U.S. Healthcare System

The healthcare system of the United States is believed to be a “paradox of excess and deprivation” because of the huge amounts of expenditure by the American government, apparently much more than many other developed nations and countries including Japan, the United Kingdom, and Canada, and the high numbers of Americans, to the tune of millions, who cannot avail these high-quality care and services due to the lack of health and medical insurance (Enthoven and Kronick, 1989).

With the high quality of services in the medical and healthcare sector, those American citizens who have secure health and medical insurance, receive optimal service delivery as compared to the millions, approximately forty million, who cannot avail of any basic health services due to lack of health insurance (Kemper, 2002). As a result of this disparity, the United States of America is believed to be the only large democracy in the world that does not provide insurance to a majority of its populace.

According to the U.S. Census Bureau (2001), about fourteen percent of the total American populace did not have access to any kind of health insurance out of which, a majority belonged to the working class with extremely low wages in small jobs. Thus, it is believed that about one-third of the total poor population of the United States was not insured due to the extremely low-income groups with the blacks constituting about twenty percent and the Hispanics constituting thirty-two percent as compared to the white American group from which only thirteen percent do not enjoy healthcare insurance and services. The poor people cannot avail of the high quality of services being offered to their richer co-Americans, who are believed to be receiving an excess of services due to their insurance coverage (Oberlander, 2002).

Analyze the current legislative debate to control cost, maintain quality and protect the consumer

Owing to the huge disparity in access to healthcare in the United States, and the expensive medical care system of the US, there has been a huge debate regarding cost control measures that should be adopted, while maintaining the quality of healthcare and protecting the consumer inappropriate ways. This resulted in a shift towards managed care which has become a norm in the country and is constantly spreading across for the public programs as well, including healthcare programs for the elderly and the poor populace, who are now able to avail these services through Medicaid and Medicare (Health Insurance association, 1988).

Ever since the concept of managed care began to be practiced in the U.S., healthcare spending has reduced initially but saw a substantial increase in the year 1999 and 2000 (Oberlander, 2002). Studies and sentiments indicate that the quality of healthcare is deteriorating due to the concept of managed care, which in turn has resulted in the demand for a bill of rights to regulate the behavior of managed care (Oberlander, 2002). However, the impact of such legislation has been debated due to its uncertain impact on the quality of care and rights of patients, due to its apparent failure to address the critical issues of financial bonuses for physicians and the quality of patient healthcare (Oberlander, 2002).


Enthoven A, Kronick R. (1989). A consumer choice health plan for the 1990s. N Engl J Med;320:29.

Health Insurance Association of America (1998). Source book of health insurance data. Washington: The Association.

Kemper V. (2002). Unlikely coalition declares health-care crisis. Los Angeles Times; Sect A: 1.

US Census Bureau. Health insurance coverage 2000. Washington: The Bureau.

Oberlander Jonathan (2002). The US health care system: On a road to nowhere? CMAJ; 167 (2) 163.

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