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Yahoo
2 days ago
- Health
- Yahoo
US health care is rife with high costs and deep inequities, and that's no accident
House Committee on Energy and Commerce Chairman Brett Guthrie, R-Ky., left, and ranking member Frank Pallone, D-N.J., right, speak during a markup of Medicaid budget cuts, May 13, 2025 in Washington, D.C. (Photo by) A few years ago, a student in my history of public health course asked why her mother couldn't afford insulin without insurance, despite having a full-time job. I told her what I've come to believe: The U.S. health care system was deliberately built this way. People often hear that health care in America is dysfunctional — too expensive, too complex and too inequitable. But dysfunction implies failure. What if the real problem is that the system is functioning exactly as it was designed to? Understanding this legacy is key to explaining not only why reform has failed repeatedly, but why change remains so difficult. I am a historian of public health with experience researching oral health access and health care disparities in the Deep South. My work focuses on how historical policy choices continue to shape the systems we rely on today. By tracing the roots of today's system and all its problems, it's easier to understand why American health care looks the way it does and what it will take to reform it into a system that provides high-quality, affordable care for all. Only by confronting how profit, politics and prejudice have shaped the current system can Americans imagine and demand something different. My research and that of many others show that today's high costs, deep inequities and fragmented care are predictable features developed from decades of policy choices that prioritized profit over people, entrenched racial and regional hierarchies, and treated health care as a commodity rather than a public good. Over the past century, U.S. health care developed not from a shared vision of universal care, but from compromises that prioritized private markets, protected racial hierarchies and elevated individual responsibility over collective well-being. Employer-based insurance emerged in the 1940s, not from a commitment to worker health but from a tax policy workaround during wartime wage freezes. The federal government allowed employers to offer health benefits tax-free, incentivizing coverage while sidestepping nationalized care. This decision bound health access to employment status, a structure that is still dominant today. In contrast, many other countries with employer-provided insurance pair it with robust public options, ensuring that access is not tied solely to a job. In 1965, Medicare and Medicaid programs greatly expanded public health infrastructure. Unfortunately, they also reinforced and deepened existing inequalities. Medicare, a federally administered program for people over 64, primarily benefited wealthier Americans who had access to stable, formal employment and employer-based insurance during their working years. Medicaid, designed by Congress as a joint federal-state program, is aimed at the poor, including many people with disabilities. The combination of federal and state oversight resulted in 50 different programs with widely variable eligibility, coverage and quality. Southern lawmakers, in particular, fought for this decentralization. Fearing federal oversight of public health spending and civil rights enforcement, they sought to maintain control over who received benefits. Historians have shown that these efforts were primarily designed to restrict access to health care benefits along racial lines during the Jim Crow period of time. Today, that legacy is painfully visible. States that chose not to expand Medicaid under the Affordable Care Act are overwhelmingly located in the South and include several with large Black populations. Nearly 1 in 4 uninsured Black adults are uninsured because they fall into the coverage gap – unable to access affordable health insurance – they earn too much to qualify for Medicaid but not enough to receive subsidies through the Affordable Care Act's marketplace. The system's architecture also discourages care aimed at prevention. Because Medicaid's scope is limited and inconsistent, preventive care screenings, dental cleanings and chronic disease management often fall through the cracks. That leads to costlier, later-stage care that further burdens hospitals and patients alike. Meanwhile, cultural attitudes around concepts like 'rugged individualism' and 'freedom of choice' have long been deployed to resist public solutions. In the postwar decades, while European nations built national health care systems, the U.S. reinforced a market-driven approach. Publicly funded systems were increasingly portrayed by American politicians and industry leaders as threats to individual freedom – often dismissed as 'socialized medicine' or signs of creeping socialism. In 1961, for example, Ronald Reagan recorded a 10-minute LP titled 'Ronald Reagan Speaks Out Against Socialized Medicine,' which was distributed by the American Medical Association as part of a national effort to block Medicare. The health care system's administrative complexity ballooned beginning in the 1960s, driven by the rise of state-run Medicaid programs, private insurers and increasingly fragmented billing systems. Patients were expected to navigate opaque billing codes, networks and formularies, all while trying to treat, manage and prevent illness. In my view, and that of other scholars, this isn't accidental but rather a form of profitable confusion built into the system to benefit insurers and intermediaries. Even well-meaning reforms have been built atop this structure. The Affordable Care Act, passed in 2010, expanded access to health insurance but preserved many of the system's underlying inequities. And by subsidizing private insurers rather than creating a public option, the law reinforced the central role of private companies in the health care system. The public option – a government-run insurance plan intended to compete with private insurers and expand coverage – was ultimately stripped from the Affordable Care Act during negotiations due to political opposition from both Republicans and moderate Democrats. When the U.S. Supreme Court made it optional in 2012 for states to offer expanded Medicaid coverage to low-income adults earning up to 138% of the federal poverty level, it amplified the very inequalities that the ACA sought to reduce. These decisions have consequences. In states like Alabama, an estimated 220,000 adults remain uninsured due to the Medicaid coverage gap – the most recent year for which reliable data is available – highlighting the ongoing impact of the state's refusal to expand Medicaid. In addition, rural hospitals have closed, patients forgo care, and entire counties lack practicing OB/GYNs or dentists. And when people do get care – especially in states where many remain uninsured – they can amass medical debt that can upend their lives. All of this is compounded by chronic disinvestment in public health. Federal funding for emergency preparedness has declined for years, and local health departments are underfunded and understaffed. The COVID-19 pandemic revealed just how brittle the infrastructure is – especially in low-income and rural communities, where overwhelmed clinics, delayed testing, limited hospital capacity, and higher mortality rates exposed the deadly consequences of neglect. Change is hard not because reformers haven't tried before, but because the system serves the very interests it was designed to serve. Insurers profit from obscurity – networks that shift, formularies that confuse, billing codes that few can decipher. Providers profit from a fee-for-service model that rewards quantity over quality, procedure over prevention. Politicians reap campaign contributions and avoid blame through delegation, diffusion and plausible deniability. This is not an accidental web of dysfunction. It is a system that transforms complexity into capital, bureaucracy into barriers. Patients – especially the uninsured and underinsured – are left to make impossible choices: delay treatment or take on debt, ration medication or skip checkups, trust the health care system or go without. Meanwhile, I believe the rhetoric of choice and freedom disguises how constrained most people's options really are. Other countries show us that alternatives are possible. Systems in Germany, France and Canada vary widely in structure, but all prioritize universal access and transparency. Understanding what the U.S. health care system is designed to do – rather than assuming it is failing unintentionally – is a necessary first step toward considering meaningful change. This article is republished from The Conversation under a Creative Commons license. Read the original article.
Yahoo
25-04-2025
- Health
- Yahoo
Chippewa Valley medical professionals weigh in on Medicaid cuts
EAU CLAIRE, Wis. (WLAX/WEUX) – Wisconsin doctors are calling on Congress to reconsider support for a recently passed resolution. Some doctors in the Chippewa Valley are calling on Congressman Derrick Van Orden to reconsider support for a recently passed resolution. Dr. Abby La Nou, an ER doctor in Eau Claire, explains, 'We're calling on them to listen to us, their constituents. As physicians, we are deeply concerned that Congressman Van Orden voted for the budget resolution that paves the way for enormous cuts to Medicaid.' The worries stem from potential cuts to a federal committee that oversees the program that benefits low-income Americans, children and those with disabilities. Dr. La Nou says, 'Further cutting that is going to result in less funding for our hospitals, particularly rural hospitals. With a higher proportion of Medicaid/Medicare patients.' President Trump and Republicans have said Medicaid funding will not be impacted. Congressman Van Orden released a statement that says, in part, 'No American citizen who is legally receiving benefits from the Federal Government will see their support cut. Last budget cycle, Democrats claimed Republicans were cutting Medicaid, Medicare, Social Security, and other vital programs. None of that happened.' The Committee on Energy and Commerce is tasked with cutting $880 billion from its budget. If it only cuts funding that's not Medicaid, it would have only cut $581 billion. That's according to a report from the Congressional Budget Office. The budget cuts are a move for Republicans to cover costs when it comes to President Trump's proposed tax cuts and to fund mass deportations, another priority of the President. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
18-04-2025
- Health
- Yahoo
Rep. Bresnahan, colleagues send letter to GOP leadership affirming commitment to Medicaid
Apr. 17—WILKES-BARRE — U.S. Rep. Rob Bresnahan Jr. on Thursday announced he and 11 of his Republican colleagues sent a letter to House Republican Leadership on the signers' commitment to protecting Medicaid. Rep. Bresnahan, R-Dallas Township, said the letter was sent to Speaker Mike Johnson, Majority Leader Steve Scalise, Majority Whip Tom Emmer and Committee on Energy and Commerce Chairman Brett Guthrie. "We acknowledge that we must reform Medicaid so that it is a strong and long-lasting program for years to come," wrote Rep. Bresnahan and the lawmakers. "However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations." The letter went on to say, "As Members of Congress who helped to deliver a Republican Majority, many of us representing districts with high rates of constituents who depend on Medicaid, we would like to reiterate our strong support for this program that ensures our constituents have reliable healthcare. "Balancing the federal budget must not come at the expense of those who depend on these benefits for their health and economic security." In addition to Rep. Bresnahan, the letter was signed by U.S. Representatives David Valadao, California; Don Bacon, Nebraska; Jeff Van Drew, New Jersey; Juan Ciscomani, Arizona; Jen Kiggans, Virginia; Young Kim, California; Rob Wittman, Virginia; Nicole Malliotakis, New York; Nick LaLota, New York; Andrew Garbarino, New York; and Jeff Hurd, Colorado. The full letter: "Dear Speaker Johnson, Majority Leader Scalise, Majority Whip Emmer and Chairman Guthrie: "As Members of Congress who helped to deliver a Republican Majority, many of us representing districts with high rates of constituents who depend on Medicaid, we would like to reiterate our strong support for this program that ensures our constituents have reliable healthcare. Balancing the federal budget must not come at the expense of those who depend on these benefits for their health and economic security. "We acknowledge that we must reform Medicaid so that it is a strong and long-lasting program for years to come. Efficiency and transparency must be prioritized for program beneficiaries, hospitals, and states. We support targeted reforms to improve program integrity, reduce improper payments, and modernize delivery systems to fix flaws in the program that divert resources away from children, seniors, individuals with disabilities, and pregnant women — those who the program was intended to help. However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations. "Cuts to Medicaid also threaten the viability of hospitals, nursing homes, and safety-net providers nationwide. Many hospitals — particularly in rural and under-served areas — rely heavily on Medicaid funding, with some receiving over half their revenue from the program alone. Providers in these areas are especially at risk of closure, with many unable to recover. When hospitals close, it affects all constituents, regardless of healthcare coverage. "To strengthen Medicaid, we urge you to prioritize care for our nation's most vulnerable populations. Our constituents are asking for changes to the healthcare system that will strengthen the healthcare workforce, offer low-income, working-class families expanded opportunities to save for medical expenses, support rural and under-served communities, and help new mothers. "We are committed to working with you to preserve Medicaid and identify responsible savings through deregulation, streamlining federal programs, and cutting administrative red tape. Communities like ours won us the majority, and we have a responsibility to deliver on the promises we made." Reach Bill O'Boyle at 570-991-6118 or on Twitter @TLBillOBoyle.
The Hill
12-02-2025
- Business
- The Hill
House Commerce chair launches data privacy working group
House Committee on Energy and Commerce Chair Brett Guthrie (R-Ky.) on Wednesday announced the creation of a data privacy working group as policymakers work towards a national privacy standard. 'We strongly believe that a national data privacy standard is necessary to protect Americans' rights online and maintain our country's global leadership in digital technologies, including artificial intelligence,' Guthrie and Rep. John Joyce (R-Pa.), the vice chair of the Energy and Commerce Committee, said in a joint statement. 'That's why we are creating this working group, to bring members and stakeholders together to explore a framework for legislation that can get across the finish line,' they continued. The working group will be led by Joyce and involves eight other Republican House members, including Rep. Jay Obernolte (R-Calif.), who co-chaired the House Task Force on Artificial Intelligence last year. An announcement about the group called for input from a 'broad range of stakeholders,' who are interested in working with it. Efforts to pass a comprehensive data privacy bill have failed for years, causing the U.S. to remain behind on protections amid a push from other global regulators. States have tried to fill the gaps, forcing tech companies to follow a patchwork of policies. The House and Senate Commerce committees tried to pass a bipartisan data privacy bill last year but received pushback from House Republican leadership. Lawmakers have largely disagreed over preemption of state laws, which Republicans pushed for. Democrats have long pushed for including a private right of action, which permits consumers to seek financial damages through court, but GOP leaders were concerned it could lead to too many attacks against small businesses by trial lawyers. It is unclear whether they will pursue another data privacy bill this session. The Hill has reached out for further details.
