As healthcare insurance is a key determinant in health, efforts to expand coverage are critical towards improving health equity and responding to the health and economic challenges, particularly during the height of the COVID-19 pandemic where many Americans were increasingly impacted by a lack of health insurance (Bosworth et. al., 2021). In 2014, the number of uninsured individuals began to decrease substantially, when Medicaid expansion was implemented in selected states and Marketplace coverage became available with premium Tax Credits and Cost-Sharing Reductions for those who qualified based on income (Bosworth et. al., 2021). The number of non-uninsured fell to 35.7 million (including those who are 65 years old and under) in 2014, with more declines in 2015 and 2016 as more states expanded Medicaid and Marketplace enrollment grew, and later in 2016 the number of uninsured individuals had decreased by 20 million people since 2010, with 28.2 million nonelderly uninsured (Bosworth et. al., 2021).
However, from 2017 to 2019, the number of uninsured rose each year, despite the strong economic conditions during this period (Bosworth et. al., 2021). The number of uninsured increased because of the Affordable Care Act (also known as Obama Care) revisions that occurred during 2016-2019, leaving many Americans without health insurance, increasing the uninsured by approximately 2.3 million, leading to a healthcare loss of a reported 3,399 deaths and potentially up to 25,180 more deaths (Harvard T.H. Chan School of Public Health, 2020). The U.S. spends on average, 2 to 3 times as much per capita on healthcare as most industrialized countries, further averaging $9,541, an estimated two-thirds falls on the federal and state government’s shoulders, accounting for entitlements such as Medicare and Medicaid (Merelli, 2017).
During the early 20th century in World War I, there had been some attempts by the federal government to follow the examples of other industrialized nations to create a universal health system, but these efforts were met with opposition from physicians, insurance companies, businesses, and conservative labor organizations that considered state-sponsored healthcare paternalistic and unnecessary (Merelli, 2017). Labor unions worried that it would decrease their own bargaining power, as they were otherwise responsible for getting their members social services, yet the root of the current system, and the precursor to the current state of the healthcare system is often credited to World War II (Merelli, 2017). In 1943, President Roosevelt imposed a freeze on labor wages, and businesses started offering healthcare and retirement benefits to retain workers instead (Merelli, 2017). This marked the beginning of employer-sponsored healthcare in the U.S., when unions began negotiating worker benefits as part of what they could obtain for workers that did not include the rest of Americans and did not put pressure on the federal government to create a universal healthcare system (Merelli, 2017).
Later, during World War II, there was a successful campaign by Clem Whitaker and Leone Baxter, the founders of Campaigns, Inc. (the alleged first political consulting firm in history), they worked on behalf of the California (CA) Medical Association and opposed former CA Governor Earl Warren’s 1944 plan to introduce compulsory health insurance in the state, paid for through Social Security (Merelli, 2017).
Whitaker and Baxter used the slogan that claimed political medicine was bad medicine and told CA residents that universal health care is a German invention known as socialized medicine, which garnered a lot of public support as during that time American soldiers were fighting abroad against the Nazi regime in Germany (Merelli, 2017). The slogan campaign worked and was used again on behalf of the American Medical Association in 1949 against President Truman, when he proposed a public health plan, like universal healthcare coverage (Merelli, 2017). Currently, many of these sentiments remain the same. However, with the continued rise in the US’ population, increased life expectancies, and chronic conditions, it may be high time for Americans to demand universal healthcare coverage in like with many other industrialized nations. Although universal healthcare coverage comes with its tradeoffs, longer medical provider wait times (particularly, specialty medical providers), sometimes lower insurance payouts to physicians, and a reduction in delivering effective long-term care. Altogether, universal healthcare offers better security of patient dignity, reduces the likelihood of medical bankruptcy, increases provider incentives, and offers less dependence on employers to provide healthcare benefits to employees. Hence, even in the event of job loss, individuals will still have healthcare coverage, and the right (rather than privilege) of access to healthcare services.
Bosworth, A., Chu, R., Conmy, A., Finegold, K., & Sommers, B. (2021). Trends in the U.S. uninsured population, 2010-2020. https://aspe.hhs.gov/system/files/pdf/265041/trends-in-the-us-uninsured.pdf
Merelli, A. (2017). A history of why the US is the only rich country without universal health care. https://qz.com/1022831/why-doesnt-the-united-states-have-universal-health-care/