The development of a national system of health care in the United States has remained a major topic of debate throughout the United States, especially since the 1980s. Healthcare costs in the United States have risen dramatically during the past 40 years, due in part to longer average life spans, which give rise to greater costs because older citizens require greater care, and the employment of technologies that extend the life of patients, which generally results in greater spending. Insurance costs have likewise increased dramatically, and a relatively large percentage of U.S. citizens and other residents are uninsured or underinsured. According to information from the census bureau in ...view middle of the document...
Many companies in the early 1980s began to require employees to pay deductibles on their insurance policies, and some small companies began to refuse to provide insurance at all.
Beginning in the 1980s, scholars and other commentators began to propose a variety of major reforms to the healthcare system to create a truly national system. In 1989, an article in the New England Journal of Medicine by David Himmelstein and Steffe Woolhander maintained that the system of health care in the United States was failing. A considerable amount of concern by those authors and others was directed towards the overhead costs and other administrative expenses incurred by insurance companies and healthcare providers. According to one study in 1987, the total cost of healthcare administration was an estimated $96.8 billion to $120.4 billion, accounting for 19.3 to 24.1 percent of the total spending on health care in the United States. In 1989, the more than 1,500 private health insurers in the United States consumed an estimated eight percent of their total revenues through overhead costs.
A number of commentators compared the healthcare system in the United States with the national system in Canada. Administrative healthcare costs in the United States were estimated in 1983 to be 60 percent higher than those in Canada, and Canada's system provides healthcare coverage for all of its citizens. Canada employs a so-called single-payer form of national health insurance in which the federal government administers and finances the plan. All Canadians are covered under the plan, which provides for a basic benefit package. Citizens are not required to pay a deductible or co-payment, and the government forbids private insurance companies from duplicating the services provided under the government plan. The single-payer approach reduces overhead expenses dramatically because the government pays the medical costs directly to the provider.
Although many in the medical community supported proposals to adopt a form of the single-payer model, critics noted the population of the United States is roughly ten times the population of Canada. These critics also noted that the costs of such a system would be paid for with taxes, so citizens are required to pay for this system indirectly. Moreover, adoption of such a system would involve a high level of governmental involvement, which conservative commentators dislike.
Other proposals for national health care have been introduced and have likewise been advocated unsuccessfully. Some proposals include mandates that all employers provide insurance coverage to all employees. Other proposals focus on market-based solutions, including the development opment of medical savings accounts holding funds, which individuals could use to spend for healthcare costs. The competing sides to the debate are generally unable or unwilling to compromise their positions, and the reform effort remains largely a matter of rhetoric.