Since its inception in the beginning of the 20th century, healthcare has remained a wildly controversial topic. Its beginnings were founded on no more than a need for employees to negotiate employer-given benefits in order to compensate for the loss of wages, decreed by the United States government, during World War II. It was from there that the foundation of healthcare policies was constructed, based solely upon employer benefits, rather than a proposed, organized system. In this sense, the healthcare system saw no substantive foundation whatsoever. “Health insurance makes a difference in…ultimately how healthy [people] are” (The Uninsured: A Primer, 11). It is this simple fact that relinquishes and dismantles any opposition to the imminent need for a healthcare system. However, due to the fact that this system, as previously touched upon, was discharged upon no more than the mere advantages doled out to employees, the healthcare system has since recognized no strong infrastructure upon which it receives support.

The current employer-based system varies drastically from that of the 1950s. The system, then, was divided into three sectors: industrial, retail, and governmental, with the retail sector receiving the least amount of benefits due to its low profit margins and lack of unionized labor forces. The industrial sector received benefits due to its importance during wartime, as these laborers were those who constructed and made successful the machinery of the troops of the United States. However, as our world developed and began to stray away from the more mechanized, factory-like work that came out of the industrial sector, the retail sector, so too, began to transform, consuming just over half of the employment population today. In the present day United States, employees within the retail sector have a more accessible route to affordable insurance. The problem, however, lies with the inequality amongst employees across all sectors, and amongst the plans which they are eligible to receive.

Many workers are impaired namely by their ethnicity and their socioeconomic status, as studies have shown. Given the so-called “social determinants of health,” (Patel, Rushefsky, 222) many people face inferiorities that prevent them from having the proper access to healthcare that is needed in order to ensure safety for themselves and their families. These inferiorities range from access to educational opportunities to language and literacy barriers. Perhaps the most dominant of these “social determinants” is access to job opportunities, although, in many cases, employment has had the opposite effect on the ability to conveniently access health insurance. “Employment increased the difficulties…faced in maintaining a stable home life, and it frequently meant the loss of Medicaid” (Angel, Lein, Henrici, 101). There are various types of workers who are ineligible for health care benefits under the employer-based system for a variety of reasons, particularly those who are part-time workers, or those “under the table” workers who receive cash in exchange for their services. Unfortunately, “those without insurance are often charged more for healthcare services than those with coverage” (Patel, Rashefsky, 211). Employers have the connections to be able to bargain for a discount on rates given to their employees. However, in spite of this fact, oftentimes employers hire part-time employees to avoid the need to pay for their benefits altogether. This tactic is nothing short of debilitating for those workers whose only income is sourced from part-time work, for they are not qualified to receive the same healthcare plans under their employers.

In turn, there is a sort of snowball effect that occurs, as “most uninsured people have few, if any, savings or assets they can easily use to pay health care costs” (The Uninsured: A Primer, 14). As technologies become more advanced, and consequently more expensive, and are implemented into more healthcare facilities, costs of payment plans begin to increase, as these institutions are in greater need of compensation. Similarly, given the rapid and continual progress the medical world has seen in recent years due to these improvements in healthcare reform and various, more complex forms of research, there are longer life expectancies, as well as elongated treatment processes that only continue to increase costs of health insurance. While these costs soar astronomically above the affordable level for those struggling to keep up with their insurance payments given their current financial situation, employers have become more rigid regarding how much of their employees’ plans they will cover. Even more detrimental to this somewhat compassionless employer-based decision is that, in the event of an economic recession, employers can no longer afford to support their employees’ healthcare needs without exhausting their finances. This, then, brings about yet another issue with the employer-based system; its dependence upon the economy.

Not only does an economic downturn affect those already uninsured, but it takes a toll on the wages and benefits of both part-time and full-time employees, as well as employers. The wages employees receive have likely already taken a large cut in order for employers to provide the benefits that these employees see through their health insurance. In efforts to save money, employers, then, will put their financial needs above those of their employees, regretfully taking away those benefits onto which their employees had clung. This does not mean that employers are stripping their employees of their health care plans, but rather, refusing to pay the percentage they had previously promised, in order to help with coverage compensation. This percentage compensation is the basis of this so-called “employer-based” system. This sudden lack of indemnity poses a great threat to these struggling employees, many of whom already find themselves in major financial debt due to their low-income positions and high-deductible health insurance plans.

An even more perplexing fact regarding those facing arrears is the quality of the care they receive. Those fortuitous enough to obtain a private health care plan are more often than not perceived as healthier than those who are forced to turn to public plans such as Medicaid. “Such people are at a higher risk of disease and death and are less likely to receive the services that they need when they need them” (Patel, Rushefsky, 209). Those who are uninsured or underinsured are at a greater risk for shorter survival rates and for increased disease rates. Ironically, employers will look upon potential employees with skepticism, and oftentimes refuse to hire them, should they have a family member requiring immediate medical care, as this means more money spent by the account of the employer. There is a vast majority of insured people, whether through their employers or through out-of-pocket payments, who are on the receiving end of inferior health insurance plans that do not offer the necessary coverage in order to protect themselves and their family members for whom they provide. The people who fall under this category are referred to as “underinsured.” “Having health insurance is no guarantee that children will get appropriate, high-quality care” (Patel, Rushefsky, 210). It is clear that regardless of the extremely taxing amount spent in order to receive various benefits, the provisions can amount to nothing more than mediocre depending upon the chosen plan. This handicap relates back to what were referred to as “social determinants,” as not receiving a proper education in regards to what types of health plans exist can lead to improper decision-making on the part of the provider.

It is evident that there needs to be a change in the overall way that the health care system is run. This lack of efficiency has protruded from the duly noted lack of groundwork underneath the healthcare system as a whole. There needs to be more standardization in terms of costs, prominently coverage given by employers, as well as increased transparency on the part of insurance companies so as to make known the plans they offer in return for specified premiums and deductibles. This clarity may be given through employers so as to ensure the utmost protection for their employees while simultaneously – in financial interest - keeping their coverage costs relatively low. These endeavors are not simple nor is there a solution that can be devised from little more than what is currently in place. The employer-based system in the United States is conclusively extremely flawed and has been toyed with over the years in order to provide for those who need providing for. It has yet to find that which will make those citizens who feel less than secure, a confidence in knowing they have the same rights to protection as all those, more fortunate, who surround them.