The US is the land of the individual and there's a strong sense of individualism, i.e. that everyone should take responsibility for their own needs. This also means there is no real empathy. The majority prefer not to think about the problems of others. Indeed, many take it further and want government to design programs and plans to prevent freeloading. Unlike many other developed nations, there's no sense that a one-size approach to health fits all. People either have jobs with health plans as part of the pay package or they pay the premiums. There's no third choice. Except, of course, that Medicaid and Medisave are accepted as essential to provide health coverage for the young and old. It's political suicide for the Democrats or Republicans to talk of reforming either national program.
This means there's no appetite for a big government national health service to match the healthcare provision in other countries. There's a clear division between nationally- and state-funded programs, with each state deciding how much of its budget to devote to healthcare. Before the recession, states were able to collect significant tax revenues and this allowed the majority of states to be quite generous in the support offered for healthcare. But as the recession has taken hold and unemployment has risen, most states now run a deficit and cuts have to be made. In Republican states, this puts significant pressure on healthcare provision.
The most common cuts have come in the safety net for children with the State Children's Health Insurance Program (SCHIP) most often being redefined to exclude more children. Pressure is also coming from some state insurance departments which have been looking at the minimum capital holdings required to hold a license to sell policies in their states. With the failure of some large banks and the troubles in AIG, states have grown worried that their local insurance companies could fail. This has forced some companies to increase premiums to improve cash reserves. At a time when hospitals and doctors have also been increasing their charges, this has made many policies increasingly unaffordable. Only in the states where there's a large population are insurers able to put together big groups of policy holders to share the risks and keep down the premiums. In smaller states, all premiums have risen sharply.
The national situation is further complicated as some individual states have proposed legislation to make it unlawful for any law to require individuals to buy health insurance or pay a penalty. These proposals are political maneuvers designed to create legal obstacles to federal healthcare reform. The Republican party is trying to slow down any move from Washington to interfere with free markets by introducing any mandatory health coverage. While these moves are purely symbolic, they could seriously delay the implementation of national reform while court battles are fought out in the affected states. This could result in a two-tier program of cheap health insurance with full reform in some states and the status quo in other states where there are court cases.
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