Episode 2: Unwrapped: The American People and Government Funded Care
60 percent of Americans today say that health insurance is the responsibility of the federal government, but there’s little agreement on what that insurance program should look like. This has been a trend throughout the past century, as healthcare policy has consistently faced heavy opposition from stakeholders on all sides of the issues, so reform has been difficult and incremental.
In this episode of The Untold Stories of American Healthcare, host Ryann Petit-Frere talks with Dr. Melinda Buntin, chair of the Department of Health Policy at Vanderbilt School of Medicine, and Nancy-Ann DeParle, former deputy chief of staff for policy under President Obama. They unpack some of the most important moments in the history of American healthcare policy and explain what those moments can teach us about our present and future.
The Slow Pace of Change
Since the start of the 20th century, there have been many attempts to expand health insurance in America. However, most of those changes have happened incrementally.
“American health policy and the availability of affordable health insurance or public health insurance to Americans has been a uniquely incremental process,” Dr Buntin argued. “Lots of small programs were put in place, but .… more than half of the elderly had any health insurance. So they clearly were not enough.” One of the most significant milestones in healthcare policy occurred in 1965, when President Lyndon B. Johnson passed both Medicare and Medicaid as part of his efforts to reduce poverty and increase civil rights.
At that time, many older adults were living in poverty because their healthcare needs were so expensive and they couldn’t get coverage because of pre-existing conditions. Additionally, most hospitals in the South were heavily segregated, so Black Americans often lacked access to quality care.
With Medicare, Johnson was able to extend coverage to people who previously could not get it, and he could also require hospitals to desegregate in order to receive federal funding.
“Of course this doesn’t mean that everything was perfect overnight, but it does show the power of a federally funded program to both add health, security from financial loss, security that you will be able to seek medical care when you are sick for the older population, while at the same time promoting and making real part of the civil rights agenda,” Dr. Buntin explained.
Dr. Buntin sees many similarities between past policy efforts and our current moment in healthcare, because healthcare changes have always faced heavy opposition.
“What seems radical in one moment seems more normal once it has a chance to settle in,” she explained.
Understanding Public Sentiment Around the ACA
It’s been 11 years since the Affordable Care Act passed, but public opinion about it still fluctuates. During COVID-19, the ACA reached its highest favorability of all time, as people were more reliant on healthcare than ever.
Even though the ACA was extremely polarizing, DeParle believes it will continue to be the best option for Americans over the next ten years.
“There are things we’ve learned that we now need to go back and do the 2.0 version of,” she acknowledged. “But I think it’s still the foundation for the next eight to ten years. I don’t see any reason why we would try to move to something else. Certainly, I don’t see any reason to eliminate it, and if anything, I think we should build on it.”
When thinking about the long-term future of the American healthcare system, DeParle argued that “change is going to be more evolutionary than revolutionary.” She believes that the government will continue to play a major role with Medicare and Medicaid, but that a switch to a single payer government system seems unlikely.
“I think that we will continue to have a hybrid system with the government financing and helping to support coverage in the middle for people who are not connected to the employer market.”
To learn more about the Nashville Health Care Council and follow along on our journey through the Untold Stories of American Healthcare, visit healthcarecouncil.com. And be sure to subscribe, rate and review this show wherever you get your podcasts.