ABSTRACT
Massive increases in insurance coverage through employer-related access left two groups of concern: retired persons and low-income persons. In the 1950s and 1960s, access issues dominated, culminating in 1965 with the passage of laws creating Medicare and Medicaid. This chapter provides some of the evidence that has disquieted many people about the US health care system. Evans et al argued that the US and Canadian health care systems were very similar in 1971 when Canada adopted universal health insurance and budget controls through its Medicare system, US health care spending has increased at a faster pace than has Canadian spending. The chapter addresses the question of both cost growth and health outcomes in various nations. It describes the annual per capita spending on health care in each of five countries. The chapter summarizes the key features of the Patient Protection and Affordable Care Act (PPACA) and discusses what might occur with new legislative attempts to repeal, replace, or repair it.
