American Health Care System

This chapter provides an overview of different eras in providing health care in the US. It focuses on current challenges and opportunities surrounding ongoing strategies to either implement or strike down all or parts of the Affordable Care Act (ACA). Historically the US depended on a mix of public and private sources to provide health insurance, never establishing universal health insurance. The period from 1910 through 1970 represented an era of significant growth, success, and authority of the medical profession. Health care became a central political issue in national electoral debates in the 1990s. Beyond the administrative, legislative and political disputes across the federal government and the states, the constitutional challenges to the ACA have been ongoing since its enactment. Although frequently characterized as one of the best in the world, the American health care system requires continuing reform to match spending with outcomes.