Health care issues: How the US system evolved

By Jim Drinkard

A look at key issues in the health care debate:

THE ISSUE: Why is the United States the only wealthy industrialized nation that does not have universal health coverage?

THE POLITICS: Health insurance in the United States is provided primarily by employers. The government picks up coverage for retirees and the disabled through Medicare, for the poor through Medicaid, and for military veterans and members of Indian tribes. That still leaves many people without coverage, estimated at 40 to 50 million. The U.S. system was shaped by a World War II government policy that imposed wage controls when much of the nation’s workforce was off at war. Barred from wage increases, employers turned to health insurance benefits to attract workers, and job-related health benefits became a staple in the post-war years. President Barack Obama takes note of the patchwork nature of the U.S. health care system, but argues it’s politically impossible to throw out the entire system and start from scratch.

WHAT IT MEANS: Any overhaul of the U.S. system will be built on a foundation of employer-provided health care. Industrialized countries that provide universal coverage do so because those systems evolved from their own unique histories. Britain, for example, found it necessary to provide government-run care to its military and civilians alike when it came under attack in World War II, and that gave rise to its current, largely government-owned, system. France’s care is built on a longstanding system of employer- and union-sponsored payroll tax insurance funds that were expanded over the years.