The state of the U.S. healthcare system has been a matter of debate ever since the 1970s. The debate took on more urgency in the years leading up to the passage of the Affordable Care Act in 2010. Those on one side claim the U.S. healthcare system is the best in the world while those on the other side say it is anything but.
Lost in the shuffle is an understanding of the terms and definitions. Is the U.S. healthcare system the best in the world? That depends on how you measure. Yet looking at the issue from multiple perspectives reveals an uncomfortable fact: the debate really isn’t about the system at all. It’s about health insurance.
Private vs. Public Healthcare
The PBS News Hour program recently began a multi-part series looking at the state of healthcare in this country. Needless to say that the series does not have a lot of good things to say about our system outside of the ability of U.S. businesses to innovate. The series is highly critical of America’s lack of universal healthcare.
The difference between the U.S. and countries with universal healthcare boils down to who pays for it. Our system is a private system in which people pay for their own care. In a universal healthcare, the government pays. And yet, from where does government derive its funds? Taxpayers. So even a universal system is ultimately paid for by the people who use it.
Our private system relies on a combination of insurance payments, out-of-pocket payments, and government payments. Throw in a little charity here and there to cover any remaining expenses and no one is denied access to healthcare as long as there is someone to pay the bill.
The Reality of Health Insurance
Speaking of paying the bill, most of us have become so accustomed to the concept of health insurance that we rarely give thought to life before it existed. Health insurance was largely unheard of in the U.S. prior to the 1960s. The few health insurance plans that were around before then were neither widely known nor utilized. When health insurance finally did catch on, it was nothing like it is today.
According to Dallas-based BenefitMall, health insurance back then was major medical. Patients paid for routine care out-of-pocket. They only turned to insurance to cover major expenses like hospitalizations and surgeries. It was not until the introduction of HMOs in the 1970s that Americans began utilizing health insurance for primary care.
Health Insurance vs. Innovation
The question the PBS series attempts to answer is whether or not our system is as good as other countries with universal healthcare. To their credit, they do acknowledge our system as being among the best in the world in terms of innovation. Nobody innovates quite like American companies, and people all over the world who need procedures they cannot get anywhere else come to our shores.
However, most of the series takes a look at access. This is where our system is said to be inferior. In reality though, federal law prohibits healthcare providers from denying anyone life-saving, critical care. Even if you can’t pay your bill, a hospital emergency room can’t turn you away when your life is in danger.
The access question is not really one of access, either. It is about who pays the bill. Thus, the debate is really about insurance. When framed that way, the problems within our system become apparent. Our insurance system is broken and in need of repair. Fix that and the U.S. system becomes the finest in the world bar none.