Our Troubled Health Care System: Why Is It So Hard to Fix?

Judy Feder, Georgetown Public Policy Institute

Policy brief no. 37


Why is it so hard for us to achieve a goal that for most of us seems so obvious? Since you know that I’ve been working on this issue for better than 30 years, I need to start by telling you that the failure is not because we’re stupid. Rather, it is because we as a nation have become invested in a health care financing system in which 85% of us have health insurance and 15% of us do not. Although those of us who have health insurance could lose it at any time—by losing a job, getting a divorce, or even getting sick—at any point in time the minority 15% of people who are without health insurance are disproportionately low- or modest-income people in jobs that don’t offer coverage. They aren’t organized as a group. They are less likely to vote than those of us who have health insurance, and they definitely aren’t making campaign contributions. The problem is that when we look at policies to get them covered, we can’t get them coverage without in some way affecting everyone else’s coverage as well. It would be great if we could wave a magic wand, tap everybody who’s uninsured on their heads, and bring them into the system. But it takes money from us to enable those with low and modest incomes to pay for health insurance. And any policy change that we are likely to make is unlikely to affect only the uninsured. Establishing a mechanism to get everybody covered is highly likely to affect those of us who already have coverage. The political challenge, then, is to assure those of us who have coverage that we, along with the uninsured, will benefit, not lose, from political action.