The American Pathology of Inequitable Access to Medical Care

This chapter maps out the complex picture of access to medical care in the United States. It reflects on how variable access illustrates an American ambivalence about health solidarity. The chapter first considers healthcare financing as one critical element that defines access to medical care and describes the multifaceted US healthcare financing structure, predominated by public insurance programs for select populations and regulated private insurance for others. Next, this chapter describes how access is equally shaped by legal requirements that create treatment obligations for doctors or hospitals regardless of how someone pays for care. There is no constitutional right to health in the United States, but various layers of statutory and common law have created some guarantees. That said, despite efforts to increase access over the past decades, the United States is still extraordinary, as compared to peer nations, on the unevenness of access to medical care among its population.