**5. Reform alternatives**

The above account of the expensive missteps in U.S. health insurance over these many years shows how important universal coverage is to meet the needs of our population, as has been shown in many advanced countries around the world. Remarkably, a proposal was made for national health insurance by Teddy Roosevelt as a presidential candidate on the progressive ticket more than a century ago in 1912. It was rejected then and thereafter as the political debate became controlled by corporate stakeholders in the present lucrative financing "system." With health care now accounting for more than one-sixth of the nation's GDP, corporate power and lobbying for its continuance have continued to block reform efforts for cost containment, health care equity, and universal coverage. It has become increasingly clear that employer-sponsored health insurance has itself been a big part of the problem, as Drs. Anne Case and Angus Deaton, Professors Emeritus of Economics and Public Affairs at Princeton University recently observed:

*The historical accident of employer-based coverage is a huge barrier to reform. So is the way that the health care industry is protected in Washington by its lobbyists— five for every member of Congress [30].*

Health care has become a front-burner issue in recent political campaigns and as we head into the 2022 and 2024 election cycles. These four reform alternatives are up for debate:


The first three of these alternatives would leave a for-profit, multi-payer financing system in place with all of the problems described previously. The fourth alternative is the only one that can bring a not-for-profit public financing system with universal coverage for all Americans, cost containment, improved access and quality of care. There is a bill in the House of Representatives (H. R. 1976) for Medicare for All with more than 120 co-sponsors. However, the Congress is sharply divided along partisan lines, and this bill may have to wait for the forthcoming elections for the Congress to clarify its priorities.
