National Health Insurance for the U.S.
NATIONAL HEALTH INSURANCE FOR THE UNITED STATES
Summary of Recent History of the Issue
Health care costs in the United States, as a proportion of gross national product, increased from 1981·8.1 percent to 1990·12.2 percent. Health care spending as a proportion of gross domestic product is higher in the United States than in any other country (Heidenheimer, Heclo, & Adams, 1995). Such spending is three-times higher in the United States than in the United Kingdom. Such a differential might be justified if health outcomes in the United States were clearly superior to this in Britain. Health outcomes in the United States, however, are often inferior to those in the United Kingdom (Appleby, 1992). Infant mortality is 10 percent more prevalent in the United States than in Britain. Male life expectancy in Britain is four months greater than that in the United States, although female life expectancy in the United States is nine months longer than that in Britain. Thus, the more costly and more exclusionary health care system in the United States fails to produce superior medical outcomes to the British system.
Approximately 60 percent of the American population is covered by private health care insurance programs (Congressional Budget Office, 1993). Most of these programs·the very great majority·are either fully or partly funded by employers, while the remainder are funded fully by the covered individuals and families. For the remaining 40 percent of the population, the delivery of health care services is either funded by the federal government (for approximately 25 percent of the population, primarily through the Medicaid program), or by individuals and families in the financial position to pay for health care services at the time of delivery, or deferred. When all is said and done, approximately 12 percent of the country’s population is without any formal health care insurance coverage, although some estimates of this …