Healthcare reform continues to be one of the most contentious subjects of debate in American politics. Healthcare accounts for over 16% of federal expenditures, forecasted to increase in the years ahead1. The two main political parties represent the interests of an array of interest groups and providers at state and national levels. Republicans protect private interests, promoting the view that healthcare should be a privilege, and quality should be preserved over expansion. Democrats champion reform, seeking to expand single-payer networks, and promote healthcare as a moral right for every citizen. The main tension in the reform debate is that the expansion coverage through a single-payer system leads to higher government expenditures and lower quality of care, while private insurers leave many Americans uninsured. Political partisanship between groups and parties fuels a circular debate over what constitutes successful reform. .
To understand the tension underlying the healthcare debate, it is important to consider how coverage is distributed to consumers. The U.S. system uses a hybrid network of private and public plans, each operating with different goals, providing coverage to a different pool of consumers. Private for-profit insurer's market expensive, high quality plans to low risk, wealthy, employed consumers. Public insurers offer single-payer plans through Medicare and Medicaid to unemployed and elderly consumers. Private insurers tend to raise prices and exclude coverage to high risk individuals in order to maximize profits. Meanwhile, the government funded Medicaid and Medicare programs fail to offer the same quality of care as private insurers.
While these two systems provide coverage to 80% of U.S. citizens, a third group of constituents, known as the chronic "working poor," are excluded from either network, unable to afford private insurance plans, yet considered to have too much money to qualify for single-payer coverage.