Access to affordable healthcare has been a perennial socioeconomic and political problem in America. According to U.S. Census Bureau data, in 2024, 92% of Americans had health insurance for some or all of the year. Within the insured population, 66.1% had private coverage, while 35.5% were covered by public programs such as Medicare and Medicaid. (The combined percentages exceed 100 because a small segment of the population had overlapping public-private coverage).
Traditionally, the majority of Americans have had employer-based health insurance. In 2024, 53.8% of the population had that type of coverage, with Medicare and Medicaid covering 19.1% and 17.6%, respectively.
The big problem is that there have always been substantial numbers of Americans who have no form of health insurance. Such people constantly live on a knife’s edge. They are always one major illness away from either bankruptcy or other financial ruin.
The Affordable Care Act (ACA), popularly known as Obamacare, was signed into law in March 2010 by President Barack Obama. It was meant to help resolve the problem of having so many Americans living without health insurance. One of the ACA’s most important provisions was the prohibition of insurers from denying coverage or increasing premiums based on preexisting conditions. Previously, people with cancer, heart disease and other serious medical conditions had great difficulty accessing insurance coverage.
There is no question that the ACA has brought tremendous benefits to a significant number of Americans. However, the sad reality is that the problem of the uninsured persists. Clear evidence of that is the Census Bureau data showing that in 2024, ten years after the ACA became law, more than 27 million of our fellow citizens still lived without any form of health insurance.
Many Democrats say that Medicare for All, a proposed single-payer national health insurance system, is the best way to ensure universal health coverage. However, conservatives have consistently criticized that idea. They say it will create a bureaucratic, inefficient system similar to what exists in Canada or the U.K. Opponents also fear that such a government-run scheme would deprive the vast majority of Americans of their cherished employer-sponsored private health insurance.
There is indeed a long list of complaints by Canadians themselves against their country’s publicly funded healthcare system. The most common gripes include extended wait times to see specialists, long delays in scheduling elective surgeries, overcrowded emergency departments, and the exclusion of certain services such as dental and vision care. It has been reported that Canadians who can afford it choose to pay for supplemental private insurance to ensure that they and their families have more comprehensive and timely healthcare.
I have relatives and friends who live in the U.K. Their complaints about the National Health Service (NHS)—the U.K.’s public healthcare system—mirror what we often hear about the Canadian system.
Opponents of a single-payer healthcare system here in America are therefore not entirely wrong when they say we should be careful about adopting that model. The problem I have with their position is that I don’t think they ever go far enough to propose viable alternatives that could help America’s substantial uninsured population obtain coverage.
I always wonder whether those who seem comfortable with the American healthcare system as it is today ever stop to think about how scary life would be for them if they didn’t have health insurance. Large numbers of people are forced to live without treatment for all kinds of illnesses that, over time, turn into medical emergencies. Even more disturbing is the fact that there are parents who cannot easily get care for their sick children because of this lack of coverage.
There are some things in life that we can safely go without if we cannot afford them. When it comes to medical care, though, we have no such choice. Even if we discipline ourselves and eat the right way and exercise regularly, as we are told to do, there is never a guarantee that we will always have good health. Any of us could be struck by some major illness at any point. Therefore, it is important for all of us, no matter our station in life, to keep this in mind and show the right kind of empathy toward the poor and the needy. It is about putting ourselves in the shoes of others.
Most of us are fortunate to have excellent health insurance through our employers. We have a wide range of choices regarding which medical specialists we can pick, and can often obtain timely care for whatever ails us. However, that is never a source of comfort because when we lose our jobs, that coverage vanishes.
Loss of employment means that some people have to live without health insurance for indeterminate periods while they search for new jobs. Purchase of temporary private insurance is an option, but it tends to be prohibitively expensive. For these reasons, I have never been too fond of the linkage between healthcare coverage and employment. This system also makes me think of my experience with healthcare as a young boy in Ghana.
I grew up in a small Ghanaian village. At the time, there were only a handful of government-run hospitals and clinics in the country, but they were located in the cities and major towns. Most families like mine had to travel to these distant places to access healthcare. Thankfully, my family didn’t have to because there was a small hospital just a couple of miles from my village. It was set up by a Catholic charity. The hospital charged for services, but the fees were modest so the mostly indigent population in the village could receive medical treatment when necessary.
The government-run hospitals and clinics operated in much the same way. Patients were charged modest fees for the treatments they received. Generally, no appointments were required. Few communication tools existed so people just walked into medical facilities when they needed care.
In those days, Ghana’s healthcare system was quite basic. Doctors and nurses mostly treated illnesses such as malaria and stomach troubles. If anyone needed surgery, it was often for something simple like a hernia repair. Cancer, heart problems, and many of the major diseases that are common here in the West were unheard of in Ghana. They probably existed but could neither be diagnosed nor treated; people must have died from them without anyone knowing.
I am thankful for modern medicine and for all the amazing things doctors and other medical professionals can do for us here in America. However, it saddens me to know that so many people have to live in such constant worry because of a lack of health insurance. That is what makes me sometimes long for the simplicity of the life we had when I was growing up in my village in Ghana.