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J Health Soc Policy. 2004;19(4):1-25.

U.S. health care policy and the rising uninsured: an alternative solution.

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University of Central Florida, USA.


The lack of adequate health insurance affects one's ability to access care, which directly affects one's health. In the 21st century, there are 44 million people in the United States without health care insurance. The majority of people without health care insurance are working people under age 65, because most people over age 65 are retired and have health insurance through the federal Medicare program. Maintaining a healthy population makes good business sense because healthy people are more able to work, buy goods, and pay taxes that contribute to a healthy economy and strong government. We must understand, through provider "cost shifting," the American public is already "footing the bill" for the uninsured. However, the actual amount is hidden and passed on to consumers in payments to insurance companies through raised premiums, deductibles, co-payments, exclusions from coverage, and direct out-of-pocket payments to providers (e.g., physicians, hospitals). Ironically, the very working poor who are uninsured and underinsured help fund the health insurance of select federally protected groups through taxation. A huge gap exists in the current United States system of health care wherein there is no cogent benefit, only a vicious cycle as the insured continue to pay more for their care to help compensate provider losses due to the uninsured. This in turn causes a growing rank of uninsured individuals that lack access to adequate health care. The purpose of this article is to assert an alternative to the current U.S. health care insurance system. It takes advantage of structures already in place to promote a "win-win" American health system premised on a workable tiered universal health care system in which there is a benefit to the major populace. As an emanation of a diverse society, the proposed system does not advocate a one-payer universal system that is not amenable to the U.S. health care, social, or political environment.

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