The future of health care in the United States
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Key Findings
- The quality of medical care in the United States has advanced tremendously in the past 100 years. Health care policy has likewise changed dramatically over the same period.
- A movement toward more government intervention and control of U.S. health care policy began early in the 20th century and the trend persists to this day.
- Although the government is expanding its control over the health care delivery system, America is still a capitalistic country with the private, free market sector of health care remaining viable at the present time.
- Free market ideas, such as the use of affordable direct primary care, telemedicine, alternative health coverage plans, and technical innovations, are growing outside of government intervention.
- It is very difficult for lawmakers to reform or reduce benefits in any government entitlement once they have been enacted. Once people receive an entitlement for free, or one that is heavily subsidized, special interests and political advocates strongly resist changes – even though those changes may guarantee the long-term viability of that program.
- Over 40 percent of Americans are in one of the government-run health care programs. It appears that these entitlements are here to stay and will probably expand.
- Half of all Americans have employer-paid health insurance plans. These are popular, well accepted in the U.S., and have a 75-year history of success.
- The country is gradually, but persistently, moving toward a single-payer health care system. The real unknown is how Americans who benefit from good-quality private coverage and are not currently in government entitlement plans will respond.
- Free market solutions do exist. To control costs, increase choice, and maintain or improve quality, patients should be allowed to control their own health care dollars and make their own health care decisions.
Introduction
Medical care in the United States has advanced tremendously over the past 100 years. From new antibiotics, to revolutionary cancer treatments, to surgical procedures that were unheard of a century ago, Americans today enjoy greater longevity and a better quality of life thanks to medical progress.
Health care policy has likewise changed dramatically over the past 100 years. Starting after the Revolutionary War, the federal government has provided health care benefits for military veterans. Government licensing of doctors began in the 1920s and health insurance, along with its federal and state regulations, began in the 1930s. Changes to the federal tax code encouraged employers to pay for employee health benefits during World War II, a policy that is firmly entrenched in the U.S. today, with half of all Americans receiving their health insurance tax-free from their employer or spouse’s employer.
A movement toward more government intervention and control of U.S. health care policy began early in the 20th century and has persisted to this day. Medicare and Medicaid began in 1965 and were originally designed to be safety-net health insurance plans. The Affordable Care Act, or Obamacare, became law in 2010, while its provisions for Medicaid expansion and taxpayer subsidies in the individual insurance market followed in 2014. Today, over 40 percent of Americans are in one of these three government-managed insurance programs.
Although the government is expanding its control over the health care delivery system, America is still a very capitalistic country with the private, free market sector of health care remaining viable at the present time.
The question is what the future of the U.S. health care system will look like. This Policy Brief describes the various possibilities as American health care continues to evolve.
Download the full Policy Brief