The United States spends more on healthcare as a percentage of GDP than other countries like the UK, Spain, and Japan, yet has many uninsured citizens. Around 46 million Americans lack health insurance due to factors like unemployment, lack of employer coverage, or existing illnesses. Hispanics have the highest uninsured rates at around 32%. The Affordable Care Act aimed to expand coverage, reduce costs, and make healthcare more equitable and accessible. However, there is ongoing debate around the appropriate role of government in healthcare and whether reform will reduce costs or freedom of choice as opponents argue it increases spending and control.

1. THE HEALTHCARE DEBATE
As we seen earlier, the USA does not have a National
Health Service like the UK that is free at the point of
entry. Instead Americas need private medical insurance
to pay for medical costs.
(It’s similar to PET insurance in the UK. If your dog, cat
or bunny rabbit is ill it’s not free to take it to the VET,
you have to pay! You can take out pet insurance so that
IF your pet gets ill the insurance will pay for it. This CAN
be cheaper than paying for care as you go as some
operations for pets cost thousands of pounds)
In the USA they need people insurance! Called MEDICAL
INSURANCE.
Healthcare unfair?
It is claimed that up to 46 million Americans are uninsured:

they are unemployed and so can’t afford it

Their employer does not provide medical cover as
part of their benefits

They don’t qualify for existing government help
because they already have a serious illness
Uninsured facts
Blacks – 21% of Blacks around (7 million people) are uninsured – this is almost TWICE the White figure
Hispanics – are the LEAST likely to be insured – around 32.4% do not have insurance. (about 14.8 million people)
Unfair??? – what did/does the government do

People who are aged over 65 can qualify for Medicare

People who are poor can qualify for Medicaid

Ex-military personnel can qualify for free healthcare
(this includes their children)

Some states have different laws on medical provision –
some force people to take out insurance while others
give tax breaks in order to take out medical insurance
Therefore many believed that the USA already provided ways
to gain medical help if they could not afford to take out private
medical insurance

2. Spending on Health
Country
How much the
government spends on
Health % of GDP
USA
15.3%
UK
Spending on Healthcare
The USA government spend almost twice as much of
their national income on health than the UK does.
So the UK with a National Health Service, which is
8.4%
FREE at the point of entry – spends less on health
than the USA which doesn’t have free healthcare.
This means that the government is already spending
Spain
8.1%
a lot of money helping people get healthcare in the
USA that can’t afford private medical insurance.
Japan
7.9%
President Obama and Healthcare provision
Due to continued inequality in the provision of healthcare, In March 2010, Congress (the American parliament)
passed President Obama’s Health Care Bill. This aims to

Make healthcare more affordable

Make insurance companies more accountable

Expand coverage of healthcare to more Americans

Make the healthcare system less unfair

Reduce the amount families and the federal government need to spend on healthcare
It does this by:
1.
Making insurance more affordable by providing a middle class tax cut – which allows people to
purchase health insurance. It is claimed this will help 32 million uninsured Americans.
2.
It sets up a new health insurance market giving millions of Americans MORE options about which
insurance to take.
3.
It forces health insurance companies to keep prices down especially in dental care
4.
It ends discrimination against Americans that have pre-existing conditions (i.e. problems they had
BEFORE they took out the insurance)

3. The Debate
Healthcare reform has proven to be a heated political
issue in the USA. Obama’s reforms aim to ensure an
additional 32 million people will have access to healthcare
HOWEVER - when this issue was debated in the US
congress it was mainly REJECTED by the Republican
party.
Democrats (the same party as Obama) who supported
the Presidents idea still point out that the USA already
has one of the most expensive healthcare systems in the
world – without the additional help Obamacare provides –
which some argue will make the US government spend
EVEN MORE on healthcare!!!!
Many believe the US government cannot afford this.
Arguments FOR healthcare reform
Most Americans agree
Not being covered cost the
Government
It’s fairer
Will save money
This means that despite strong debate
in congress and attempts to remove
Obamacare, the majority of Americans
agree that it’s the right thing to do
This means that healthcare reform is
needed as before it was passed, the
government was already spending
Billions on those who were not covered
This means that providing healthcare
is crucial to a functioning society and
should be guaranteed for all Americans
This means that by passing healthcare
reforms its argued that this will save
government money in the long run
instead of having lots of individual
government programmes to help
For example
A survey in 2009 showed that 64% of
Americans were in favour of
Healthcare reform BEFORE
Obamacare passed
For example
The estimated cost to the government
was between $65 billion and $130
billion
For example
Under President Bush the number of
people not covered was estimated to
be as high as 46 million people, which
shows the level of inequality in the
USA
For example
It is estimated that for every $1
spend on healthcare in the USA 31
cents go to insurance companies,
healthcare reform will reduce this and
so save money.

4. HOWEVER!!!!
Many Americans are passionate about their freedoms and
many see healthcare reform as a step to far by the
government.
They feel that the government is interfering by forcing
people to make choices the government provides.
Others simply feel that paying lower taxes and government
having small control is part of the American Dream. They
feel they had to work hard and pay for medical insurance so
why should other people get it for free?
Arguments AGAINST healthcare reform
Fewer Choices
Increase government spending
Goes against US ideology
Not save money
This means that many argue that
healthcare reform in the USA will
actually lead to less treatment options
for Americans.
This means that it is argued that
increased health cover through
healthcare reform will COST the
government significantly more money
This means that part of the American
ideal is the notion of small government,
with little interference and intervention
in people’s lives
This means that people who want health
reform often state it will save money,
this is NOT the case the cost to run the
programme will not go down.
For example
The government decide what options
people needing treatment can take
rather than the insurance companies i.e.
government decide what drug or
treatment procedure.
For example
By 2020 it is estimated that the US
government will be spending ANOTHER
$593 billion to fun healthcare.
For example
US groups like the TEA PARTY believe
Greater control over healthcare should
not be an area in which government has
influence
For example
The Administrative cost of running the
government funded health programme
will be the same as it is for private
health insurance 13.2% = no saving, the
same cost!
Activities
1 – Why do Americans need Medical insurance? Do you think medical insurance is a good idea?
2 – Give 3 reasons why up to 46 million Americans are/were uninsured?
3 – Which ethnic group is least likely to be insured? Provide evidence. Why do you think this happens?
4- Many people in the USA think the government already spends too much on healthcare, what evidence is there
that the US spends more on healthcare than other countries?
5 – Briefly describe how Obamacare aims to help millions of Americans
6 - EXAM STYLE QUESTION – “in recent years there has been much debate over healthcare provision in the
USA”
Explain, in detail, why some Americans support healthcare reform, while others are against healthcare reform.
(NAT 4 = 4 marks)
(NAT 5 = 8 Marks)