. The vast majority of U.S. citizens were covered by either private or public insurance at that time. However, healthcare costs experienced a dramatic growth during the 1970s, and employers were forced to pay for the bulk of this increase as they paid their employees' premiums. Many companies in the early 1980s began to require employees to pay deductibles on their insurance policies, and some small companies began to refuse to provide insurance at all.

Beginning in the 1980s, scholars and other commentators began to propose a variety of major reforms to the healthcare system to create a truly national system. In 1989, an article in the New England Journal of Medicine by David Himmelstein and Steffe Woolhander maintained that the system...