United Health Insurance Quotes

America's health care system is neither healthy, caring, nor a system.

Everyone should have health insurance? I say everyone should have health care. I'm not selling insurance.

I need to make money. I need to write today. I need to clean the bathroom. I need to eat something. I need to quit sugar. I need to cut my hair. I need to call Verizon. I need to savor the moment. I need to find the library card. I need to learn to meditate. I need to try harder. I need to get that stain out. I need to find better health insurance. I need to discover my signature scent. I need to strengthen and tone. I need to be present in the moment. I need to learn French. I need to be easier on myself. I need to buy organizational storage units. I need to call back. I need to develop a relationship with a God of my understanding.

On Rachel's show for November 7, 2012: We're not going to have a supreme court that will overturn Roe versus Wade. There will be no more Antonio Scalias and Samuel Aleatos added to this court. We're not going to repeal health reform. Nobody is going to kill medicare and make old people in this generation or any other generation fight it out on the open market to try to get health insurance. We are not going to do that. We are not going to give a 20% tax cut to millionaires and billionaires and expect programs like food stamps and kid's insurance to cover the cost of that tax cut. We'll not make you clear it with your boss if you want to get birth control under the insurance plan that you're on. We are not going to redefine rape. We are not going to amend the United States constitution to stop gay people from getting married. We are not going to double Guantanamo. We are not eliminating the Department of Energy or the Department of Education or Housing at the federal level. We are not going to spend $2 trillion on the military that the military does not want. We are not scaling back on student loans because the country's new plan is that you should borrow money from your parents. We are not vetoing the Dream Act. We are not self-deporting. We are not letting Detroit go bankrupt. We are not starting a trade war with China on Inauguration Day in January. We are not going to have, as a president, a man who once led a mob of friends to run down a scared, gay kid, to hold him down and forcibly cut his hair off with a pair of scissors while that kid cried and screamed for help and there was no apology, not ever. We are not going to have a Secretary of State John Bolton. We are not bringing Dick Cheney back. We are not going to have a foreign policy shop stocked with architects of the Iraq War. We are not going to do it. We had the chance to do that if we wanted to do that, as a country. and we said no, last night, loudly.

Society never advances. It recedes as fast on one side as it gains on the other. It undergoes continual changes; it is barbarous, it is civilized, it is christianized, it is rich, it is scientific; but this change is not amelioration. For every thing that is given, something is taken. Society acquires new arts, and loses old instincts. What a contrast between the well-clad, reading, writing, thinking American, with a watch, a pencil, and a bill of exchange in his pocket, and the naked New Zealander, whose property is a club, a spear, a mat, and an undivided twentieth of a shed to sleep under! But compare the health of the two men, and you shall see that the white man has lost his aboriginal strength. If the traveller tell us truly, strike the savage with a broad axe, and in a day or two the flesh shall unite and heal as if you struck the blow into soft pitch, and the same blow shall send the white to his grave. The civilized man has built a coach, but has lost the use of his feet. He is supported on crutches, but lacks so much support of muscle. He has a fine Geneva watch, but he fails of the skill to tell the hour by the sun. A Greenwich nautical almanac he has, and so being sure of the information when he wants it, the man in the street does not know a star in the sky. The solstice he does not observe; the equinox he knows as little; and the whole bright calendar of the year is without a dial in his mind. His note-books impair his memory; his libraries overload his wit; the insurance-office increases the number of accidents; and it may be a question whether machinery does not encumber; whether we have not lost by refinement some energy, by a Christianity entrenched in establishments and forms, some vigor of wild virtue. For every Stoic was a Stoic; but in Christendom where is the Christian?

A Harris/Harvard School of Public Health poll of 1989 showed that most Americans (61 percent) favored a Canadian-type health system, in which the government was the single payer to doctors and hospitals, bypassing the insurance companies, and offering universal medical coverage to everyone. Neither the Democratic nor the Republican party adopted that as its program, although both insisted they wanted to “reform” the health system.

I need to make money. I need to write today. I need to clean the bathroom. I need to eat something. I need to quit sugar. I need to cut my hair. I need to call Verizon. I need to savor the moment. I need to find the library card. I need to learn to meditate. I need to try harder. I need to get that stain out. I need to find better health insurance. I need to discover my signature scent. I need to strengthen and tone. I need to be present in the moment. I need to learn French. I need to be easier on myself. I need to buy organizational storage units. I need to call back. I need to develop a relationship with a God of my understanding. I need to buy eye cream. I need to live up to my potential. I need to lie back down.

The United States spends more than twice as much per capita on health care as other rich capitalist countries —around $9,400 compared to around $3,600—and for that money its citizens can expect lives that are three years shorter. The United States spends more per capita on health care than any other country in the world, but 39 countries have longer life expectancies. [...] Under the current US system, rich, insured patients visit doctors more than they need, running up costs, while poor patients cannot afford even simple, inexpensive treatments and die younger than they should. Doctors spend time that could be used to save lives or treat illness by providing unnecessary, meaningless care. What a tragic waste of physician care.

At present the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance,” the Yale economist Irving Fisher pointed out in 1916.

Cooperative Care in Wisconsin, which provides care to the elderly, was able to give its 81 members in 2004 relatively high pay, workers’ compensation, ten days’ paid vacation, and 50 to 75 percent health insurance coverage, all only three years after beginning operations.79 Similarly, Cooperative Home Care Associates in the Bronx, New York, founded in 1985, offers its 1700 members “significantly better pay and working conditions than most home health aides.”80

From the very beginning of its history, the manifold social evils of capitalism have given rise to oppositional movements. The one I am concerned with in this book is cooperativism, specifically worker cooperativism. There are many other kinds of cooperatives, including those in the credit, agriculture, housing, insurance, health, and retail sectors of the economy. But worker cooperativism is potentially the most “oppositional” form, the most anti-capitalist, since it organizes production in anti-capitalist ways. Indeed, the relations of production that constitute worker cooperativism also define socialism in its most general sense: workers’ democratic control over production and, in some varieties, ownership of the means of production (whether such ownership is organized individually, by owning shares of equity, or collectively). As one common formulation states, in the worker co-op, labor has power over capital, or “labor hires capital.” In the conventional business, by contrast, capital has power over labor, i.e., “capital hires labor.” None of the other kinds of cooperativism directly rejects these capitalist power-relations, although some may signify an implicit undermining of capitalism insofar as the co-op exists not primarily for the sake of maximizing profit but for satisfying some social need.

Somehow many have convinced themselves that the man who pulled the United States back into some semblance of financial health, reduced unemployment to its lowest level in decades, secured health insurance for millions of citizens, ended one of our recent, all-too-intractable wars in the Middle East, reduced the staggering deficit he inherited from George W. Bush, and masterminded the takedown of Osama bin Laden actually hates America.76

In times of crisis you either deepen democracy, or you go to the other extreme and become totalitarian. Our struggles for democracy have taught us some important and valuable lessons. Over a million citizen activists of all ethnic groups, mostly young people, made history by going door to door, urging voters to go to the polls and send Barack Obama to the White House in 2008. We did this because we believed and hoped that this charismatic black man could bring about the transformational changes we urgently need at this time on the clock of the world, when the U.S. empire is unraveling and the American pursuit of unlimited economic growth has reached its social and ecological limits. We have since witnessed the election of our first black president stir increasingly dangerous counterrevolutionary resentments in a white middle class uncertain of its future in a country that is losing two wars and eliminating well-paying union jobs. We have watched our elected officials in DC bail out the banks while wheeling and dealing with insurance company lobbyists to deliver a contorted version of health care reform. We have been stunned by the audacity of the Supreme Court as it reaffirmed the premise that corporations are persons and validated corporate financing of elections in its Citizens United decision.

The United States is famously resistant to anything smacking of redistribution. Yet it allocates 19 percent of its GDP to social services, and despite the best efforts of conservatives and libertarians the spending has continued to grow. The most recent expansions are a prescription drug benefit introduced by George W. Bush and the eponymous health insurance plan known as Obamacare introduced by his successor. Indeed, social spending in the United States is even higher than it appears, because many Americans are forced to pay for health, retirement, and disability benefits through their employers rather than the government. When this privately administered social spending is added to the public portion, the United States vaults from twenty-fourth into second place among the thirty-five OECD countries, just behind France.

In her book The Government-Citizen Disconnect, the political scientist Suzanne Mettler reports that 96 percent of American adults have relied on a major government program at some point in their lives. Rich, middle-class, and poor families depend on different kinds of programs, but the average rich and middle-class family draws on the same number of government benefits as the average poor family. Student loans look like they were issued from a bank, but the only reason banks hand out money to eighteen-year-olds with no jobs, no credit, and no collateral is because the federal government guarantees the loans and pays half their interest. Financial advisers at Edward Jones or Prudential can help you sign up for 529 college savings plans, but those plans' generous tax benefits will cost the federal government an estimated $28.5 billion between 2017 and 2026. For most Americans under the age of sixty-five, health insurance appears to come from their jobs, but supporting this arrangement is one of the single largest tax breaks issued by the federal government, one that exempts the cost of employer-sponsored health insurance from taxable incomes. In 2022, this benefit is estimated to have cost the government $316 billion for those under sixty-five. By 2032, its price tag is projected to exceed $6oo billion. Almost half of all Americans receive government-subsidized health benefits through their employers, and over a third are enrolled in government-subsidized retirement benefits. These participation rates, driven primarily by rich and middle-class Americans, far exceed those of even the largest programs directed at low income families, such as food stamps (14 percent of Americans) and the Earned Income Tax Credit (19 percent). Altogether, the United States spent $1.8 trillion on tax breaks in 2021. That amount exceeded total spending on law enforcement, education, housing, healthcare, diplomacy, and everything else that makes up our discretionary budget. Roughly half the benefits of the thirteen largest individual tax breaks accrue to the richest families, those with incomes that put them in the top 20 percent. The top I percent of income earners take home more than all middle-class families and double that of families in the bottom 20 percent. I can't tell you how many times someone has informed me that we should reduce military spending and redirect the savings to the poor. When this suggestion is made in a public venue, it always garners applause. I've met far fewer people who have suggested we boost aid to the poor by reducing tax breaks that mostly benefit the upper class, even though we spend over twice as much on them as on the military and national defense.

Believe me," Dr. Tamalet summed up, "if you wanted that operation in France, you could get it" Which is, of course, the boon and the bane of France's health care system. It offers a maximum of free choice among skillful doctors and well-equipped hospitals, with little or not waiting, at bargain-basement prices [in out-of-pocket terms to the consumer]. It's a system that enables the French to live longer and healthier lives, with zero risk of financial loss due to illness. But somebody has to pay for all that high-quality, ready-when-you-need-it care--and the patients, so far, have not been willing to do so. As a result, the major health insurance funds are all operating at a deficit, and the costs of the health care system are increasing significantly faster than the economy as a whole. That's why the doctors keep striking and the sickness funds keep negotiating and the government keeps going back to the drawing board, with a new 'major health care reform' every few years. So far, the saving grace for France's system has been the high level of efficiency, as exemplified by the 'carte vitale,' that keeps administrative costs low--much lower than in the United States.

Take Canada again: why does Canada have the health-care program it does? Up until the mid-1960s, Canada and the United States had the same capitalist health service: extremely inefficient, tons of bureaucracy, huge administrative costs, millions of people with no insurance coverage―exactly what would be amplified in the United States by Clinton's proposals for "managed competition" [put forward in 1993].21 But in 1962 in Saskatchewan, where the N.D.P. is pretty strong and the unions are pretty strong, they managed to put through a kind of rational health-care program of the sort that every industrialized country in the world has by now, except the United States and South Africa. Well, when Saskatchewan first put through that program, the doctors and the insurance companies and the business community were all screaming―but it worked so well that pretty soon all the other Provinces wanted the same thing too, and within a couple years guaranteed health care had spread over the entire country. And that happened largely because of the New Democratic Party in Canada, which does provide a kind of cover and a framework within which popular organizations like unions, and then later things like the feminist movement, have been able to get together and do things.

About half of employer-provided health plans in the United States are self-insured plans, giving employers even more latitude in designing and administering such plans.

only a remote possibility in the United States, since existing reproductive procedures such as IVF and PGD, which routinely cost tens of thousands of dollars, are seldom covered by health insurance. But in places like France, Israel, and Sweden, countries whose national health plans cover assisted reproduction, it’s possible that simple economics will incentivize governments to make gene editing available to patients who need it. After all, providing lifelong treatment to a single person with a genetic disease could be much more expensive than prophylactic intervention in the embryo using gene editing.

Currently, the wealthy who have no pre-existing conditions can afford high-quality health care, while the poor and sick are relegated to hoping for and negotiating whatever health care safety net might exist in their area. This neoliberal form of capitalism structuring health care in the United States has led to those with the highest burden of sickness being simultaneously those with the least access to care.

I met Dr. Freeman in 1991 when he came to Harvard to talk to my fellowship program about his New England Journal of Medicine article. With calm deliberation, this tall, elegant physician disrupted my vision of Harlem and other Black communities throughout the United States. He detailed a cascade of health conditions triggered by inadequate facilities, lack of access to health insurance, and a shortage of medical personnel, healthy food, safe neighborhoods, and basic education. He called the problem a national tragedy, an emergency analogous to a hurricane, flood, or other ruinous natural disaster, yet one for which no one was sounding the alarm.

What are your feelings from Bush to Obama? Besides being responsible for the death of half a million people, I feel like Bush dealt a huge economic and social blow to the USA, one from which we may never fully recover. He directly flushed 3 trillion dollars down the toilet on hopeless, pointlessly destructive wars in Afghanistan and Iraq …and they’re not even over! For years to come, we’ll be paying costs for all the injured veterans (over 50,000) and destabilizing three countries, because you have to look at the impact that the Afghan war has on Pakistan. Bush expanded the use of torture, and created a whole new layer of government bureaucracy (the “Department of Homeland Security”) to spy on Americans. He created Indefinite Detention (at Guantanamo and other US military bases) and expanded the use of executive-ordered assassinations using the new drone technology. On economic issues, his administration allowed corporations to run things and regulate themselves. The agency that was supposed to regulate oil drilling had lobbyist-paid prostitutes sleeping with employees while oil industry lobbyists basically ran the agency. Energy companies like Enron, and the country’s investment banks were deregulated at the end of the Clinton administration and Bush allowed them to run wild. Above all, he was incompetent and appointed some really stupid people to important positions at every level of government. Certainly, Obama has been involved in many of these same activities. A few he’s increased, such as the use of drone assassinations, but most of them he has at least tried to scale back. At the beginning of his first term, he tried to close the Guantanamo prison and have trials for many of the detainees in the United States but conservatives (including many Democrats) stirred up public resistance and blocked this from happening. He tried to get some kind of universal healthcare because over 50 million Americans don’t have health insurance. This is one of the leading causes of personal bankruptcies and foreclosures because someone gets sick in a family, loses their job, loses their health insurance (because American employers are source of most people’s healthcare) and they can’t pay their health bills or their mortgage. Or they use up all their money caring for a sick family member. So many people in the US wanted health insurance reform or single-payer, universal health care similar to what you have in the UK. Members of Obama’s own party (The Democrats) joined with Republicans to narrowly block “The public option” but they managed to pass a half-assed but not-unsubstantial reform of health insurance that would prevent insurers from denying you coverage when you’re sick or have a “preexisting condition.” The minute it was signed into law, Republicans sued in the courts (all the way to the supreme court) and fought, tooth and nail to block its implementation. Same thing with gun control, even as we’re one of the most violent industrial countries in the world. (Among industrial countries, our murder rate is second only to Russia). Obama has managed to withdraw troops from Iraq and Afghanistan over Republican opposition but, literally, everything he tries to do, they blast it in the media and fight it in Congress. So, while I have a lot of criticisms of Obama, he is many orders of magnitude less awful than Bush and many of the positive things he’s tried to do have been blocked. That said, the Democratic and Republican parties agree on more things than they disagree. Both signed off on the Afghan and Iraq wars. Both signed off on deregulation of banks, of derivatives, of mortgage regulations and of the energy and telecom business …and we’ve been living with the consequences ever since. I’m guessing it’s the same thing with Labor and Conservatives in the UK. Labor or Democrats will SAY they stand for certain “progressive” things but they end up supporting the same old crap... (2014 interview with iamhiphop)

According to a 2009 Harvard Medical School study, as many as 45,000 people die annually in the United States because they lack health insurance. As one of the study’s coauthors pointed out, this works out to about one death every twelve minutes. It’s

Since 2000, no important technology innovation in the United States has been scaled up to create millions of manufacturing, marketing, and engineering jobs here, as personal computers and related industries did. While selling online and social networking are clearly transformational movements that have created entrepreneurial opportunities, fewer than fifty thousand traditional jobs—those with full-time hours, benefits, and health insurance—have been created.

The most controversial part of the controversial legislation now derided by Republicans as “Obamacare”—the mandate that individuals buy health insurance—was originally proposed by Republican economists, championed by the conservative Heritage Foundation, introduced in Congress by Republican politicians, and enacted in Massachusetts under Republican governor Mitt Romney.16 Planned Parenthood, now anathema to Republicans because of its pro-choice policies, enjoyed the support of two of the biggest dynasties of Republican politics, the Goldwater and Bush families, until the rise of the Religious Right in the 1980s made the pro-life position a litmus test for the GOP. And Republican platforms from 1940 to 1976 endorsed the Equal Rights Amendment for women.

HMOs have been so successful that they now occupy a dominant position in the market for health care in the United States. Approximately forty-five million Americans are uninsured. Of the remainder, about half are enrolled in some type of HMO. Most others receive some sort of managed care plan. Less than 10 per cent of Americans still have classic fee-for-service private health insurance (down from more than 70 per cent in the late ’80s). So even though many people equate HMOs with private health care, these sorts of corporations exist only because of the failure of private markets to supply appropriate health care. HMOs succeed precisely because they are more efficient than insurance markets. There should be no illusions about the character of these organizations—they are giant bureaucracies. The largest of them, Kaiser Permanente, employs over eleven thousand physicians and has more than six million subscribers in the state of California alone. This makes Kaiser larger than most of the government-run health care systems in Canada. And while the Canadian system is extremely decentralized, Kaiser Permanente is a single, vertically integrated corporation.

Lack of health insurance is one factor contributing to poorer health, especially among the poor. Life expectancy in the United States is 78 years, lower than Japan’s 83 years, or Australia’s or Israel’s 82 years. According to the World Bank, in 2009 the United States ranked fortieth overall, just below Cuba.54 Infant and maternal mortality in the United States is little better than in some developing countries; for infant mortality, it is worse than Cuba, Belarus, and Malaysia, to name a few.55 And these poor health indicators are largely a reflection of the dismal statistics for America’s poor. For instance, America’s poor have a life expectancy that is almost 10 percent lower than that of those at the top.56 We

Harvard’s Ichiro Kawachi agrees. He identifies a range of social policies that would be vital to promoting greater socioeconomic equality—and hence, better health. “Make an investment in education, for example, to give people a decent start in life,” he says. “We can subsidize childcare, which is a major stress for low-income mothers, especially those who are single parents. We can expand unemployment insurance and expand access to health care. This is controversial only in the United States. Other societies view health care as a basic human right.

I feel that the government should uphold the concept that it is there for us, “We the People.” That it does what we alone cannot do. By standing unified and proud, we have strength because of our numbers and the power to do what is right. That we always remain on the right side of history and care for and respect our less fortunate. Now, you may think that I’m just spouting out a lot of patriotic nonsense, which you are entitled to do, however I did serve my country actively in both the Navy and Army for a total of forty years, six months and seven days as a reservist and feel that I have an equal vested interest in these United States. If we don’t like what is happening we have responsible ways and means to change things. We have Constitutional, “First Amendment Rights to Freedom of Speech.” There are many things I would like to see change and there are ways that we can do this. To start with we have to protect our First Amendment Rights and protect the media from government interference…. I also believe in protecting our individual freedom…. I believe in one person, one vote…. Corporations are not people, for one they have no human feelings…. That although our government may be misdirected it is not the enemy…. I want reasonable regulations to protect us from harm…. That we not privatize everything in sight such as prisons, schools, roads, social security, Medicare, libraries etc.….. Entitlements that have been earned should not be tampered with…. That college education should be free or at least reasonable…. That health care becomes free or very reasonable priced for all…. That lobbyist be limited in how they can manipulate our lawmakers…. That people, not corporations or political action committees (PAC’s), can only give limited amounts of money to candidates…. That our taxes be simplified, fair and on a graduated scale without loop holes….That government stays out of our personal lives, unless our actions affect others…. That our government stays out of women’s issues, other than to insure equal rights…. That the law (police) respects all people and treats them with the dignity they deserve…. That we no longer have a death penalty…. That our military observe the Geneva Conventions and never resort to any form of torture…. That the Police, FBI, CIA or other government entities be limited in their actions, and that they never bully or disrespect people that are in their charge or care…. That we never harbor prisoners overseas to avoid their protection by American law…. That everyone, without exception, is equal…. And, in a general way, that we constantly strive for a more perfect Union and consider ourselves members of a greater American family, or at the very least, as guests in our country. As Americans we are better than what we have witnessed lately. The idea that we will go beyond our rights is insane and should be discouraged and outlawed. As a country let us look forward to a bright and productive future, and let us find common ground, pulling in the same direction. We all deserve to feel safe from persecution and/or our enemies. We should also be open minded enough to see what works in other countries. If we are going to “Make America Great Again” we should start by being more civil and kinder to each other. Now this is all just a thought, but it’s a start…. “We’re Still Here!

Meanwhile, administrative costs are eating up 15–30 percent of all health-care spending in the United States. That’s twice the rate of most other advanced nations. This money goes mainly into collecting money: doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policyholders. At some hospitals, billing clerks outnumber physicians. A third of nursing hours are devoted to documenting tests and procedures so insurers have proof.

Netherlands, which has a restrictive immigration policy compared to the United States. Most European nations, including the Netherlands, after all, have universal health insurance coverage, which makes drug treatment and psychiatric treatment more available, and the Dutch government subsidizes more housing. Finally, the Netherlands’ big success was with heroin, which has effective pharmacological substitutes, methadone and Suboxone, not with meth, which lacks anything similar. But there may be fewer obstacles than appear. The Netherlands has a private health-care insurance system similar to that of the United States and covered the people who needed health care in ways similar to Medicaid and the Affordable Care Act, which significantly expanded access to drug treatment, including medically assisted treatment, in the United States.4 San Francisco subsidizes a significant quantity of housing, as we have seen. While California is larger than the Netherlands, the population of Amsterdam (872,000) is nearly identical to San Francisco’s (882,000).5 And while California’s population and geographic area are larger and more difficult to manage than those of the Netherlands, California also has significantly greater wealth and resources, constituting in 2019 the fifth-largest economy in the world.6 And the approach to breaking up open drug scenes, treating addiction, and providing psychiatric care is fundamentally the same whether in five European cities, Philadelphia, New York, or Phoenix.

private insurance and away from Medicare. The result would be “two-tier medicine,” a term that is as pejorative in Canada as “socialized medicine” is in the United States. Many fear that if Canada did move to two-tier medicine, the rich might get better care, with less waiting, than the poor. The rich getting better access to health care—that’s a fact of life that we take for granted in the United States. But in Canada, such a result would violate the powerful egalitarian impulse that is a crucial element of the national culture.

Wellness programs offer important benefits, but these data policies underscore the less visible and more dangerous privacy risks they pose.82 Most are exempt from traditional health data privacy regulations. The Health Insurance Portability and Accountability Act of 1996 (known as HIPAA), for example, protects individuals’ identifiable health information in the United States. But it doesn’t apply when employers offer workplace wellness programs directly rather than in connection with their group health plans. Without laws preventing them from using the data collected through wellness programs, employers can mine the data they collect, which many do with abandon.83 Employers learn everything that employees share in the questionnaires and online surveys they complete as part of these programs, from what prescription drugs they use to whether they voted and when they stopped filling their birth control prescriptions.84 And employers are using that data in increasingly more intrusive ways.

Nurses work in a pitiless system. We in the United States don’t have a unified approach to maximizing people’s health and well-being. We mostly have a for-profit medical industry focused on illness and conditions and, then, on potential billable cures and fixes. Health care workers generally do their very best to provide good care, but our “system” is often at cross-purposes with that effort. Nurses in particular, whose discipline is not medicine, are trying to work in a medical industry that was not built to make the most of their expertise or, really, even to recognize it. The fee-for-service model dictates that physicians—mainly the ones billing patients’ insurance companies—are the revenue generators. Nursing is just as important to people’s outcomes, but the fees for nursing are generally lumped in with hospital room and board—meaning that nursing is seen by hospitals as an expense, like meals or supplies.

The earliest health insurance policies were designed primarily to compensate for income lost while workers were ill. Long absences were a big problem for companies that depended on manual labor, so they often hired doctors to tend to workers. In the 1890s, lumber companies in Tacoma, Washington, paid two enterprising doctors 50 cents a month to care for employees. It was perhaps one of the earliest predecessors to the type of employer-based insurance found in the United States today.

...the United States is the sickest of the rich. ... The United States spends more than twice as much per capita on health care as other capitalist countries on Level 4--around $9,400 compared to around $3,600--and for that money its citizens can expect lives that are three years shorter. the United States spends more per capita on health care than any other country in the world, but 39 countries have longer life expectancies. ...US citizens should be asking why they cannot achieve the same levels of health, for the same cost, as other capitalist countries that have similar resources. The answer is not difficult, by the way: it is the absence of the basic public health insurance that citizens of most other countries on Level 4 take for granted.

Perhaps less pernicious but still worrisome is reliance on “wellness” programs, which most medium to large employers in the United States have, despite the fact that, overall, they have not been validated to promote health outcomes. Typically, a wellness program combines step counting, weight and blood pressure readings, and cholesterol lab tests, as well as some incentive for employees to participate (such as a surcharge on an employee’s contribution to the cost of insurance). But wellness is poorly defined, and the cost effectiveness of such strategies has been seriously questioned.50 One way such programs could be improved, however, is through the use of virtual medical coaches, which could gather and make use of far more granular and deeper information about each individual.

What American Healthcare Can Learn from Italy: Three Lessons It’s easy. First, learn to live like Italians. Eat their famous Mediterranean diet, drink alcohol regularly but in moderation, use feet instead of cars, stop packing pistols and dropping drugs. Second, flatten out the class structure. Shrink the gap between high and low incomes, raise pensions and minimum wages to subsistence level, fix the tax structure to favor the ninety-nine percent. And why not redistribute lifestyle too? Give working stiffs the same freedom to have kids (maternity leave), convalesce (sick leave), and relax (proper vacations) as the rich. Finally, give everybody access to health care. Not just insurance, but actual doctors, medications, and hospitals. As I write, the future of the Affordable Care Act is uncertain, but surely the country will not fall into the abyss that came before. Once they’ve had a taste of what it’s like not to be one heart attack away from bankruptcy, Americans won’t turn back the clock. Even what is lately being called Medicare for All, considered to be on the fringe left a decade ago and slammed as “socialized medicine,” is now supported by a majority of Americans, according to some polls. In practice, there’s little hope for Italian lessons one and two—the United States is making only baby steps toward improving its lifestyle, and its income inequality is worse every year. But the third lesson is more feasible. Like Italy, we can provide universal access to treatment and medications with minimal point-of-service payments and with prices kept down by government negotiation. Financial arrangements could be single-payer like Medicare or use private insurance companies as intermediaries like Switzerland, without copying the full Italian model of doctors on government salaries. Despite the death by a thousand cuts currently being inflicted on the Affordable Care Act, I am convinced that Americans will no longer stand for leaving vast numbers of the population uninsured, or denying medical coverage to people whose only sin is to be sick. The health care genie can’t be put back in the bottle.

There are thirty-seven million people in the United States without any form of medical insurance. Every other leading industrial nation in the world—Germany, Italy, France, Japan, England, Canada, and all the others—supplies health care to all its citizens, at a fraction of what the world’s richest country spends for inadequate health care. It’s our national shame.

At the time, few people had or felt the need for private health insurance. Most Americans paid their doctors visit by visit, but the field of medicine was quickly growing more sophisticated, and as more diagnostic tests and surgeries became available, the attendant costs began to rise, tying health more explicitly to wealth. Both the United Kingdom and Germany had addressed similar issues by instituting national health insurance systems, and other European nations would eventually follow suit.