The Vexing Problem of Access to Health Care in America: Is Employer-Based Health Insurance the Real Culprit?

Abstract

As a country without universal access to health care, the United States struggles with ways to provide access to care. The United States is the only high-income country that does not guarantee health coverage and concomitantly it has worse outcomes on many measures. 1,2 An article in this issue of Family Medicine discusses a student-run free clinic, an access-to-care strategy based on voluntarism. 3 The use of student-run free clinics is a limited fix to the bigger problem of health care access in the United States. 4 Another strategy based on voluntarism is to provide care via physician volunteers. 5 According to the National Association of Free and Charitable Clinics (NAFC), in 2022, physician volunteers helped 1.7 million patients through 5.8 million patient visits. 5 Importantly, the majority of the patients at these charitable clinics are employed. 6 One study showed that 34% had full-time employment but no benefits. 7 The US health system is built on the bedrock of employerbased health insurance. This is a structural flaw for guaranteeing health care access. The data from free clinics show that a health system built on employer-based health insurance is insufficient for access. Perhaps this structural flaw of employer-based health insurance is the root cause we need to address.