Written by Suzanne Hite, former publications editor serving the technology services sector

Question: My friends on campus have been very active in politics this year. As for me, though, I’m not so political. Don’t get me wrong, I care about the issues – I just don’t have a ton of time to research everything! Maybe it’s not the best excuse, but I have a very busy schedule and a very tough major. I know all about my area of study, but sometimes I don’t feel like I know nearly enough about the issues to feel comfortable speaking out.

But I do think my friends have some good point about our healthcare system. I want to talk to them about it, but I feel very ignorant about the whole thing. Without getting too political, can you explain the history of healthcare in our country? How does healthcare work in the U.S.A., and why does it work that way?

Answer:

To understand America’s healthcare system, you have to go back to World War II. The war required the service of 16.1 million Americans, and that created a labor shortage back home. Demand for workers threatened to spark a bidding war on wages that could cause runaway inflation, so the government implemented wage controls that restricted salaries. Benefits, however, were excluded – and businesses created elaborate benefits packages that included healthcare.

Seven decades later, the country’s healthcare system is still largely employer-based: when we get a job, we expect our benefits to include access to health insurance coverage. Since companies buy health insurance in large quantities, they can get lower rates for each of their employees.

This works well for those of us with jobs, but in the 1960s American politicians grappled with the problem of what to do about two other groups: the elderly and the very poor. The elderly were retired and, in many cases, in no condition to return to work even if they needed to. The poor may be unemployed or may work part-time jobs that do not offer healthcare coverage. In 1965, under President Lyndon B. Johnson, the government created Medicare and Medicaid. Medicare is a government-run program that provides healthcare to those over 65 (Medicare recipients are also allowed to purchase additional coverage in the form of so-called “Medigap” policies from private insurance). Medicaid provides coverage the poor – qualifying rules vary from state to state. Today, Medicare covers 52.3 million people and Medcaid covers more than 70 million.

This did not mean, of course, that everyone in the United States had health insurance after 1965. From early retirees to part-time workers, many remained uncovered: 49.9 million in 2010, when President Barack Obama successfully pushed for a new law.

The Affordable Care Act (ACA, often called “Obamacare”) did not disrupt the employer-based system. Instead, it built on it, creating new requirements for employers based on things like the number of their employees or the hours those employees worked. The ACA also requires every individual to have health insurance, under penalty of a fine. We will leave the controversial part to you and your friends, but suffice it to say that many Republicans disagree with the law, and under President Trump they have made several attempts to repeal or replace it. For now, though, the ACA remains in place.

This brings us to the current day. America’s healthcare system is a mix of private and public solutions that is still heavily employer-based. A majority (55.4%) of Americans get their healthcare through their employers (or through the employer of a loved one), while comparatively few – 16.3% – buy healthcare individually on the state-run exchanges set up under the ACA. Government-sponsored healthcare plans (Medicare, Medicaid, as well as employer-based coverage when the government is the employer) cover the rest of the insurance population, and some Americans remain uninsured despite the penalty.

We will not get into the politics here, but the debate on healthcare is still raging on. Some conservatives believe that the ACA goes too far in its mandates, while some liberals believe it does not go far enough. What you and your friends support, of course, is up to you – and now you have the facts you need to start the debate.

“I told my doctor, I broke my arm in two places. He told me to keep outta those places.” – Rodney Dangerfield