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Books, Journals, New Media
August 17, 2005

Health Care System

Author Affiliations

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; Journal Review Editor: Brenda L. Seago, MLS, MA, Medical College of Virginia Campus, Virginia Commonwealth University.

JAMA. 2005;294(7):849-850. doi:10.1001/jama.294.7.849-b

With the exception of the United States, all Western industrialized countries guarantee all citizens coverage for essential health care services. At any given time, one in six Americans lack any coverage, and one in three have been uninsured at some time during the past 2 years.

Why doesn’t the United States have universal coverage? Quadagno argues that current arrangements for financing health care are the result of contentious and continuing struggles over the past century between social reformers and physicians, employers, insurance companies, and trade unions. Each attempt to enact national health insurance has met with a fierce attack by powerful stakeholders. First physicians, then insurers and employers mobilized their considerable resources to keep the financing of health care a private affair. The author suggests that the only instance in which this was not the case was in 1965, with Medicare (for the aged) and Medicaid (for the poor), which provided insurance for groups “that private insurers have no desire to cover.” (p 6)