Healthcare Coverage in the U.S.

Change In Challenging Times: A Plan For Extending And Improving Health Coverage

Jeanne M. Lambrew, John D. Podesta, Teresa L. Shaw
Health Affairs, 10.1377/w5.119-132

By any objective standard the U.S. health care system has serious problems, which are getting worse. Since 2000 the number of uninsured Americans has risen by five million, to forty-five million or nearly 16 percent of all Americans. There are more uninsured Americans than the total population of Canada or people living worldwide with AIDS; the uninsurance rate is three times higher than the unemployment rate. Health insurancematters, according to a recent review by the Institute of Medicine (IOM), which found that uninsured people tend to have worse health outcomes because of delayed and sometimes denied care and are treated differently once in the system.

The lack of coverage exacts a large personal financial toll, running up debt and contributing to personal bankruptcy. It also results in billions of dollars in uncompensated care costs that get passed along through the health system. Uninsurance is perhaps the most important, but not the only, problem in the system. In 2004 the cost of employer based health benefits increased at a rate five times higher than that of wages; since 2000 the family share of such coverage increased by more than 60 percent. This not only strains the middle class but also limits employers’ willingness to create jobs.

For all we pay, we have worse-than-expected health: lower life expectancy than more than twenty other countries, near-epidemics of preventable conditions, and an infant mortality rate that rose in 2002 for the first time in forty years. Yet as the public policy agenda rolls out for 2005, major health proposals are nowhere in sight.

President George W. Bush did not include new ideas for expanding coverage in the State of the Union address or his budget. Also, Congress seems intent on scaling back rather than stepping up federal funding to solve health system problems. This lack of political attention is not for lack of public support. We know that people recognize the problem: Among 2004 election voters, 93 percent were concerned about the availability and affordability of health care.

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