Universal Coverage in the United States: Lessons from Experience of the 20th Century

The absence of universal health insurance coverage is one of the great, unsolved problems facing the United States at the onset of the 21st century. Proposals to expand health insurance coverage were frequently considered but infrequently enacted during the 20th century, and the goal of creating a universal health insurance system remained elusive. As a result, today the American health care system relies on a patchwork of insurance coverage, including employer-sponsored health insurance for the majority of working-age adults, the Medicare program for the elderly and disabled, and Medicaid and the State Children's Health Insurance Program (CHIP) for low-income adults and children. This system has serious consequences for the approximately 39 million Americans who are left without insurance—onsequences for their health, access to care, preventive care, and quality of care—s well as for those with inadequate health insurance.