Academic journal article Health and Social Work

Will the United States Ever Have Universal Health Care?

Academic journal article Health and Social Work

Will the United States Ever Have Universal Health Care?

Article excerpt

The profession of social work has long been linked with efforts for health care reform. At the dawn of the 20th century, Jane Addams, Lillian Wald, and others advocated reforms to prevent the spread of communicable diseases in urban areas and raised concern about high rates of infant mortality. During the 1930s Frances Perkins, a settlement house worker, became secretary of labor and advocated compulsory universal health insurance. Social workers also played central roles in the enactment of Medicare and Medicaid, and during the 1990s, NASW developed its own legislative proposal for national health care, which Senator Daniel Inouye (D-HI) introduced in 1992 (Moniz & Gorin, 2003). The 1999 Delegate Assembly enacted a policy statement committing NASW to a "national health policy that ensures the right to universal access to a continuum of health and mental health care" (NASW, 2003, p. 172).

The failure of efforts to reform the health care system during the 1990s led to a period of disillusionment about the nation's ability to expand coverage to the uninsured population (Gorin, 1997). In recent years, however, interest in this issue has resurfaced. Since 2001, the Institute of Medicine has released a series of in-depth studies on the problem of health care coverage in the United States (http://www.iom.edu/project.asp?id=4660). The National Coalition on Health Care (NCHC), which consists of large businesses, labor unions, religious organizations, health care providers, and others representing "at least 150 million Americans," has advocated fundamental reforms aimed at instituting universal coverage (NCHC, 2004, p. 2). Other groups, such as the Universal Health Care Action Network and Physicians for a National Health Program have accelerated their efforts for reform and universal coverage.

Despite this, serious problems remain with our health care system, particularly in terms of access and coverage. Tens of millions of individuals lack health care coverage for an entire year, and millions more have only partial or inadequate coverage. Despite efforts by the Clinton administration to enact policies for universal health care, the United States remains the only industrialized nation that does not provide universal access to health care. Problems with the health care system have only grown worse during the Bush administration. This National Health Line column examines the current status of health care coverage, considers proposals for expanding coverage, and concludes with a discussion of implications for social workers.

HEALTH CARE COVERAGE IN THE UNITED STATES

The precise number of individuals without health care coverage is open to debate (Congressional Budget Office [CBO], 2003). The figures most often cited come from the U.S. Census Bureau's Current Population Survey (CPS), which every March asks individuals about their insurance status during the preceding year (CBO). By this measure, in 2003 (the most recent year for which we have figures), 45 million individuals went without health insurance for the entire year (U.S. Census Bureau, 2004). However, some analysts believe that these figures exaggerate the scope of the problem (Institute of Medicine, 2001). Although the CPS ostensibly captures information about individuals who were without coverage for an entire year, data from other surveys suggests that it really measures the number of people who lack coverage at the time of the survey (CBO). According to CBO estimates, in 1998 between 21 and 31 million people were without coverage for the entire year, whereas between 39 million and 42.6 million were without it at a particular point in time; between 56.8 million and 59 million individuals were without coverage at some time during the year. By the CPS measure 43.9 million people were without coverage in 1998, and 45 million were without it in 2003, so we can conclude that the CBO estimates for 1998 are roughly comparable to 2003. In any event, however one measures it, "the number of uninsured Americans is substantial" and increasing (Institute of Medicine, 2001, p. …

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