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Universal Coverage, Health Inequalities, and the American Health Care System in Crisis (Again)
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2 RICK
MAYES APSA
2004
“The system is collapsing around us.”
1
. . . “I’ve become more convinced as time
goes by that our health care system is fundamentally broken and needs major surgery; . . . I
think we’re standing on the edge of a cliff.”
2
—U.S. Senator John Breaux
“But Thou, O Lord, how long?”
—King David
3
Another health care crisis has emerged in the United States. It was inevitable. Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died so ignominiously, the same problems—only worse—have returned, and even some new ones have appeared. The following is a brief overview of just some of the leading problems associated with our nation’s health care system.
After declining slightly in 1999 and 2000, at the height of the country’s
economic boom, the number of uninsured Americans rose to 45 million in 2003 (15.6% of the population ).
4
The lack of health insurance coverage has become as
much a “working class” and “middle class” phenomenon as it is a “poor” one. Roughly one-third of all Americans earning between $25,000 and $75,000 (20,110,000 individuals) are uninsured.
5
More than 75% of the uninsured work
full-time and about one-third earn more than $50,000 annually.
6
If you include
individuals who have experienced a temporary lack of coverage, the number of Americans without health insurance at some point during the last two years rose to 75 million in 2002, which is nearly one-third of all Americans younger than 65.
7
Even the affluent are not immune. The number of uninsured people with household
1. Marcia Angell, The Forgotten Domestic Crisis, N.Y.
T
IMES
, Oct. 13, 2002, at A13.
2. Gail R. Wilensky, Interview, Thinking Outside the Box: A Conversation with John Breaux,
H
EALTH
A
FFAIRS
W
EB
E
XCLUSIVE
,
W3-124, W3-124, W3-130 (March 5, 2003), at
http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.124v1.pdf (last visited May 28, 2004).
3. Psalm 6:3.
4. M
ILT
F
REUDENHEIM
,
Record Number of Americans Not Insured on Health, N.Y.
T
IMES
, Aug.
27, 2004, at A1.
5. R
OBERT
J.
M
ILLS
&
S
HAILESH
B
HANDARI
, U.S.
C
ENSUS
B
UREAU
,
C
URRENT
P
OPULATION
R
EP
.
P
UB
.
P60-223,
H
EALTH
I
NSURANCE
C
OVERAGE IN THE
U
NITED
S
TATES
:
2002,
C
ONSUMER
I
NCOME
4
(2003), available at http://www.census.gov/hhes/www/hlthin02.html (last visited May 30, 2004) [hereinafter H
EALTH
I
NSURANCE
C
OVERAGE
:
2002].
6. Ceci Connolly & Amy Goldstein, Health Insurance Back as Key Issue, W
ASH
.
P
OST
, Mar. 16,
2003, at A5.
7. R. Toner, Study Raises Estimate of the Nation’s Uninsured, N.Y.
T
IMES
, Mar. 5, 2003, at A19.
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2 RICK
MAYES APSA
2004
“The system is collapsing around us.”
. . . “I’ve become more convinced as time
goes by that our health care system is fundamentally broken and needs major surgery; . . . I
think we’re standing on the edge of a cliff.”
—U.S. Senator John Breaux
“But Thou, O Lord, how long?”
—King David
Another health care crisis has emerged in the United States. It was inevitable. Ten
years after President Clinton’s ambitious attempt at comprehensive health care
reform died so ignominiously, the same problems—only worse—have returned,
and even some new ones have appeared. The following is a brief overview of just
some of the leading problems associated with our nation’s health care system.
After declining slightly in 1999 and 2000, at the height of the country’s
economic boom, the number of uninsured Americans rose to 45 million in 2003
(15.6% of the population ).
The lack of health insurance coverage has become as
much a “working class” and “middle class” phenomenon as it is a “poor” one.
Roughly one-third of all Americans earning between $25,000 and $75,000
(20,110,000 individuals) are uninsured.
full-time and about one-third earn more than $50,000 annually.
individuals who have experienced a temporary lack of coverage, the number of
Americans without health insurance at some point during the last two years rose to
75 million in 2002, which is nearly one-third of all Americans younger than 65.
Even the affluent are not immune. The number of uninsured people with household
1. Marcia Angell, The Forgotten Domestic Crisis, N.Y.
T
IMES
, Oct. 13, 2002, at A13.
2. Gail R. Wilensky, Interview, Thinking Outside the Box: A Conversation with John Breaux,
H
EALTH
A
FFAIRS
W
EB
E
XCLUSIVE
,
W3-124, W3-124, W3-130 (March 5, 2003), at
http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.124v1.pdf (last visited May 28, 2004).
3. Psalm 6:3.
4. M
ILT
F
REUDENHEIM
,
Record Number of Americans Not Insured on Health, N.Y.
T
IMES
, Aug.
27, 2004, at A1.
5. R
OBERT
J.
M
ILLS
&
S
HAILESH
B
HANDARI
, U.S.
C
ENSUS
B
UREAU
,
C
URRENT
P
OPULATION
R
EP
.
P
UB
.
P60-223,
H
EALTH
I
NSURANCE
C
OVERAGE IN THE
U
NITED
S
TATES
:
2002,
C
ONSUMER
I
NCOME
4
(2003), available at http://www.census.gov/hhes/www/hlthin02.html (last visited May 30, 2004)
[hereinafter H
EALTH
I
NSURANCE
C
OVERAGE
:
2002].
6. Ceci Connolly & Amy Goldstein, Health Insurance Back as Key Issue, W
ASH
.
P
OST
, Mar. 16,
2003, at A5.
7. R. Toner, Study Raises Estimate of the Nation’s Uninsured, N.Y.
T
IMES
, Mar. 5, 2003, at A19.
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