Why hasn't the United States tried to solve its health insurance problems?

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The cold-blooded assassination of a healthcare CEO has unleashed a torrent of public anger against the health insurance industry. Should the ugliness of this fact cause Americans to suppress their anger?

Suspected killer Luigi Mangione is preparing for a murder trial in New York and his lawyer has said he will plead not guilty. But the rest of the country has an opportunity, delicate as it is, to examine its long-standing frustration with a health insurance system unique in the developed world, which deprives private companies of patients' profits.

CNN's Tami Luhby has collected insurance horror stories from CNN readers, including that of a recent college graduate who simultaneously battled cancer and her insurer's decision that she should pay a monthly co-pay of $13,000 for a drug that could save lives. It's no wonder that a significant minority of Americans report having medical debt.

A Gallup poll released this week but taken before the assassination of UnitedHealthcare CEO Brian Thompson found that most Americans, 62 percent, believe it is the federal government's responsibility to ensure that all Americans enjoy health care coverage. A minority, 36%, said it was not the government's responsibility.

Gallup has been asking this question for years, and this new data reflects a gradual reversal from 11 years ago, during the rocky rollout of private health insurance exchanges created by the Affordable Care Act, or Obamacare. At the time, a minority, 42%, said it was the federal government's responsibility to ensure people had health coverage, and a majority, 56%, said that was not the case.

There is a partisan story behind these numbers, as almost all Democrats, 90%, now say the government is responsible, up from just over two-thirds in 2013. Nearly a third of Republicans now share the same point of view, even if it is false. compared to just 12% who said the government had a responsibility in 2013.

Regardless, any health insurance reform effort aimed at increasing government involvement in the system would be met with fierce resistance, just as was the case in 2010, when then-President Barack Obama signed the Affordable Care Act.

The upward trend among Americans who believe the government has a responsibility to ensure its citizens have health care coverage has been accompanied by a decline in satisfaction with the health care system overall, according to Gallups polls.

In 2013, a majority, 54%, of Americans were satisfied with the quality of health care in the United States. Today, that figure has fallen to 44%.

Satisfaction with health care coverage has never been higher in the more than two decades that Gallup has tracked it. It reached a high of 41% in 2012 and now sits at 28%, the lowest since the early 2000s, years before Obamacare radically reformed the insurance industry and required insurers to cover pre-existing illnesses and to keep young people under their parents' insurance until the end of the year. at age 26, as well as significantly expanded Medicaid coverage.

No other country, and certainly no other wealthy country like the United States, does it this way, relying on employers to provide voluntary health coverage to most of the country.

Some countries have government-run health systems. Others require citizens to pay for more affordable private insurance. All except the United States insure almost all of their citizens.

Many studies claim similar things, namely that the United States pays much more per person and as a percentage of its gross domestic product, or GDP, to cover a much smaller portion of its population and achieve a much longer life expectancy. low, although life expectancy in the United States is also affected by gun deaths, suicides and drug overdoses.

KFF, the Peter G. Peterson Foundation, and the Commonwealth Fund have all completed detailed evaluations comparing the U.S. system with insurance in other countries. The bottom line is that administrative costs are much higher in the United States than in other rich countries. This may be fueled by a universe of insurers, who contribute to these costs.

A major difference with the United States is that these other countries require coverage for everyone and subsidize it to a greater extent than the United States.

Here, the government provides health care only to the neediest, through Medicaid, and to older Americans, who generally qualify for government-run health coverage under Medicare. Through Obamacare, the government also subsidizes care for those up to a certain income level who do not receive coverage from their employer. The government also subsidizes employer-provided health care in the form of tax breaks.

Another story to watch is the increase in the number of Medicare beneficiaries opting for Medicare Advantage plans managed by private insurers. The Wall Street Journal recently documented how Medicare Advantage plans can end up costing the government more and also that sicker patients, rather than being denied coverage by private insurers, return to Medicare when they need it. of the most expensive procedures.

Health insurance challenges are not unique to the United States. The most notable single-payer government system, the United Kingdom's National Health Service, enjoyed a 70% satisfaction rate in 2010. That rate fell to just 24% in 2023, according to a national survey, although that this survey found that Britons want to improve the system to reduce waiting times for services rather than scrapping it for something else.

Yet the American political debate barely turned to health insurance during the just-concluded presidential campaign, and the health care system was not at the top of voters' concerns in recent polls. 'public opinion.

President-elect Donald Trump was elected with only health policy as his ideas. He defeated Vice President Kamala Harris, who had proposed minimal expansions of Medicare rather than major change to the system.

The last major change to the system was Obamacare, for which Democrats paid a short-term political price by losing control of the House of Representatives. The law slowly became more popular. 62% of Americans have a favorable opinion, according to a KFF tracking poll. But that clearly hasn't solved the problem of making health care affordable.

A major step toward lowering prescription drug costs was made by Democrats during the Biden administration, when, after years of effort, they won Medicare the right to negotiate lower prices for certain drugs. But it faces an uncertain future in the new Trump administration as it brings its plan concepts to fruition.

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