The Vexing Problem of Access to Health Care in America: Is Employer-Based Health Insurance the Real Culprit?

As a country without universal access to health care, the United States struggles with ways to provide access to care.The United States is the only high-income country that does not guarantee health coverage and concomitantly it has worse outcomes on many measures. 1,2An article in this issue of Family Medicine discusses a student-run free clinic, an access-to-care strategy based on voluntarism. 3The use of student-run free clinics is a limited fix to the bigger problem of health care access in the United States. 4Another strategy based on voluntarism is to provide care via physician volunteers. 5According to the National Association of Free and Charitable Clinics (NAFC), in 2022, physician volunteers helped 1.7 million patients through 5.8 million patient visits. 5Importantly, the majority of the patients at these charitable clinics are employed. 6 One study showed that 34% had full-time employment but no benefits. 7