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Government’s Role in Public Health Care

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Andrew Vaz
Jan. 20, 2017

PracticingtheArtThe public health care system in the United States is one of the most complicated systems in existence. I wouldn’t call it unique, as many other nations have a hybrid array of public and private insurance markets; it’s just the masses of lobbyists and special interest groups have more of a hold on the way the system operates than in countries such as England and Canada. The U.S. remains the largest first world nation to not operate a national government-run, or single payer health care system. However, with advancements including Medicare and the Affordable Care Act (ACA), they have opened up the prospect of, perhaps one day, a universal health care system becoming a reality for Americans.

Problems with the U.S. Health Care System

The biggest problem with the current health care system is the number of citizens who are uninsured. The Center for American Progress estimated in 2009 that the lack of health insurance in the U.S. cost society $124-$248 billion per year. While the low end of the estimate represents just the cost of the shorter lifespans of those without insurance, the high end represents both the cost of shortened lifespans and the loss of productivity due to the reduced health of the uninsured.

The ACA, passed in 2010, represented a fundamental shift in health care policy; it enabled 97 percent of citizens to sign up for coverage without a preexisting medical condition, some for the first time. While it allowed Americans to sign up for coverage, it does not force citizens to participate in health care exchanges. In fact, Americans are refusing to sign up for health coverage, believing paying the penalty fee in their taxes is worth the cost rather than an insurance program with high premiums. In 2005 for example, the average annual premiums for employer-sponsored health insurance were $2,713 for single coverage and $8,167 for family coverage. In 2015, premiums more than doubled to $6,251 for employer-sponsored single coverage and $17,545 for employer-sponsored family coverage.

The ACA also allowed citizens to apply for an exemption from the health care exchanges that exempt people from penalty fees. However, a majority of Americans are not aware of the full extent of the ACA’s options. Special interest groups and others employ misinformation and as much of health care reform is seen as political, opponents to the law will insure the law will fail and seek its repeal.

This leads to Congress. For 50 years, the fight for health care reform has started and ended with the House of Representatives and Senate. Let’s look at the efforts of Presidential administrations and Congress to legislate health care reform.

History of Health Care Reform and Congress

From the Truman administration to today, reform for health care has seen both progress and failure. President Truman recommended to Congress a proposal for universal health insurance coverage, administered and paid for by a National Health Insurance Board. Unfortunately, the American Medical Association decried it as “socialized medicine,” and the bill died in Congress.

The Kennedy administration pursued a more modest form of health care coverage than that proposed by President Truman. The Kennedy administration supported the King-Anderson bill, under which health insurance coverage would be limited to those 65 years of age and older and be part of the Social Security benefits package. Kennedy, in addition, created more avenues to develop the foundation of what would ultimately become Medicare. Unfortunately, Kennedy’s health care plan was denied by Congress—opposed by the powerful American Medical Association, with help from conservative Democrat Wilbur Mills, chairman of the House Ways and Means Committee, the bill was defeated in Committee.

Moving forward to the Clinton Administration, a proposal was developed that would allow for health insurance coverage to be provided through private insurers competing for customers in a highly regulated market, overseen and coordinated by regional health alliances to be established in each state—a precursor to Obamacare. All health plans would be required to provide a minimum level of benefits and employers would be required to provide insurance coverage for their employees. However, President Clinton’s bill was opposed by the health care and health insurance industries; by September 1994 the proposal was declared dead by Senate Majority Leader George Mitchell.

With the Bush Administration, Congress passed an aggressive Medicaid expansion package, called Medicare Part D—a prescription drug coverage benefit. Medicare Part D was the first successful health care reform in the U.S. and laid the framework for what would eventually be the biggest comprehensive reform package known as the Affordable Care Act under the Obama Administration.


Health care reform will be tabled again under the new administration. What will become of health care reform going into the next administration is anyone’s guess, however, the pursuit for universal health access will continue.

AuthorAndrew R Vaz, M.Sc., M.P.A. is a doctoral student in public policy and administration program at Walden University. He is a graduate of the Master of Science in Criminal Justice and Master of Public Administration double master’s program at Florida International University. He can be reached at [email protected]

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