Having reliable and affordable health insurance is crucial in order for a person to maintain health. While having health insurance is a commodity in developed countries, the health system of the U.S. is mostly designed under a capitalist structure, where private, for-profit companies dictate benefit packages that are not suitable for all people. In this paper, I will interpret the healthcare system in the U.S from scholarly research articles. Also, I will note the efficacy of the healthcare system compared to other countries. Lastly, I will identify who the uninsured and underinsured groups are and address the way that our government has reformed our healthcare system.
In the U.S., the health system operates in a complex institutional set-up with public or private mixed sectors (Zhu & Johansen, 2014). For Americans covered by the private sector, they are dependent on their employer for the coverage (Martin & Martin, 2011). Private sectors such as United HealthCare, Blue Cross Blue Shield, and Cigna work with large companies to develop benefit packages. Furthermore, the government-mandated all companies offer extended benefits without employment, such as the Consolidated Omnibus Reconciliation Act (COBRA), which is limited and often expensive (Martin & Martin, 2011).
On the other hand, there are public sector healthcare systems in the U.S., such as Medicare, Medicaid, or Children’s Health Insurance Programs (Zhu & Johansen, 2014). The public healthcare programs are not accessible to all general public because they aid those who cannot provide for themselves. Medicare is for all citizens who are 65 and older, regardless of income. Medicaid, on the other hand, is a federally established but state-run health insurance program that is dedicated to the poor and disabled (Kraft & Furlong, 2018).
The American healthcare system is not very effective, considering its limited and uneven service to the general public. Zhu and Johansen’s study found that there are significant inequalities and disparities in coverage across different levels of income groups (2014). Both public and private healthcare systems have flaws. The public healthcare systems have a funding structure that varies across states because each state can budget differently on how much public health insurance is provided (Zhu & Johansen, 2014). The private healthcare system is tied to one’s employment, and thus could be instable as the job market and the economy fluctuate (Martin & Martin, 2011). People may lose employment due to unforeseen reasons; COVID-19 serves as a great example as the employment rate is at a historical record high. It is common for those who became unemployed or underemployed to lose their health benefits and default on the payments for their home (Martin & Martin, 2011). Since COBRA is expensive and limited, as previously stated, it is counter-intuitive for people who are unemployed or underemployed. It is common for a U.S. citizen to file bankruptcy over medical expenses, while it is rare for other developed countries.
Compared to other industrialized and developed countries, the U.S. is the only one that does not have a national healthcare system. Zhu and Johansen (2014) have noted in their study from other researchers and conclude that public-public partnerships are efficacious at enhancing equity in public service compared to public-private partnerships. Other private employers in other industrialized countries around the world do not pay for health insurance, because it is provided uniformly by a national sector. Martin and Martin identified that, in those countries, “publicly managed health insurance is typically extended to all citizens and legal residents. Australia’s Medicare, Canada’s Medicare, the United Kingdom’s National Health Service, and Taiwan’s National Health Insurance are examples of single-payer universal health care systems” (2011, p.151).
Aside from people who lost their job due to economic failure or disability, not all companies in the U.S. offer health insurance benefits for their employees; for those reasons, many are often uninsured or underinsured. Since the market systems of the U.S. do not guarantee everyone to have access to healthcare, the government steps in to correct market failures (Kraft & Furlong, 2018); as a result, policymakers have taken a role to reshape American healthcare reform. Both the public and private healthcare sectors were actively involved in negotiations that ultimately led to the establishment of the Affordable Care Act in 2010, colloquially known as Obamacare (Kraft & Furlong, 2018).
During the deliberation, private insurance companies lobbied for the individual mandate under Obamacare. While the private sector helped retain security for themselves as they faced changes in practices and finances (Kraft & Furlong, 2018), their involvement has shaped the public healthcare system. Private health care plans emerged earlier than public programs in the United States. Soss and Moynihan (2014) identified from other political analysis in their studies that state officials adapted in ways that unfortunately resulted in a fragmented healthcare system, which is expensive and its implementation undercuts the constituency for reform while raising the political costs of policy change. Policy reformers eventually were pressured to focus on residual populations left out of private coverage (Soss & Moynihan, 2014).
Obamacare fixes the problem of the variability and inconsistency of medical coverage within states to adopt universal health insurance coverage (Zhu & Johansen, 2014). However, it was still only catered towards a particular group of people like Medicaid. By setting quantitative income eligibility limits, not all citizens who are socially and economically marginalized will be able to receive Obamacare (Zhu & Johansen, 2014). One of the social issues regarding inequity is the infamous Medicaid gap, where people are still uninsured because they are too poor to pay for private health insurance but make too much income to qualify for Medicaid.
In conclusion, healthcare insurance in the U.S. is a complex system that involves both the public and private sectors. While the U.S. has a public insurance program, it is not available to all citizens, unlike universal healthcare in other developed nations, such as the U.K. or Taiwan. While American policymakers have started to focus on national health insurance in recent reforms, future work needs to consider reducing inequality in health insurance coverage directly.
Kraft, M. & Furlong, S. (2018). Public Policy, Politics, Analysis, and Alternatives (6th ed.). Thousand Oaks, CA: C.Q. Press, an imprint of SAGE Publications, Inc.
Martin, E., & Martin, A. (2011). Economic crisis in the united states: Management strategies for a democratic economy. Public Administration and Management, 16(2),145-170.
Soss, J. & Moynihan, D. (2014). Policy Feedback and the Politics of Administration. Public Administration Review, 74. doi:10.1111/puar.12200
Zhu, L. & Johansen, M. (2014). Public responsibility and inequality in health insurance coverage: An examination of American state health care systems. Public Administration, 92(2):422-439. doi: 10.1111/padm.12083