The American Healthcare System

Between 28.8 and 31.4 million Americans. That is out of approximately 327.4 million Americans total. That translates to between 8.8 and 9.6% (“Comparison of the Prevalence of Uninsured Persons from the National Health Interview Survey and the Current Population Survey”). These are the Americans that are uninsured. This percent may seem “small” for it is not in the double digits, but when we talk about people’s quality of life, and survival itself, the number should not and cannot be that high. These statistics are from surveys done by the National Center for Health Statistics’ National Health Interview Survey (NHIS) and the U.S. Census Bureau’s Current Population Survey (CPS) during 2017. Websites, newspapers, and magazines have found higher percents, and while these evaluations are less reputable, they are plentiful, hinting that the number of uninsured might be even larger. These numbers and percentages mean nothing without context. What does it mean to be uninsured, what is health insurance, who provides healthcare? Healthcare (also health care, with nearly identical meanings, although slightly different connotations) is simply “the organized provision of medical care to individuals or a community” (“healthcare”) as defined by the oxford dictionary. In today’s America, the medicine behind medical care is not hugely debated, but the access to this care is the problem that needs focus. In the past 100 years the idea of health insurance developed, the same idea of insurance for cars or houses, where a small amount of money is paid repeatedly in some interval, so that if an accident or health crisis occurs, the insurance company or provider will pay the large bills otherwise unaffordable. Health insurance originated from private insurance companies as well as insurance offered with jobs but with time health insurance expanded from the private sector and various forms of government provided health insurance were created. While there are many ways to access health insurance there are still people that are completely without it, or do not have comprehensive or effective versions and these people are constantly at risk of poor health as well as economic ruin.



I am interested in the American healthcare system because I think it is, and has been a major problem in the United States that affects many Americans, with now over 10% of them being currently uninsured (Luhby). I also believe every person has the right to be healthy, and when a person is part of a society, that society has an obligation to guarantee access to the care that allows for that health. On a more personal level, I am interested in this problem because my Dad is a pediatric nephrologist at UCSF and has dealt with his patient’s insurance or the lack thereof. Hearing first-hand stories of people that can’t get  proper medical treatment in a timely manner and have their health suffer due to that is really eye-opening. I am also interested in pursuing a career in medicine when I am older, and I want to be able to help as many people as possible. Sadly, with the current healthcare system, medical expertise and advancements alone, won’t be able to help a significant chunk of the population. By exploring this topic, I hope to discover the roots of the problems with healthcare in the United States. I also want to understand the historical context through which the system developed and how that has affected our present-day situation. I intend figure out what the biggest issues are, what is causing them, and then find solutions to those issues.


A depiction of the direct care given by physician’s and other medical professionals during the Colonial Era. (“Grissell Hay Lodging House Architectural Report”)

Throughout United States history, the accessibility of medical care and the means through which it is delivered, have shifted dramatically. Colonial Era American healthcare consisted of two-party, direct exchanges of medical services and goods (“History of Medicine in the United States”). With time, medical care and it’s delivery grew, but large changes did not appear until third party accident insurance was offered in the 1850’s, followed by sickness insurance 1890’s, and then hospitals’ prepaid services as well as employer-sponsored hospitalization plans in the 1920’s. (“Health Insurance in the United States”). All of these forms of insurance were centered around money being paid on a regular basis to the company or organization so that if serious injury or sickness occurred, they would have enough stocked up money to pay for the expenses of treatment (“Introduction to Health Care in the U.S.”). Ever since the beginning of healthcare, there have been people that don’t have access to it, which is a problem that has become more prominent with time.

The first half of the 20th century, had many critical turning points for healthcare in America. The most dramatic shifts during the 1900’s in healthcare were: the creation of Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and government healthcare programs (such as Medicare and Medicaid). For the first quarter of the 20th-century, healthcare programs were not often used or needed, but during the 20’s, the cost of healthcare rose due to more effective treatments (Hansler). Fewer people could afford it out of pocket so groups were created that provided insurance to employers and citizens. The first of these groups, was created in Dallas. The idea caught on, and grew. A famous example of these groups, is the Blue Cross which evolved during this time. During WWII private companies took this up when businesses started offering insurance to get around wartime regulations (Noah).

(“Health Insurance in the United States”)

From the second half of the 20th century to today, those changes were expanded on and shaped the current systems and issues. WWII private insurance companies became HMOs and PPOs which have differences in size, cost, and coverage but are similar and many aspects (“HMO vs. PPO Insurance Plans”). The government got involved in health insurance when President Lyndon B. Johnson signed Social Security Amendments of 1865 law into effect. This created Medicare and Medicaid. Medicare provides health insurance to 65+ year old Americans while Medicaid provides it to Americans deemed unable to afford it themselves (Hansler). While many original plans and reform plans were proposed, there was often resistance from private health insurance companies as well as people afraid of a strong government with too much power (“History of Health Care Reform in the United States”).







Today, about half of the population receives health insurance through their jobs, where their employers pay premiums (fees) to insurance companies (HMOs or PPOs). About a third of the population, has healthcare under government programs, a few people pay premiums directly to insurance companies, and almost one-sixth of Americans are completely uninsured (“Introduction to Health Care in the U.S.”). The actual care provided by hospitals, clinics, and medical professionals have some issues related to restrictive care based on race/ethnicity bias or gender bias, hospital errors, and medical fraud, the medical care received by patients is not a majorly debated issue (“Social Problems: Continuity and Change”). But the availability and affordability of that medical care, the healthcare system, is one of the top fifteen most worried about issues in the nation (Feather). The issue of health insurance coverage and effectiveness is  has as clear visibility throughout history, but sadly no solution has yet to fix this complex, deep-rooted issue.


In today’s healthcare system almost one-sixth of Americans are completely uninsured (“Introduction to Health Care in the U.S.”). Then there is the problem of those that are insured receiving subpar care. The US ranks as having one of the lowest performing healthcare systems among other similar developed countries and also has high rate of deaths that doctors and hospitals could have presented as well as doctors saying they spend a lot of time getting medication (Khazan). Because of these issues the U.S. healthcare system, is one of the top fifteen most worried about issues (Feather). A solution articulated in many online article’s and which I found clearly explained in an article from The Week magazine website. The solution is simply converting the American healthcare system to single payer national health insurance (Cooper). It is described very well by the PNHP, “single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands” (…). This would most likely happen on a state level and the result would be everybody, no longer limited to age, health, or economic position, would be provided health insurance by the government. The strongest argument against this is that it would cost too much and while the cost would rise from its current place the difference can be shrunk by reduced prices on medical procedures and medicines that the government would have more control of due to this system. Studies have shown hundreds of billions of dollars wasted in the American billing system and a single payer system would streamline all the administrative procedures producing less waste. In this system more people would be covered and the coverage could be more comprehensive including inpatient, outpatient, emergency services, and more making the system worth its price (Cooper).

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