Historical and comparative reflections on the U.S. national health insurance reforms

The 2010 US reforms addressed forms of public and private insurance designed to reinforce a delivery system that developed to maximize the autonomy of physicians and hospitals. That autonomy emphasizes fees and specialization, which led to for-profit incorporation and overtreatment. Powerful corporate lobbies have defeated previous reforms and diluted the impact of the Obama reform. It barely passed and does little to manage costs or rationalize medicine. US health care does not fit established models of welfare states and contains five different models of health care delivery. Most interesting are forms of democratically run community health centres. Selected features of the reforms are highlighted.