Congress passed into law the Social Security Act of 1965. Title XVIII of this controversial act allowed for the establishment of Medicare, a health insurance program for (1) citizens age 65 and older regardless of income or medical history and (2) persons under age 65 with certain qualifying disabilities. At the time, Medicare’s passage was extremely controversial given that it aided civil rights causes by making fund allocations to healthcare providers contingent on the desegregation of hospitals and waiting rooms. Life expectancy has increased significantly increased since Medicare’s inception, necessitating several major changes. For example, hospice aid was added in 1984, and Medicare was expanded to offer benefits to younger citizens with permanent disabilities (typically known as Social Security Disability Insurance, or SSD I). The costs of Medicare benefits to patients have risen steeply in recent years, mirroring cost increases across the healthcare industry. Seniors now must weigh their options very carefully when considering private insurance against Medicare’s public option.
The Affordable Care Act of 2010 (also known as Obama Care) was designed to address the large number of American citizens without health insurance (some 50 million as of 2013) as well as skyrocketing healthcare costs. The Affordable Care Act contains legislation that mandates small business owners who have 50 or more full-time employees provide health insurance to each full-time staff member or pay a financial penalty. In addition, the ACA establishes several tiers of public health insurance for people. If citizens choose to opt out of coverage, they must pay a penalty of $95 or 1% of their total income, whichever is higher (2014 figures).
Although the Affordable Care Act is expected to allow tens of millions of American citizens to access healthcare services they might not otherwise have been able to afford, the law has come under harsh criticism for its mandates and their outcomes. For example, ACA opponents have cited the pre-emptive shift by many large companies to part-time labor in order to avoid the ACA’s full-time employee health insurance requirements. While the full effects of this shift remain to be seen, many people have found themselves suspended between two part-time positions, neither of which offers health insurance benefits.
Looking toward the future of healthcare delivery in the United States, the Affordable Care Act may serve as a transition to universal coverage, a system in which the socialized programs of Medicare and Medicaid are expanded to cover all citizens. A taxpayer-funded, government managed healthcare fund would allow the government to negotiate effectively with healthcare providers, health insurance companies, and medical product manufacturers by awarding national contracts. Private manufacturers would then have tremendous incentive to keep their products and services safe, effective, and affordable.