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US health care is rife with high costs and deep inequities, and that’s no accident

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Last Updated on July 20, 2025 by Daily News Staff

A public health historian explains how the system was shaped to serve profit and politicians

health care
Concessions to the private sector are one reason why health care is so costly. FS Productions/Tetra images via Getty Images
Zachary W. Schulz, Auburn University A few years ago, a student in my history of public health course asked why her mother couldn’t afford insulin without insurance, despite having a full-time job. I told her what I’ve come to believe: The U.S. health care system was deliberately built this way. People often hear that health care in America is dysfunctional – too expensive, too complex and too inequitable. But dysfunction implies failure. What if the real problem is that the system is functioning exactly as it was designed to? Understanding this legacy is key to explaining not only why reform has failed repeatedly, but why change remains so difficult. I am a historian of public health with experience researching oral health access and health care disparities in the Deep South. My work focuses on how historical policy choices continue to shape the systems we rely on today. By tracing the roots of today’s system and all its problems, it’s easier to understand why American health care looks the way it does and what it will take to reform it into a system that provides high-quality, affordable care for all. Only by confronting how profit, politics and prejudice have shaped the current system can Americans imagine and demand something different.

Decades of compromise

My research and that of many others show that today’s high costs, deep inequities and fragmented care are predictable features developed from decades of policy choices that prioritized profit over people, entrenched racial and regional hierarchies, and treated health care as a commodity rather than a public good. Over the past century, U.S. health care developed not from a shared vision of universal care, but from compromises that prioritized private markets, protected racial hierarchies and elevated individual responsibility over collective well-being. Employer-based insurance emerged in the 1940s, not from a commitment to worker health but from a tax policy workaround during wartime wage freezes. The federal government allowed employers to offer health benefits tax-free, incentivizing coverage while sidestepping nationalized care. This decision bound health access to employment status, a structure that is still dominant today. In contrast, many other countries with employer-provided insurance pair it with robust public options, ensuring that access is not tied solely to a job. In 1965, Medicare and Medicaid programs greatly expanded public health infrastructure. Unfortunately, they also reinforced and deepened existing inequalities. Medicare, a federally administered program for people over 64, primarily benefited wealthier Americans who had access to stable, formal employment and employer-based insurance during their working years. Medicaid, designed by Congress as a joint federal-state program, is aimed at the poor, including many people with disabilities. The combination of federal and state oversight resulted in 50 different programs with widely variable eligibility, coverage and quality.
A brief history of Medicaid expansion.
Southern lawmakers, in particular, fought for this decentralization. Fearing federal oversight of public health spending and civil rights enforcement, they sought to maintain control over who received benefits. Historians have shown that these efforts were primarily designed to restrict access to health care benefits along racial lines during the Jim Crow period of time.

Bloated bureaucracies, ‘creeping socialism’

Today, that legacy is painfully visible. States that chose not to expand Medicaid under the Affordable Care Act are overwhelmingly located in the South and include several with large Black populations. Nearly 1 in 4 uninsured Black adults are uninsured because they fall into the coverage gap – unable to access affordable health insurance – they earn too much to qualify for Medicaid but not enough to receive subsidies through the Affordable Care Act’s marketplace. The system’s architecture also discourages care aimed at prevention. Because Medicaid’s scope is limited and inconsistent, preventive care screenings, dental cleanings and chronic disease management often fall through the cracks. That leads to costlier, later-stage care that further burdens hospitals and patients alike. Meanwhile, cultural attitudes around concepts like “rugged individualism” and “freedom of choice” have long been deployed to resist public solutions. In the postwar decades, while European nations built national health care systems, the U.S. reinforced a market-driven approach. Publicly funded systems were increasingly portrayed by American politicians and industry leaders as threats to individual freedom – often dismissed as “socialized medicine” or signs of creeping socialism. In 1961, for example, Ronald Reagan recorded a 10-minute LP titled “Ronald Reagan Speaks Out Against Socialized Medicine,” which was distributed by the American Medical Association as part of a national effort to block Medicare. The health care system’s administrative complexity ballooned beginning in the 1960s, driven by the rise of state-run Medicaid programs, private insurers and increasingly fragmented billing systems. Patients were expected to navigate opaque billing codes, networks and formularies, all while trying to treat, manage and prevent illness. In my view, and that of other scholars, this isn’t accidental but rather a form of profitable confusion built into the system to benefit insurers and intermediaries.
President Donald Trump’s proposed cuts would reduce Medicaid spending by about US$700 billion.

Coverage gaps, chronic disinvestment

Even well-meaning reforms have been built atop this structure. The Affordable Care Act, passed in 2010, expanded access to health insurance but preserved many of the system’s underlying inequities. And by subsidizing private insurers rather than creating a public option, the law reinforced the central role of private companies in the health care system. The public option – a government-run insurance plan intended to compete with private insurers and expand coverage – was ultimately stripped from the Affordable Care Act during negotiations due to political opposition from both Republicans and moderate Democrats. When the U.S. Supreme Court made it optional in 2012 for states to offer expanded Medicaid coverage to low-income adults earning up to 138% of the federal poverty level, it amplified the very inequalities that the ACA sought to reduce. These decisions have consequences. In states like Alabama, an estimated 220,000 adults remain uninsured due to the Medicaid coverage gap – the most recent year for which reliable data is available – highlighting the ongoing impact of the state’s refusal to expand Medicaid. In addition, rural hospitals have closed, patients forgo care, and entire counties lack practicing OB/GYNs or dentists. And when people do get care – especially in states where many remain uninsured – they can amass medical debt that can upend their lives. All of this is compounded by chronic disinvestment in public health. Federal funding for emergency preparedness has declined for years, and local health departments are underfunded and understaffed. The COVID-19 pandemic revealed just how brittle the infrastructure is – especially in low-income and rural communities, where overwhelmed clinics, delayed testing, limited hospital capacity, and higher mortality rates exposed the deadly consequences of neglect.

A system by design

Change is hard not because reformers haven’t tried before, but because the system serves the very interests it was designed to serve. Insurers profit from obscurity – networks that shift, formularies that confuse, billing codes that few can decipher. Providers profit from a fee-for-service model that rewards quantity over quality, procedure over prevention. Politicians reap campaign contributions and avoid blame through delegation, diffusion and plausible deniability. This is not an accidental web of dysfunction. It is a system that transforms complexity into capital, bureaucracy into barriers. Patients – especially the uninsured and underinsured – are left to make impossible choices: delay treatment or take on debt, ration medication or skip checkups, trust the health care system or go without. Meanwhile, I believe the rhetoric of choice and freedom disguises how constrained most people’s options really are. Other countries show us that alternatives are possible. Systems in Germany, France and Canada vary widely in structure, but all prioritize universal access and transparency. Understanding what the U.S. health care system is designed to do – rather than assuming it is failing unintentionally – is a necessary first step toward considering meaningful change. Zachary W. Schulz, Senior Lecturer of History, Auburn University This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Lifestyle

How to Practice Thoughtful Grief Etiquette Online

Grief experts advise caution in sharing condolences and loss-related information on social media, emphasizing the importance of prioritizing the grieving family’s needs. Thoughtful posting practices include waiting for family approval, reaching out privately first, and avoiding speculation about the cause of death. Compassionate communication is essential in these sensitive situations.

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How to Practice Thoughtful Grief Etiquette Online

(Feature Impact) News of a death can spread online in seconds – often before families have notified close family members privately. That’s why grief experts urge people to rethink how they share condolences, tributes and loss-related information on social media, particularly during the winter months when grief can feel especially isolating.

“Grief etiquette is about putting the needs of the grieving family first, not our urge to say something publicly,” said Dr. Camelia L. Clarke, National Funeral Directors Association (NFDA) spokesperson, funeral director and grief educator with nearly 30 years of experience. “Just because information can be shared instantly doesn’t mean it should be.”

Social media has become a common place for sharing condolences, tributes and memories. However, grief experts caution that, without thoughtful consideration, online posts can unintentionally cause harm. Knowing when to post, what to say and when to remain silent can make a meaningful difference for families experiencing loss.

Consider this advice from the experts at the NFDA.

Grief Etiquette in the Digital Age

Grief etiquette refers to the unspoken guidelines for how individuals acknowledge death, loss and mourning, particularly online.

According to Clarke, one of the most important principles is restraint.

“When a death is shared online too quickly, families can feel exposed and overwhelmed at a moment when they’re still processing the loss themselves,” she said. “Waiting is an act of compassion.”

Best Practices for Posting About Loss Online

As social media continues to play a role in modern mourning, grief professionals encourage users to pause before posting and consider a few key guidelines:

  • Let the family lead. Don’t post about a death until the immediate family has made it public.
  • Ask permission. Obtain consent before sharing photos, stories or tributes.
  • Reach out privately first. A direct message, call or handwritten note can be more meaningful than a public comment.
  • Avoid speculation. Don’t ask about or share details regarding the cause of death.
  • Offer ongoing support. Grief extends far beyond the first days or weeks after a loss.

What to Say (and Avoid)

When expressing condolences online, experts recommend simplicity, sincerity and sensitivity. Messages that acknowledge loss without attempting to explain or minimize it are often the most supportive.

Helpful phrases include:

  • “I’m sorry for your loss.”
  • “Thinking of you and your family.”
  • “I’m here if you want to talk or need anything.”

By contrast, well-meaning cliches can unintentionally cause harm. Phrases such as “They’re in a better place” or “Everything happens for a reason” may reflect the speaker’s beliefs, but they can feel dismissive to someone grieving.

“Grieving people don’t need answers – they need presence,” Clarke said. “Listening matters more than saying the perfect thing.”

Resources for Families and Friends

As digital spaces continue to shape how people communicate during life’s most difficult moments, experts agree empathy, patience and respect remain timeless.

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“Grief is deeply personal,” Clarke said. “When we slow down and lead with compassion, we honor both the person who has died and those who are left to grieve.”

To learn more about how to support a grieving person and access free, expert-reviewed resources for navigating grief, expressing condolences and supporting loved ones before, during and after a loss, visit RememberingALife.com, an initiative of the NFDA.

Photo courtesy of Shutterstock

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SOURCE:

National Funeral Directors Association


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Food and Beverage

Fresh Thinking About Frozen: Bring Quality Meals to the Table While Cutting Food Waste and Stretching Your Budget

For many families, the freezer is for last-minute meal options. However, new federal nutrition guidance and growing scientific consensus reveal a different reality: frozen foods can be the starting point for healthy eating, not a backup plan.

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Last Updated on February 21, 2026 by Daily News Staff

For many families, the freezer is for last-minute meal options. However, new federal nutrition guidance and growing scientific consensus reveal a different reality: frozen foods can be the starting point for healthy eating, not a backup plan.

(Feature Impact) The key to easy preparation of high-quality meals, wasting less food and saving money may already be sitting in your kitchen.

For many families, the freezer is for last-minute meal options. However, new federal nutrition guidance and growing scientific consensus reveal a different reality: frozen foods can be the starting point for healthy eating, not a backup plan. That’s why the American Frozen Food Institute (AFFI) is launching “Fresh Thinking About Frozen,” a campaign to help families discover these benefits of frozen foods.

Making Nutrition Achievable

The recently released 2025-2030 Dietary Guidelines for Americans, the nation’s top nutrition advice, emphasizes portion control and nutrient-dense foods. Frozen options deliver on both counts.

Families who keep frozen produce on hand tend to eat more fruits and vegetables overall. Pre-portioned frozen meals also help people eat what they need without overdoing it. Plus, the convenience factor matters: frozen berries are ready for a morning smoothie, pre-cut frozen vegetables can be added to tonight’s stir-fry and a balanced frozen meal can be quickly paired with a salad.

That isn’t cutting corners. It’s being smart on how best to feed a family well.

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Freezing Hits the Pause Button on Fresh Foods

Freezing food only changes a food’s temperature, not its nutrition. Freezing keeps food close to its original state without requiring additives.

Produce begins to lose nutritional value right after it’s harvested. Freezing fruits and vegetables hours after harvest pauses nutrient degradation and locks in the vitamins and minerals, so the food remains farm fresh even as it travels across the country to your grocery store. Frozen meals are similarly made with real ingredients and turned into just-cooked recipes then frozen for families to eat when they’re ready.

The nutrition community understands this. A recent survey conducted by AFFI found 94% of registered dietitians agree frozen fruits and vegetables are just as nutritious as their fresh counterparts. Another 92% said frozen foods offer a variety of nutritious meal offerings. These findings are central to the “Fresh Thinking About Frozen” message: Frozen is not second-best. It’s simply smart.

Solving the Food Waste Problem

Nearly 40% of food in the United States gets thrown away, according to the nonprofit ReFED. That translates to roughly $1,500 per year per household, straight into the trash along with unused produce and forgotten leftovers.

Frozen helps fix that problem. Eight in 10 consumers agree buying frozen helps reduce food waste at home, AFFI research finds. The reason is simple: You use what you need, when you need it and the rest stays perfectly preserved. No more dreading the refrigerator cleanouts and feeling guilty over the uneaten food going into the trashcan.

Time for Fresh Thinking

Families already making this shift aren’t settling for less. They’re strategic about nutrition, budget and time. They integrate the freezer into regular meal planning. They feel confident about providing quality foods that are simply frozen.

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The freezer isn’t a place of last resort. It’s a tool for eating well in real life. Visit frozenadvantage.org/FTAF for tips, recipes and resources to make the most of your freezer.

Photos courtesy of Shutterstock

    

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SOURCE:

American Frozen Food Institute

At our core, we at STM Daily News, strive to keep you informed and inspired with the freshest content on all things food and beverage. From mouthwatering recipes to intriguing articles, we’re here to satisfy your appetite for culinary knowledge.

Visit our Food & Drink section to get the latest on Foodie News and recipes, offering a delightful blend of culinary inspiration and gastronomic trends to elevate your dining experience. https://stmdailynews.com/food-and-drink/

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health and wellness

Stacking Healthy Habits for Progress, Not Perfection

Healthy Habits: Many struggle with building healthier habits due to unrealistic expectations rather than lack of motivation. The American Heart Association’s My Life Check tool offers personalized heart health insights, helping to set attainable goals. Simple lifestyle changes—focused on nutrition, movement, sleep, and stress management—can gradually lead to significant health improvements.

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Despite the best of intentions, it’s common for plans to build healthy habits to fall flat. Often, the culprit isn’t a lack of motivation or discipline; rather, it’s unrealistic expectations. Understanding your personal health needs and the challenges you need to overcome can help give you a more realistic roadmap toward better health.

(Feature Impact) Despite the best of intentions, it’s common for plans to build healthier habits to fall flat. Often, the culprit isn’t a lack of motivation or discipline; rather, it’s unrealistic expectations.

Overhauling your lifestyle requires a level of commitment that isn’t always practical. Understanding your personal health needs and the challenges you need to overcome can help give you a more realistic roadmap toward better health.

Tools to Guide You
Every plan needs a starting point and there are many reputable sources that can help guide you toward a plan that addresses your personal health needs.

For example, the American Heart Association introduced My Life Check, a simple, free tool to help individuals understand their heart health and what’s driving it. Users answer simple questions about their daily habits and health factors to get a personalized Heart Health Score in minutes.

The results are private and downloadable, giving you full control of your information. The tool turns big goals into small, specific actions you can start right away. Knowing your numbers relative to your heart health (and where you are in comparison to target ranges for optimal health) can help you decide how to build a better map to get you where you want to be.

While the report is customized to each individual, no personal data is stored and answers are only used to calculate health scores and provide personalized recommendations and practical steps to improve your health, so you can use your results to focus on what matters most to you. Every small step you take, such as moving more, eating smarter, sleeping better or managing stress, can add up over time.

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Finding Your Path
Once you’re armed with data and know where you stand on your heart health numbers, small steps become clearer and more manageable. That knowledge makes it easier to choose one area to focus on, such as getting more sleep, taking daily walks or adding more color to your meals.

Healthy changes don’t need to be expensive or complicated. The best habits are ones that fit real life when every action you take moves you closer to your goals.

Eat Smart
Choose foods that help you feel your best, one meal at a time. Add more color to your plate and focus on balance, not restriction. Simple, affordable swaps can make a real difference.

Move More
Find movement that fits your life, such as a walk, a stretch or dancing while you cook. Every bit of activity counts and it all supports your heart and mind. Move for joy, not just for results.

Sleep Well
Rest is a foundation of good health, not a reward. Protect your bedtime routine and give your body the recovery it deserves. Notice how good sleep makes everything else easier.

Manage Stress
Check in with yourself regularly, both mentally and emotionally. Create simple moments to pause, breathe, laugh or step outside. Connection, kindness and calm all support a healthy heart.

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Staying motivated and on track is also easier when you can check back in, see your progress and realize the steps you’re taking are making an impact. Checking in every few months to see how you can grow gives you the chance to celebrate your progress, learn from challenges and keep building lasting habits that feel good.

To get started with personalized tips to set your own health goals, visit heart.org/mylifecheck.

Photos courtesy of Shutterstock

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American Heart Association


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