The story of a great compromise
It was in the year 2010 that after an epic struggle, a historic Bill was passed into US law, enacting President Obama’s long held ambition to effect health care reform. The changes that have been made to US Health care are not going to pass into law immediately but only gradually over a period of several years.
These changes will affect the both the general population and the private health insurance industry, which fought long and hard for modifications to the initial proposals. In large part they succeeded, so that in the final version, a national public insurance scheme has not been created as was the original intention.
The final version means that individuals will still use private health insurance policies, but such policies will be subject to various obligations and restrictions, making them more widely available and accessible to those for example who have pre-existing conditions. The public Medicaid scheme will also be expanded, with the aim that every American will have health care cover of some sort.
The position at the moment is that individuals and families who are not eligible for some form of group insurance through work or through association with some other body offering such insurance, need to buy the cover privately. This is naturally more expensive since in the case of group cover, the risks are spread and the cost is averaged out.
In the case of a person with an illness which started before the application for insurance was made (a ‘pre-existing condition’) it has often in the past been difficult or impossible for them to obtain cover for that condition. The insurers are in the business of insuring against a risk, not a certainty, and understandably have been reluctant to take on a person with chronic and expensive needs which are already present.
This problem has been one of the most frequently cited in relation to the US health care debate. The reforms as enacted go a long way to solving this issue but through private rather than public means, which fits in with the general US ethos of individualism.