title: Is Health Care a Right? Health Reforms in the USA and their Impact Upon the Concept of Care.
abstract: In 2008 United States President Barack Obama declared that health care "should be a right for every American".(1) This statement, although noble, does not reflect US healthcare statistics in recent times, with the number of uninsured reaching over 50 million in 2010.(2) Such disparity has sparked a political drive towards change, and the introduction of the Patient Protection and Affordable Care Act (PPACA).(3) These changes have been highly polemical, raising the fundamental question of whether health care is a right; a contract between the nation and its inhabitants granted at birth, or an entitlement; a privilege that must be earned as opposed to universally provided. Access to healthcare in the US is mediated by insurance coverage, either in the form of private or employer based cover, which may be government based for public sector employees or private for private sector employees. The majority of spending on healthcare however, comes from government expenditure on health programs such as Medicare, Medicaid, Tricare, and the State Children's Health Insurance Program (SCHIP).(4) Medicare is a federal government funded social insurance program that provides health insurance to people aged 65 and older, younger people with disabilities, and those with end stage renal failure requiring dialysis. Medicaid is a means tested insurance coverage program for individuals with low incomes and their families, and is jointly funded by state and federal governments. Tricare is a healthcare program that provides healthcare insurance for military personnel, retirees, and their dependents. The SCHIP provides states with federal government funding to provide health insurance to children from families with modest incomes that do not qualify for Medicaid. As such, although the majority of the US population is insured by federal, state, employer, or private health insurance, the remainders go uninsured.
authors.affiliation: Green Templeton College, University of Oxford, Oxford, UK.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
authors.affiliation: Imperial College London, London, UK.
authors.forename: Rele
authors.initials: R
authors.lastname: Ologunde
authors.affiliation: New York University, New York, USA.
authors.forename: Ayinkeran
authors.initials: A
authors.lastname: Gunarajasingam
keywords: Policy; Public Health; Reform; US healthcare; Universal Care