This document provides background information and summarizes the debate over providing health insurance for the uninsured. The links to the left will lead you to public documents that we have found.
This nation's
health care system has remarkable strengths. In terms of advanced treatments
and surgical procedures, the United States is unparalleled. But not all is
well with the healthcare system. In the richest country on earth, 41 million
went without medical insurance in 2001. Since many people move from employed
to unemployed status during the course of a year, the number of people who
were uninsured at any one time during this 12 month period was 75 million.
This means that nearly one out of every three Americans under the age of 65
were uninsured for part of 2001.
Employment status
is key because most Americans receive their health insurance as part of their
compensation from their job. Typically, an employer pays a portion of the
monthly premium and the employee pays a portion. An individual or a family
can purchase insurance directly but it is much more expensive than doing so
through one's employer. The insurance companies offer lower premium rates
if they're servicing a large group of people rather than a single subscriber.
Among the western industrialized democracies the United States is unusual
in tying health insurance to employment. In Canada, for example, there is
a single payer system where all citizens are insured by the government.
Uninsured Americans
are not completely without access to healthcare, but many receive very spotty
care or fail to take advantage of what's available because they don't understand
the complex publicly supported systems for treating the uninsured. Some states
have relatively progressive Medicaid programs that enroll those without insurance
in community health centers. The federally funded CHIP program provides care
for many low-income children, but doesn't reach all children who lack insurance.
Sadly, many uninsured defer needed care and end up at hospital emergency rooms
very ill, instead of being treated when it would have been much simpler and
less costly.
Everyone agrees
that the lack of health insurance for all Americans is a terrible problem
and something needs to be done about it. In the 106th Congress (1999-2000)
there was considerable discussion and, philosophically, the differences were
great. Conservative Republicans favor plans that would give the poor a tax
credit that they could use to purchase a bare bones health plan from private
insurers. Liberal Democrats tend to favor either a single payer system or
a broadened Medicaid program. But as far apart as these plans are, there should
be room for compromise if there is a commitment on the part of both parties
to make the issue a priority.
Complicating
the philosophical divide is a more basic and practical one: cost. It's a very
expensive proposition to cover the uninsured, even taking into account the
savings from giving those without insurance regular care instead of treating
them when they've deteriorated to the point of an emergency. An additional
problem for the 106th Congress was that President Clinton was still skittish
because of the resounding defeat of his ambitious health care restructuring
bill in the first years of his administration. A lobbyist for physicians complained,
"The White House had very little, if anything, in their budget for the
uninsured." Various health groups floated proposals in abstract terms,
trying to find a starting point for negotiation. Everyone knew, however, that
ultimately the 106th Congress would pass the problem onto to the next president
and the next session of Congress. And that's what happened.