Introduction

Over ten years have passed since President Clinton's failed attempt to reform the United States’ health care system. In its wake, federal and state governments have tried to increase access to health care incrementally by passing a new layer of patchwork quilt programs and regulations, and pinning their hopes on the increased expansion of managed care plans and free-market forces.

These strategies have failed miserably. Despite a short-term hiatus in health care inflation and in the uninsured rolls during the economic boom of the late 90s, increases in health care spending and the numbers of uninsured persons has returned with a vengeance. In 2001, the United States’ health care spending grew by 8.7 percent to $5,035 per person, and overall spending reached $1.4 trillion. The number of uninsured and underinsured persons increased to over 42 million and 31 million, respectively, making about 73 million Americans inadequately insured.

By contrast, countries that provide universal health insurance spend significantly less than the United States. In 2000, for example, the United States spent $4,631 per person, while Germany spent $2,748, Canada $2,535, Japan $2,012, and the United Kingdom spent $1,763. Although critics of this comparison point out, correctly or not, that other countries ration care by limiting elective procedures, expensive medical intervention, and instituting long waiting lists, these differences in per-person spending actually suggest that such problems would dissolve if these other countries decided to spend as much as the United States on health care. Put another way, if the United States adopted a “system” similar to any one of these other countries and spent just as much as it does now, it might insure everyone without substantially limiting care to anyone.

Why Health Insurance Matters

The importance of having adequate health insurance cannot be overstated. The overwhelming evidence conclusively shows that having health insurance is “an essential component of access to quality health care or to health outcomes.” Persons who lack health insurance confront numerous short-term and long-term health, medical, and financial problems.