The American Health Care System

Six times in the 20th century, America has flirted unsuccessfully national health insurance legislation -- the provision of medical care to citizens. Instead, policy makers have allowed subsidies to finance part of health insurance by exempting employer-paid premiums from taxation. government has also provided or funded services for groups deemed vulnerable or entitled to them -- Native Americans, migratory, other categorically defined poor people, veterans of military, the permanently disabled, people with end-stage renal disease, and elderly people. Medicare, which provides the nation's elderly with ready to short-term medical services, represents the most ambitious dimension this strategy of incrementalism. The program is the single largest payer in U.S. medical care system, purchasing about 20 percent of all personal services in 1991, and its expenditures are expected to more than double the year 2000. From an international perspective, it is a peculiar; no other nation has compulsory health insurance for its elderly alone....