Health Insurance refers to financial coverage for healthcare expenses. Health coverage is among the most intensely debated subjects in American life, both because of the generally high cost of healthcare expenses, and because access to coverage varies significantly based on employment and socioeconomic status. Some Americans believe the government should take greater responsibility for the millions who are uninsured or underinsured, with many arguing that the United States should provide universal health coverage for all Americans. By contrast, others believe that paying for health coverage should be the individual responsibility of every American, and argue that universal healthcare coverage is a socialist policy.
Today, health insurance is largely a privatized industry in which various health insurance providers compete for clients. Most insured Americans have health insurance coverage through employers, and in most cases, pay some portion of this expense through paycheck deductions. As of 2010, 55.1% of Americans were covered through employer-sponsored plans. Another 34.4%—typically the elderly, disabled, and those living below the poverty line—are covered through the publicly-funded Medicare and Medicaid plans.
To learn more about these coverage options, check out our look at the Social Security Controversy.
An additional 5% of Americans are covered through plans selected on the Affordable Care Act (ACA) marketplace. However, at the time of writing, there are roughly 30 million Americans without health insurance. And the massive employment crisis created by the COVID-19 pandemic has seen a further drop in the number of Americans with coverage through their employers. Individuals living without health insurance face far greater health risks and a higher mortality rate because they are more likely to avoid care for existing health conditions, to take preventative health screening measures, or to have access to adequate treatment. The ever-rising cost of medical expenses further magnifies the challenges faced by those without health insurance.
These conditions frame the debate over health insurance between two distinct and competing viewpoints:
While healthcare reform is a top political issue for most Americans, and while observers on both sides believe that reform is necessary, there are competing views on how to pursue this reform. The healthcare reform issue often splits on political party lines, with those who identify as liberal, progressive, or Democratic more likely to support expanded public funding for health insurance. Some in these demographics support universal health coverage, arguing that the United States is actually the only developed, democratic nation in the world which does not ensure health coverage for all of its citizens. Some advocates have called for a “single-payer” health insurance program, in which the competitive marketplace is replaced by a single, quasi-public coverage provider.
Those who identify as conservative, libertarian or Republican are more likely to argue that health coverage is a personal choice, and that Americans who have earned coverage through employment or by financing it themselves have the right to abstain from funding care for others. Also aligned with this view are those who argue that a competitive health coverage market follows the general spirit of capitalism, a position that is shared by health insurance companies and their lobby groups. They argue that an absence of market competition would reduce quality and availability, while also raising national debt and deficits.
The goal of this discussion is to examine the various perspectives shaping the public discussion over health insurance, and to provide you with a look at some of the figures past and present who have influenced this discussion. The figures selected may not always be household names, but are instead selected to provide a nuanced look at the public discourse on this subject, and in some cases, even to provide you with a list of individuals to contact as part of your research.
In the U.S., the Industrial Age saw the emergence of a few early modes of insurance coverage, including:
In most cases, the coverage provided from these insurance policies was for disability from work, rather than for the coverage of medical expenses.
In the early 20th Century, all medical service costs were paid out of pocket on a fee-for-service basis. However, the 1920s saw the initiation of pre-paid services in some hospitals, where an individual would pay a modest monthly fee to a specific local hospital for some measure of coverage in the event of an upcoming hospital visit. As such services became more widespread, Blue Cross organizations emerged to broker such arrangements. These Blue Cross organizations began providing predetermined levels of medical coverage for individuals who paid into such plans. The first of such models, an employer-sponsored plan for teachers in Dallas, Texas, went into effect in 1929. As this model became more widespread, the early accident and disability companies gradually evolved into medical coverage agencies.
During World War II, the United States experienced both a labor shortage and an increased demand for goods. However, federally-imposed wage and price controls prevented companies from luring workers by dramatically scaling up pay. By contrast, benefits such as health coverage were not counted against the wage cap. As companies used the promise of health coverage to attract workers during the war, employer-sponsored health insurance proliferated widely throughout the U.S. The Revenue Act of 1954 permanently instituted a tax deduction for companies providing their employees with access to health coverage.
In 1945, President Truman outlined his plan for a national system that would be optional, but accessible to every American for a monthly fee. This would cover all medical expenses as well as disability coverage for lost wages due to illness or injury. In spite of the plan’s popularity with the general public, it was derided as socialism by an axis of powerful professional groups including the American Medical Association (AMA), American Hospital Association (AHA), and the Chamber of Commerce. In many ways, this would be the starting point for a public debate over health coverage in the U.S. that has persisted for 75 years.
Truman’s plan was never adopted, and it would be another 20 years before a true public option would become available. In 1965, President Lyndon Johnson signed the Social Security Amendments of 1965, creating Medicare and Medicaid programs. This would provide public coverage for the elderly and poor for the first time. Coverage would later be expanded to include the disabled and those with certain terminal conditions.
To learn more about Medicare and Medicaid, check out our look at the Social Security Controversy.
While Medicare and Medicaid widely expanded access to public coverage, and employer-sponsored health coverage extended to many full-time workers, millions of Americans continued to lack access to coverage, either public or private. The 1970s saw meaningful debate on the subject, but little actual movement. Democratic Senator Ted Kennedy became one of the first prominent legislators to advocate for a “universal single-payer system,” but butted heads with President Nixon, who instead supported expansion of existing public coverage and incentives to employers for making coverage more widely available to American workers.
No compromise was reached prior to Nixon’s 1974 resignation, which effectively scuttled the conversation for another two decades. During that time, Democrats and Republicans largely staked out two competing positions on the subject, with the former pushing increasingly for expanded, or universal, health coverage and the latter arguing that a single-payer system was tantamount to socialism.
Even as fierce debate persisted, healthcare costs spiraled out of control, and the number of uninsured Americans numbered in the tens of millions, health insurance reform was elusive until President Obama’s 2008 election. Healthcare reform was a top priority for the incoming Obama Administration, which passed the Affordable Care Act through a divided Congress in 2010. The new plan, sometimes also referred to as Obamacare, mandated that employers provide access to coverage options, and created a marketplace where individuals could access private coverage. The Act also restricted companies from denying coverage to those with “preexisting conditions.”
Though the Act generated intense partisan disagreement, more than 16 million previously uninsured Americans obtained coverage during its first five years. According to healthline.com, because of the ACA, “Insurance companies must now spend at least 80 percent of insurance premiums on medical care and improvements. The ACA also aims to prevent insurers from making unreasonable rate increases. Insurance coverage isn’t free by any means, but people now have a wider range of coverage options.”
There are many who still lack access to health insurance, healthcare costs continue to grow, and public healthcare spending is expected to account for nearly half of all public mandated spending by 2025. However, the Affordable Care Act effectively cut the number of Americans without health insurance in half. Efforts by Republican leaders in both the legislative and executive branches to repeal and replace the Affordable Care Act have so far been unsuccessful.
Using our own backstage Ranking Analytics tools, we’ve compiled a list of the most influential figures around the health insurance debate in the U.S. between 1990 and 2020. Though our lists are typically vetted to exclude politicians and heads of state, the history outlined above reveals the direct impact that such figures have had on the public debate and policy development around health coverage. Absent this vetting, our ranking engine produced a list composed entirely of executive and legislative leaders who have impacted the direction of health coverage in the U.S. :
|3||George W. Bush|
Using our own backstage Ranking Analytics tools, we’ve compiled a list of the most influential books on the topic of health insurance in the U.S. between 1900 and 2020. This list is vetted to exclude popular fiction and otherwise irrelevant findings. The list is built from a combination of non-fiction texts on American healthcare, and reference sources concerning both medical policy and American legislative code:
|1||The Healing of America|
|2||United States Code|
|3||International Classification of Primary Care|
|4||The Undercover Economist|
|6||The World Is Flat|
|7||The Social Transformation of American Medicine|
|8||It Takes a Village|
|9||The Almanac of American Politics|
The Affordable Care Act is now a decade old, and while it was effective at adding millions to the roll of insured Americans, healthcare costs and coverage remain top issues for legislators and Americans. Even with coverage, healthcare is a major expense for American families. According to the Brookings Institution, roughly 18% of the GDP is spent on healthcare today.
In spite of this, coverage remains elusive for many Americans. Roughly 27.5 million people, or 8.5% of the U.S. population still do not have health insurance. And in the economic fallout of the COVID-19 pandemic, this number has been on the rise. According to the Organization for Economic Co-operation and Development (OECD), the U.S. is the only nation among 37 affiliated nations “that does not have universal health care either in practice or by constitutional right.”
Accordingly, says top economist Paul Krugman, “cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice” and that “America is the worst place in the advanced world if you need care after-hours or on a weekend.”
These conditions frame the present debate, which concerns the ability of Americans to both access and afford health coverage. While some members of the public, legislators, and policy experts support universal single-payer coverage for the millions of Americans who are uninsured or underinsured, other members of the public, legislators, and industry advocates believe that universal coverage is a form of socialism, and that acquiring and paying for health coverage should be the individual responsibility of every American.
Our goal in presenting subjects that generate controversy is to provide you with a sense of some of the figures both past and present who have driven debate, produced widely-recognized works of research, literature or art, proliferated their ideas widely, or who are identified directly and publicly with some aspect of this debate. By identifying the researchers, activists, journalists, educators, academics, and other individuals connected with this debate—and by taking a closer look at their work and contributions—we can get a clear but nuanced look at the subject matter. Rather than framing the issue as one side versus the other, we bring various dimensions of the issue into discussion with one another. This will likely include dimensions of the debate that resonate with you, some dimensions that you find repulsive, and some dimensions that might simply reveal a perspective you hadn’t previously considered.
On the subject of health insurance, the debate requires us to consider those who have taken part in the early construction of the American “health insurance” infrastructure and those who have both advocated for and opposed the concepts of “universal health care” and “single-payer health care.” Also included in our research are key terms connected to both legislation and lobbying on the subject, such as the “Affordable Care Act,” “America’s Health Insurance Plans,” and the “Kaiser Foundation.” These key terms have produced a balance of those in favor of single-payer health coverage, those who have opposed universal care, and those who have attempted to stake out compromise between these two positions.
As with any topic that generates public debate and disagreement, this is a subject of great depth and breadth. We do not claim to probe either to the bottom of this depth or the borders of this breadth. Instead, we offer you one way to enter into this debate, to identify key players, and through their contributions to the debate, to develop a fuller understanding of the issue and perhaps even a better sense of where you stand.
For a closer look at how our InfluenceRankings work, check out our methodology.
Otherwise get started with a look at the key words we used to explore this subject:
The key term in our discussion, “health insurance” refers to the array of options available to Americans for covering medical expenses, including employer-sponsored coverage, public options like Medicare and Medicaid, and private plans selected through the ACA marketplace. Our search results yielded a set of influencers on both sides of the debate–both those who have advocated for reform and those who have worked for or lobbied on behalf of the private health insurance industry.
While the “health coverage” term seems largely synonymous with health insurance, insofar as it refers to the variety of options for covering medical expenses, our search yielded influencers largely on the side of advocacy for expanded coverage access, including physicians, activists, and public health experts.
The term “universal health care” refers to the idea that a national government should take responsibility to ensure that all citizens have access to medical coverage and care. This is the standard of coverage held by most developed, democratic nations. Advocates argue that the U.S. should adopt this same standard. Key influencers include such advocates from the medical and public health communities, as well as public leaders in other nations who have had a hand in implementing effective universal healthcare policies.
Like universal coverage, “single-payer health care” refers to a system in which all citizens would have access to health coverage and care. This approach, which is advocated for by a number of public leaders with progressive ideologies, calls for a single, quasi-public agency to administer distribution of coverage to all Americans. Key influencers include such advocates from the medical and public health communities.
Passed in 2010 by the Obama Administration, the Affordable Care Act (ACA), sometimes also referred to as Obamacare, was the first major reform to the health insurance system in decades. By eliminating preexisting conditions, mandating that employers provide health coverage options, and creating a state-by-state online marketplace for selecting from affordable plans, the ACA cut the number of uninsured Americans in half. Though the policy continues to generate partisan debate, it is the current law of the land. Influencers include both those who helped to develop this policy and those who have publicly opposed it.
A lobby group with significant political influence, AHIP is a representation of those industry groups which have opposed reforms such as the Affordable Care Act, and which continue to build arguments against the adoption of a universal, single-payer healthcare system. Influencers in this area are typically those who have served in leadership roles within private healthcare and insurance industries.
The Kaiser Foundation is a left-leaning think tank that generally advocates for reform of healthcare and the health insurance industry. Its interest in realistic public health reform has inclined the Kaiser Foundation to frequently stake out a position of compromise between private and public options. Influencers include experts in public health, public policy, and hospital administration.
If you would like to study this topic in more depth, check out these key organizations...
Interested in building toward a career on the front lines of Health Insurance? As you can see, there are many different avenues into this far-reaching issue. Use our Custom College Ranking to find:
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