Summary: Yet again, cogent review of the failings of absurdly complex US health insurance, reducing medical access for vulnerable populations and indeed, almost all of us. Yet again, acceptance of the dysfunctional patchwork and a call for “new reforms.” Yet again, we say: adopt the only sensible solution, single payer.
U.S. Health Insurance Coverage and Financing, New England Journal of Medicine, December 22, 2022, by Sabrina Corlette, J.D. and Christine H. Monahan, J.D.
The United States has a patchwork system of health insurance coverage, in which people’s access to services and level of financial protection — not to mention whether they have coverage at all — varies depending on their birthplace, age, job, income, location, and health status. If you are 65 years of age or older or have a disability, you might be eligible for Medicare. If you work full time for a company that chooses to offer benefits, you might be eligible for employer-sponsored insurance. Depending on your income, state of residence, and other factors, you might qualify for Medicaid. You could also fall through the cracks: 12 years after the enactment of the ACA, more than 9% of Americans remain uninsured.
Many people in the United States work for employers that do not offer insurance or do not sufficiently subsidize it, making it unaffordable for lower-income workers. Most documented immigrants must wait 5 years to qualify for Medicare or Medicaid; those who are undocumented may never be eligible for any type of government insurance. And immigration status aside, millions of people live in states where eligibility rules mean they are actually too poor to qualify for subsidized coverage.
No one would purposefully design the system we have. Unlike many of our peer countries, the United States has never had a centrally planned, cohesive system to help its citizens obtain and pay for health care services. Ours is a system built on happenstance, unintended consequences, and gap filling.
The United States has made sporadic efforts at creating a national system of health coverage… (the article provides a brief history of these attempts with which we are all too familiar).
Among the people still most at risk for falling through the cracks are historically marginalized populations.
Americans who have “good” insurance today may be surprised to learn that they, too, are vulnerable.
Our patchwork system of health coverage is not going away anytime soon. However, the primary reason millions of Americans remain uninsured or have insurance coverage that leaves them financially exposed is the high costs in our health care system. Constraining the growth of costs while reducing inequities in access and outcomes will require new but difficult reforms.
Comment:
By Don McCanne. M.D.
Can you believe it? We are entering yet another new year with the same old problem: We have the most expensive health care system on earth, and yet we continue to perpetuate the inequities in health care access and outcomes that we know would be dramatically reduced or eliminated with enactment and implementation of a single payer version of an improved Medicare that is designed to serve all of us.
Let’s resolve to make this the year of health care justice for all: Single Payer!
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