Health Insurance in the United States: Failure of Private and Multi-Payer Financing

Abstract

Since the 1960s, the United States has subscribed to a business model of health care, largely for-profit with most private insurers on a mission to maximize their own revenues. Most insurers use cost sharing through deductibles and copayments based on the principle that enrollees will overuse health care services unless they have enough “skin in the game.” As health care has been corporatized within a medical-industrial complex, even public insurers such as Medicare and Medicaid have been privatized with the same mission. Employer-sponsored health insurance has been the core of insurance in the U.S. since World War II, but has become unaffordable for employers and employees alike. This article brings historical perspective to how health insurance has been transformed from its not-for-profit origins in the 1930s, how it has become unaffordable in recent decades as it costs more and covers less, and how our multi-payer financing system has failed the public interest. Reform alternatives are discussed, but a system of universal coverage through a public, single-payer national plan is still beyond reach politically.