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Healthcare has been a highly debated issue within the United States of America for decades, the US health system is fundamentally based on private funding – American citizens either rely on employers to cover their health insurance or they pay for it themselves. The operating health care system is a huge burden to small businesses, unemployed people and the government itself. In 2002 the total health expenditure within America was $1.

5 trillion and rising annually by 8%, of which only $713 billion came from public funding programmes such as Medicare, Medicaid and The Children’s Health Insurance Program. (Mckeever 2006)1 The rest came from employers and uninsured people’s pockets. This essay will explore how much of a burden the US healthcare system is and on who, the system’s strong points as well as negative and it will also explore legislation considered and passed since the welfare system was established.

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All of which will hopefully provide a clearer insight into America’s health care system and whether it is in need of a radical reform. President Obama entered the oval office on 20th January 2009 ready to fulfil his promise of bringing change to America. One of the key domestic issues he wishes to change is healthcare. Obama and his running mate, Joe Biden believe that American citizens are only offered two extremes in terms of healthcare; either government run control with higher taxes or insurance company private plans which operate without rules.

President Obama plans to provide a health care system which is accessible to all, regardless of income, race or genetics. For currently uninsured Americans, a choice of new affordable insurance options will be made available, of which will cost Obama’s administration $50-65 billion per year. 2 President Obama plans to undo Bush’s previous tax cuts for people who earn over $250,000 per annum in order to pay for the new system.

President Obama and Joe Biden strongly believe that the American health care system is failing, and with over 40 million uninsured American’s, but the question must be why has the current system been left to operate in such a way for such a long time? One of the biggest plans for reforming the health care system came in 1994 when President Clinton was in office. At the time of the proposed reform 40 million American’s were without insurance and there was a high level of discontent concerning the issue from all over the country.

A CBS poll held in 1999 found that the majority of those surveyed described the “problem of the uninsured” to be the “biggest healthcare problem facing the nation” 3 and a Washington Post Poll in 2000 showed that 72% of participants believed that the “federal government should work to increase the number of American’s covered by health insurance. “4 The surveys, have both illustrated the level of discontent with the current system of health care, but surprisingly Clinton’s reform proposal still failed.

Fording et al (2006) states that the reason the plan failed was due to an “apathetic public”. 5 Health care is very important and if people can’t afford it they are making themselves highly vulnerable. Health care policy decision making in America is a ‘quasi corporatist’6 process in which decisions and negotiations take place between insurance companies, health care stake holders and physician groups – the people who have the most to gain from private health care. Very little public participation has ever taken place concerning health care and perhaps this is where the problem lies.

If the population continue to be ignorant when it comes to healthcare, they are less likely to want change. But people are suffering; if people can’t afford health cover and they are employed they have to ensure they are careful so as not to miss work otherwise they’ll lose money – making themselves worse off. America is the only democratic nation of the West not to offer universal coverage; it’s also the nation which spends the most on health care but considering what it does spend (currently 16% GDP) it has the poorest record of equity, efficiency and general record of achievement.

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