Barring any massive upheaval to the political forces currently in Washington, DC, the Affordable Care Act is set to become part of the nation’s social fabric. But the real goal, universal health care, is still far off.
One hundred years after Theodore Roosevelt proposed studying the European model of nationalized health insurance, America has finally listened. Instead of a direct route to the Bismarck-style system in which the population is divided among multiple private payers, Americans opted for a voluntary employer-based system.
It took nearly fifty years to provide elderly retirees and extremely poor Americans coverage with Medicare and Medicaid. All the while, federal employees, the military, and veterans were placed into other risk pools. Still, most Americans either obtained their health insurance through the benevolence of “the progressive employer” or went without insurance.
The uninsured were left at the mercy of a for-profit insurance industry designed to do one thing: deliver profits for shareholders. That is the system we have inherited, largely unchanged, until recently.
The Affordable Care Act, recently affirmed by the Supreme Court will require that almost all Americans obtain health insurance. But it falls far short of ensuring universal health care in the United States.
While the passage and implementation of the Affordable Care Act is a step in the right direction, the rational and universal health care system envisioned by Roosevelt requires several additional reforms….
Cedric Dark, MD, MPH