See also: Preventive medicine, Social medicine, and Universal health care
Social health insurance is where a nation's entire population is eligible for health care coverage, and this coverage and the services provided are regulated. In almost every country, state or municipality with a government health care system a parallel private, and usually for-profit, system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care. The scale, extent, and funding of these private systems is variable.
A traditional view is that improvements in health result from advancements in medical science. The medical model of health focuses on the eradication of illness through diagnosis and effective treatment. In contrast, the social model of health places emphasis on changes that can be made in society and in people's own lifestyles to make the population healthier. It defines illness from the point of view of the individual's functioning within their society rather than by monitoring for changes in biological or physiological signs.
United States
See also: Health care reform in the United States
Health care reform in the United States
Healthcare reform in the US
Patient Protection and Affordable Care Act
Healthcare Bill (PPACA): Provisions
Debate over reform
History
Public opinion
Rationing
Uninsured
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United States currently operates under a mixed market health care system. Government sources (federal, state, and local) account for 45% of U.S. health care expenditures. Private sources account for the remainder of costs, with 38% of people receiving health coverage through their employers and 17% arising from other private payment such as private insurance and out-of-pocket co-pays. Opponents of government intervention into the market generally believe that such intervention distorts pricing as government agents would be operating outside of the corporate model and the principles of market discipline; they have less short and medium-term incentives than private agents to make purchases that can generate revenues and avoid bankruptcy. Health system reform in the United States usually focuses around three suggested systems, with proposals currently underway to integrate these systems in various ways to provide a number of health care options. First is single-payer, a term meant to describe a single agency managing a single system, as found in most modernized countries as well as some states and municipalities within the United States. Second are employer or individual insurance mandates, with which the state of Massachusetts has experimented. Finally, there is consumer-driven health, in which systems, consumers, and patients have more control of how they access care. This is argued[by whom?] to provide a greater incentive to find cost-saving health care approaches. Critics of consumer-driven health say that it would benefit the healthy but be insufficient for the chronically sick, much as the current system operates. Over the past thirty years, most of the nation's health care has moved from the second model operating with not-for-profit institutions to the third model operating with for-profit institutions; the greater problems with this approach have been the gradual deregulation of HMOs resulting in fewer of the promised choices for consumers, and the steady increase in consumer costs that have marginalized consumers and burdened states with excessive urgent health care costs that are avoided when consumers actually have adequate access to preventive health care.
A few states have taken serious steps toward universal health care coverage, most notably Minnesota, Massachusetts and Connecticut, with recent examples being the Massachusetts 2006 Health Reform Statute and Connecticut's SustiNet plan to provide quality, affordable health care to state residents.
The Patient Protection and Affordable Care Act (Public Law 111-148) was signed into law by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (signed March 30), the Act is a product of the health care reform efforts of the Democratic 111th Congress and the Obama administration. The law includes health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level (FPL), subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of 4 in 2010) so their maximum "out-of-pocket" payment for annual premiums will be on sliding scale from 2% to 9.8% of income, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research.