28.5 million people in the United States (8.8% of the US population) do not have health insurance. Among people who do have health insurance, 67.2% have private insurance while 37.7% have government-provided coverage through programs such as Medicaid or Medicare. Employer-based health insurance is the most common type of coverage, applying to 56% of the US population.The United States is the only nation among the 36 OECD (Organization for Economic Co-operation and Development) nations that does not have universal health care either in practice or by constitutional right.
Proponents of the right to health care say that no one in one of the richest nations on earth should go without health care. They argue that a right to health care would stop medical bankruptcies, improve public health, reduce overall health care spending, help small businesses, and that health care should be an essential government service.
Opponents argue that a right to health care amounts to socialism and that it should be an individual’s responsibility, not the government’s role, to secure health care. They say that government provision of health care would decrease the quality and availability of health care, and would lead to larger government debt and deficits.
Health Care Spending
In 2012 US health care spending totaled $2.8 trillion dollars and accounted for 17.2% of the US Gross Domestic Product (GDP).The average annual cost of health care for the typical US family of four was over $20,000, and health care costs that year rose at double the rate of inflation. According to a 2012 study from Consumer Reports, paying for health care is the top financial problem for US households. About 62% of all individual bankruptcies are related to medical expenses according to the most recent study available from 2009. According to a 2011 report, of the 34 member states of the OECD, the United States ranks #1 in per capita health care expenditures at $8,508 per person, which is 2.5 times more than the OECD average of $3,339 per person.
US health care spending is financed by a mixture of households (28%), the federal government (26%), businesses (21%), state and local governments (18%), and other private sources (7%).Health care is the largest private-sector industry in the United States accounting for about 13% of the total US workforce.
Health Care in a Global Context
The United States is one of the world’s only developed nations that does not guarantee universal health coverage for its citizens.In 2005 the United States and the other member states of the World Health Organization signed the World Health Assembly resolution 58.33, which stated that nations should “transition to universal coverage of their citizens… with a view to sharing risk among the population and avoiding catastrophic health-care expenditure and impoverishment of individuals as a result of seeking care.”
Compared to the 34 nations of the OECD, the United States had the third highest rate of infant mortality (behind Turkey and Mexico), 2.4 practicing physicians per 1,000 people (lower than the OECD average of 3.1), and an average life expectancy of 78.7 (lower than the OECD average of 80.1 years).
In the United States, fewer than 10% of patients wait more than two months to see a specialist versus 41% in Canada, 34% in Norway, and 28% in France.The US 5-year survival rate for all cancers is 64.6%, over 10% higher than the 5-year cancer survival rate in Europe (51.6%). A 2009 study found that the United States had better cancer screening rates than 10 European countries including France, Germany, Sweden, and Switzerland. The United States is estimated to have the highest prostate and breast cancer survival rates in the world.
The World Health Organization ranked the US health care system at #37 out of 191 countries in its 2000 report, between Costa Rica and Slovenia.In 2014, the Commonwealth Fund ranked the United States last in overall health care behind (in order) United Kingdom, Switzerland, Sweden, Australia, Germany, Netherlands, New Zealand, Norway, France, and Canada.
Historic Debate on Right to Health Care
Throughout the 18th and 19th century the US federal government did not finance or otherwise provide health care to the public.However, in the early 20th century, a debate over the right to health care began to emerge. In 1915 the American Association for Labor Legislation drafted a series of bills to provide state medical benefits to low income workers. In 1920 the New York State Commissioner of Health, Hermann Biggs, began promoting public health services at the county level, and Charles-Edward Amory Winslow, the Chair of the Department of Public Health at Yale University, wrote: “I look to see our health departments in the coming years… enable every citizen to realize his birthright of health and longevity.” That same year the American Medical Association’s House of Delegates passed a resolution officially opposing compulsory health insurance in the United States, with one group of delegates from Illinois calling it a “dangerous bolshevik” scheme.
Government-funded health insurance was considered by President Roosevelt’s Committee on Economic Security, but it was never included as part of the 1935 Social Security Act,in part due to opposition from the American Medical Association. In 1938, health care reform to provide universal coverage was proposed by President Franklin D. Roosevelt as an extension of social security, and US Surgeon General Thomas Parran argued that “equal opportunity for health is a basic American right.” In Feb. 1939, Senator Robert Wagner (D-NY) introduced the National Health Care Act of 1939 which would have implemented a national health care system, however, the bill did not gain the necessary support in Congress and died in committee.
In 1945, in another attempt at universal healthcare, Harry S. Truman sent a message to the United States Congress asking for a new national health insurance program to be run by the federal government. The voluntary program would have allowed individuals to pay monthly fees in return for coverage of all medical expenses. The program was introduced in Congress as the Social Security Expansion Bill. The bill never passed, in part, due the American Medical Association characterizing it at “socialized medicine.”Although a national health program for all US citizens was not achieved, proponents of the plan continued to advocate for government-funded health insurance by shifting focus to providing coverage to Americans over the age of 65 and the economically disadvantaged.
By the early 1960s, debate grew over the King-Anderson bill, a precursor to Medicare, that would have extend Social Security to cover the medical bills of Americans over the age of 65. Ronald Reagan, who opposed the bill, warned in a 1961 spoken word record that “one of the traditional methods of imposing statism or socialism on a people has been by way of medicine.”Despite some public opposition, Medicare (the Social Security Act Amendments of 1965) was eventually passed by the House (307-116) and the Senate (77-6), and was signed into law by President Lyndon B. Johnson on July 30, 1965.
In 1971, President Richard Nixon laid out a National Health Strategy to reform the health insurance system and move towards universal healthcare.In a 1972 message to Congress, President Nixon continued to advocate for universal healthcare, arguing that “reform of our health care system – so that every citizen will be able to get quality health care at reasonable cost regardless of income and regardless of area of residence – remains an item of highest priority on my unfinished agenda for America in the 1970s.” A competing plan by Senator Ted Kennedy, the Health Security Act, sought to implement a universal single-payer federal health insurance plan to be financed through taxes. Despite their efforts, by the end of the Nixon presidency, no health care legislation had reached the President’s desk.
President Clinton brought the issue of national health care back to the forefront in 1993. On Sep. 22, 1993, he delivered a speech to Congress stating that the “most urgent priority” of the nation was to provide “every American health security, health care that can never be taken away, health care that is always there.”Three months later the Health Security Act was introduced to move the United States towards the goal of universal coverage by requiring all individuals to obtain health insurance and instituting an employer mandate to provide insurance. The Association of American Physicians and Surgeons (AAPS) called the act “socialist,” and a “forfeiture of our freedom” that would “destroy private insurance.” During this same time period other legislators introduced a competing act to create a federally run “single-payer” national health insurance plan. As in the 1970s, none of the plans gained enough support to pass Congress, much less make it to the President’s desk.
Obamacare and the Right to Health Care
During a presidential candidate debate on Oct. 7, 2008,then-US Senator Barack Obama stated that health care should be a “right for every American.” In a June 15, 2009 speech delivered to the American Medical Association (AMA), President Obama urged Congress to craft legislation that would ensure coverage for all Americans. After intense debate, lawmakers passed the Patient Protection and Affordable Care Act (PPACA), which President Obama signed into law on Mar. 23, 2010. According to a 2013 White House estimate, 27 million previously uninsured people will gain coverage under Obamacare. A separate 2013 study found that despite the expansion in health insurance coverage under Obamacare, 29.8 to 31 million people would still remain without health care coverage by 2016.
The PPACA did not institute a universal right to health care, and some members of Congress, including Senator Bernie Sanders (I-VT)and Representative Jim McDermott (D-WA), and organizations, including Physicians for a National Health Program (PNHP) and the American Nurses Association, continue to advocate for the implementation of a “single-payer” health care system in the United States that would guarantee the right to health care for all Americans under a federally run health insurance plan. On Sep. 13, 2017, Senator Sanders introduced a “Medicare for All” bill to create a single-payer health care system in the United States. His bill, which had been introduced previously without any co-sponsors, drew at least 15 Senate co-sponsors this time around.
According to a Gallup poll that began in 2000, support for a right to health care (financed by the federal government) peaked at 69% in 2006, shrank to 42% by 2013,and rose back up to 52% in 2017.
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