Although the federal government had an increased role in the healthcare during the 1960s, the authority over health issues was shared among the federal and state governments. President Reagan’s attempts to reduce federal authority on health policies and programs gave states a bigger role in the implementation of health policies. Given the involvement of federal, state and local governments, the healthcare system included fragmented authorities, complex processing, avoiding of responsibilities and finger pointing by different levels of government.
The need to satisfy a huge diverse population made it more difficult as there was no single institution which represented the nation or its public aspirations (Patel and Rushefsky, 1999). With many agencies involved in healthcare, pursuing their own agenda, the health policies formed are not clearly defined and attributed to serving selected sections. By the early 1990s, about 60% of Americans had wished to see fundamental changes in the healthcare system while another 29% felt the entire system needs to be overhauled.
A telephonic ABC NEWS and Washington Post poll conducted on a random sample of 1200 adults in 2003, determined that 62% of the Americans preferred a universal health insurance program. However, if such a universal program reduced their choice of doctors or put them in waiting lists for emergency treatments, they would like to continue with the current employer based system. Support for a change in the healthcare system is mainly due to escalating costs in the current system. About 78% of the people are dissatisfied with the costs of the healthcare system (Langer, 2004).
The US is perhaps the only developed nation that doesn’t have a national health insurance or a direct health service delivery system. The absence of a national health insurance means that people who do not fit within a particular category like the aged, veterans, unemployed etc. , should go in for private healthcare. With sky rocketing medical expenses and newer diseases rapidly becoming prominent, there have been considerable demand to bring medical cover to the entire population.
The idea of a national health insurance program for the US can be traced to the Truman administration (Peters, 1986). When President Truman included a comprehensive health insurance program in 1945 with the Social Security Program, many business organizations and the American Medical Association opposed it. The opponents termed the plan as ‘socialized medicine’, and invested several million dollars campaigning against it.