User:Manorhe18/Healthcare reform debate in the United States

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Add History of Insurance section

Healthcare access within the US has changed rapidly, even just over the past decade, yet the country still faces significant inequities and disparities in access to care. The idea of universal healthcare and accessibility to healthcare services has a long and complicated history that is integral to understanding the context in which the Free Clinic Movement began.

Some of the first evidence of compulsory health insurance in the United States was in 1915, through the progressive reform protecting workers against medical costs and sicknesses in industrial America. Prior to this, within the Socialist and Progressive parties, health insurance and coverage was framed as not only an economic right for workers health , but also as an employer’s responsibility and liability- healthcare was in this context centered on working-class Americans and labor unions.

Throughout the 1920s, access to care and medical costs became a more central issue, however many of these movements were denounced by the American Medical Association (AMA) as “socialized medicine”. The AMA and many physicians actively held political roles in preventing many grassroots movements of compulsory health insurance to take hold due to private/ profit incentives as well as a disbelief in “socialism”.  In the 1930s, under president Franklin D. Roosevelt- whose legislation for universal health care was vehemently opposed and attacked by the American Medical Association.

A decade later, the AMA’s fight against health insurance reform was still going. President Truman, who was a strong supporter of the Wagner-Murray-Dingell bill which would instate a national medical insurance program financed by taxes, was elected in the late 1940s and the AMA spent over $1 million on an anti-health reform campaign, denouncing the bill and fueled even more by cold war rhetoric of socialism. As illustrated by these tensions, Cold war propaganda and socialism was so central in the debates of healthcare that ideas of health insurance and accessibility became inextricable from politics.

Addressing the shortage of doctors, nurses and hospital capacity [[edit]]

The U.S. is facing shortages of doctors and nurses that are projected to grow worse as America ages, which may drive up the price of these services. Writing in The Washington Post, cardiologist Arthur Feldman cited various studies that indicate the U.S. is facing a "critical" shortage of doctors, including an estimated 1,300 general surgeons by 2010.

The American Academy of Family Physicians predicts a shortage of 40,000 primary care doctors (including family practice, internal medicine, pediatrics and obstetrics/gynecology) by 2020. The number of medical students choosing the primary care specialty has dropped by 52% since 1997. Currently, only 2% of medical school graduates choose primary care as a career. An amendment to the Senate health bill includes $2 billion in funds over 10 years to create 2,000 new residency training slots geared toward primary care medicine and general surgery. Writing in Forbes, a physician argued that this is a "tiny band-aid at best," advocating full loan repayments and guaranteed positions upon graduation.

The U.S. had 2.4 doctors per 1,000 people in 2002, ranking 52nd. Germany and France had approximately 3.4 and ranked in the top 25. The OECD average in 2008 was 3.1 doctors per 1,000 people, while the U.S. had 2.4.

The American Association of Colleges of Nurses cited studies estimating that a shortage of registered nurses would reach 230,000 by 2025 as America ages, with over 135,000 open positions during 2007. An additional 30% more nurses would have to graduate annually to keep up with demand. A study by Price Waterhouse advanced several strategies for addressing the nursing shortage, including developing more public-private partnerships, federal and state-level grants for nursing students and educators, creating healthy work environments, using technology as a training tool, and designing more flexible roles for advanced practice nurses given their increased use as primary care providers.

In addition, the U.S. also does not measure favorably vs. OECD countries in terms of acute care hospital beds. Only four OECD countries have fewer acute care hospital beds per capita than the U.S, which has 2.7 per 1,000 population versus an OECD average of 3.8. Japan has 8.2 acute care beds per 1,000 population.

One way in which the US has been addressing this need for a social safety net is through the advent of Free Clinics. The creation of the National Council of Free Clinics reflects not only a need for