During this season of discord, the topic of health insurance arises frequently. US health insurance is unlike other systems in the world because it has a private enterprise core to it. With this type of incentive structure, various strengths and weaknesses emerge and are bitterly debated. Sometimes the best way to address disagreements is to start at the beginning.
US health insurance did not arise from the Federal Government. Instead, health insurance arose during World War II as a means of attracting and retaining workers. Wage controls had limited the prices that could be paid to workers, but "fringe benefits," such as health insurance, were allowed. The benefit of health insurance became enormously popular and due to wide adoption became a fixture in the average American's financial picture.
Clearly this structure meant several things. First, it meant that the people most likely to need health insurance - such as the elderly or disabled - were unable to attain coverage. Second, it meant that the health insurance premiums were exceptionally low with superior benefits, due to covering only the healthiest population. This meant that cultural expectations were developed for high quality coverage. Third, it meant that the identity of this high quality coverage at modest prices made it difficult to expand to expand it to the non-working population.
As a result, the working population became fiercely dedicated to the idea of such outsize benefits and loathe to give them up to some "universal health" plan. At the same time, the non-working population became increasingly frustrated with what was developing into an inordinately expensive system for its own higher utilization needs.
The advocates of private insurance are correct in their perception of a superior system - for those who participate. However, I think that the issue of a general standard level of healthcare for all has to be made available. The legitimate fears of the beneficiaries of the current system are that such a general, standard level would either demand the diminution of current plans or an unmanageable expense load would occur by expanding such benefits to the entire population.
The crucial discussion, then, seems to be how the U.S. could deliver a standardized healthcare plan for all - akin to the public school system - while protecting and allowing for the maintenance of the much more expensive system of employer healthcare - akin to the private school system. To some extent, it would seem the key is what is deemed "essential."
