Uninsured in America: problems and possible solutions
Failure to ensure access to health care for all lies at the heart of the US failure to achieve value for money, says Karen Davis
The United States is the only major industrialised nation without universal health insurance, and coverage has deteriorated in the past six years. The consequences are increasingly well known: inequities in access to care, avoidable mortality and poor quality care, financial burdens on people who are uninsured or underinsured, and lost economic productivity. The US spends twice as much on health care as the median industrialised nation but does not systematically achieve the best quality care (table). What are the prospects for reform?
Nearly all of the growth in the uninsured is among people aged 18 to 64, most of whom are working. The average family premium for employer based cover is $11 480 (£5900; €8800) a year4. Employers have cut back on coverage and benefits in response to rising healthcare costs and adverse economic circumstances.
Enactment of a state children's health insurance programme in 1997 has provided insurance for five