ABSTRACT
The 20th century has witnessed many achievements and improvements in healthcare delivery in the United States. The United States spends 40% more per capita on healthcare than any other Western industrialized nation. However, the United States remains the only industrialized nation in the world that does not provide a basic health benefit package to all its citizens, despite the high level of spending on healthcare. Millions of Americans are disenfranchised, especially ethnic minorities, who encounter numerous barriers to the US healthcare system. The basic issues underlying efforts to improve the US healthcare system are concerned mainly with reducing costs; increasing access to healthcare, especially for the insured or the underinsured; and further improving and maintaining quality healthcare.
This article discusses the reasons for increase in healthcare spending, despite measures taken by health stakeholders (eg, federal government, private health insurance industry, employers) to contain or reduce cost. This article further discusses attempts to create equitable healthcare for all Americans during the 1960s and 1970s. The Reagan era brought an end to such attempts by applying the "free-market" concept to healthcare, which saw movement away from domestic social programs by the federal government and the corporatization of healthcare. In the first half of the 1990s, concerns of the US healthcare system moved into the mainstream of political consciousness and debate. Five major attempts since 1912 to reform the US healthcare system have failed. This has left many to conclude that despite the increasing problems of access, cost, and quality of care in the United States, the country remains on a path of incremental changes in the healthcare system.