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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

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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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Consumer Corner

Tips for Cleaning and Maintaining Hardwood Floors

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Last Updated on February 1, 2026 by Daily News Staff

Hardwood floors

(Family Features) Hardwood floors come in a variety of types. Before diving into the cleaning process, it’s important to recognize the type of floor – and its finish – in your home.

Whether solid wood or engineered wood (multiple layers of wood veneer), each flooring type has specific cleaning needs. The same is true for the type of finish used, including durable and water-resistant surface finishes like polyurethane and polycrylic or penetrating finishes such as oil or wax, which require more meticulous care to ensure longevity and maintain shine.

Transform your hardwood floors from dull to dazzling with these cleaning tips.

  1. Prepare the Area: Remove furniture and rugs from the room to ensure you can clean every inch of the floor. Check for any debris or dirt that can be swept away with a soft-bristle broom or vacuumed using a hardwood floor vacuum attachment.
  2. Dust and Sweep: Thoroughly sweep the floor to remove dust and dirt. Use a microfiber mop to capture finer particles the broom might miss.
  3. Spot Clean: Identify any stubborn stains or spots. Use a damp cloth and small amount of hardwood floor cleaner to gently scrub these areas. Avoid harsh chemicals (including vinegar and ammonia), abrasive scrubbers and soaked cloths to prevent damage to the wood or finish.
  4. Mop the Floor: Fill a bucket with water and add a few drops of pH-neutral hardwood floor cleaner. Dip the microfiber mop into the solution, wring out excess water and mop the floor following the grain of the wood. Work in small sections to prevent water from sitting on the floor too long. Note: Excessive water can seep into the wood and cause swelling, warping or mold growth.
  5. Dry the Floor: Immediately after mopping, use a dry microfiber cloth to wipe the floor to remove any remaining moisture and streaks before walking on it.
  6. Prevent Long-Term Danage: Place doormats at entryways to catch dirt and moisture before they reach your floors. Use area rugs in high-traffic areas, felt pads under furniture legs to prevent scratches and a dehumidifier to control humidity levels, which can impact wood stability.
  7. Maintain the Shine: Apply a hardwood floor polish every few months according to the manufacturer’s guidelines. Test the polish in an inconspicuous area first to ensure compatibility with your floor’s finish.

For more home maintenance guidance, visit eLivingtoday.com.

Photo courtesy of Shutterstock

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SOURCE:
eLivingtoday.com

https://stmdailynews.com/the-fate-of-lucky-supermarkets-in-socal/


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Health

5 Rare Kidney Diseases You May Not Know About

The article highlights five rare kidney diseases, including IgA Nephropathy, APOL1-Mediated Kidney Disease, Polycystic Kidney Disease, Cystinosis, and Complement 3 Glomerulopathy. These conditions, often misunderstood or undiagnosed, emphasize the importance of awareness and education to improve early detection and management, particularly for those affected.

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5 Rare Kidney Diseases You May Not Know About

5 Rare Kidney Diseases You May Not Know About

(Family Features) While the leading cause of kidney disease is diabetes, many other factors can lead to kidney disease and failure – including a collection of rare and genetic conditions. According to the National Organization for Rare Diseases (NORD), a disease is considered rare if it affects fewer than 200,000 people in the United States. Today, 30 million Americans are living with rare diseases.

This Rare Disease Day, observed on Feb. 28 worldwide, the American Kidney Fund is committed to improving the understanding of rare kidney diseases by providing educational resources.

IgA Nephropathy
An autoimmune disease, IgA nephropathy (IgAN) is related to improper function of the immune system. IgAN causes the immune system to produce abnormal antibodies, which build up in the kidneys, triggering inflammation and reducing the kidneys’ ability to filter waste and fluid, causing damage and potentially leading to kidney failure.

According to NORD, approximately 70% of rare diseases begin in childhood, which was the case for Malkia White. She had no symptoms – the only indication of her kidney problem was protein and blood in her urine detected through a routine test. She was diagnosed with IgAN but continued living her life without any changes – the disease was so rare, little was known at the time about how to manage it.

“From 6 years old to the age of 42, I maintained my medical appointments and lived an active lifestyle,” White said. “I was an honor student. I was always in dance class. In high school, I was in a marching band and on the field hockey team. In that time period, I was being checked. It never occurred to me, or my family, to investigate or research [IgAN].”

APOL1-Mediated Kidney Disease
Known as AMKD, this is a spectrum of kidney diseases associated with variants (mutations) in the apolipoprotein L1 (APOL1) gene. Everyone has two copies of the APOL1 gene, but mutations of the gene can raise the chance of rapidly progressive kidney disease in people of western and central African descent.

Polycystic Kidney Disease
Polycystic kidney disease (PKD) is a genetic disease that causes cysts to grow inside the kidneys. There are two forms of PKD: autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD). The former is more prevalent, accounting for about 9 of 10 cases of PKD.

Cystinosis
A rare, multisystem genetic disease, cystinosis accounts for nearly 5% of all childhood cases of kidney failure, although some people with cystinosis do not develop kidney disease until they’re teens or adults. Caused by mutations in the CTNS gene, cystinosis happens when cystine, a component of protein, builds up in your body’s cells. Too much cystine causes crystals to form and can damage organs including kidneys, eyes, pancreas, liver and brain.

Complement 3 Glomerulopathy
With complement 3 glomerulopathy (C3G), a part of the immune system called the complement system becomes overactive and doesn’t work properly, leading to damage and inflammation in the kidneys. Specifically, it damages the kidneys’ glomeruli, which help kidneys filter toxins out of the blood. It can cause kidney failure in about half of adults who are diagnosed with the disease.

Michelle Farley had a hard time getting her C3G diagnosis despite high blood pressure and an irregular heartbeat in her youth and suffering from daily vomiting and weekly headaches while in college. After a trip to her college medical center, she discovered her blood pressure was so high she was at risk for stroke or heart attack. Bloodwork determined she had markers for kidney disease, but she wouldn’t receive a full diagnosis until she was 25.

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“I was left undiagnosed for almost 22 years due to preconceived notions of how disabilities and sicknesses should ‘look’ on the outside and how old you need to be to have a chronic disease,” Farley said. “I think it’s important to spread awareness about rare kidney diseases so patients can be diagnosed faster and more accurately. I always wonder how long I could have maintained my native kidneys if I was diagnosed as a child.”

Learn more about rare kidney diseases and the Rare Kidney Disease Action Network by visiting kidneyfund.org.

Photo courtesy of Shutterstock

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SOURCE:

American Kidney Fund

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health and wellness

Seeing the Possibilities: Living with Low Vision

Millions of Americans face challenges due to low vision, a condition that is not an inevitable part of aging. February’s Low Vision Awareness Month highlights the importance of eye exams and awareness. Effective management strategies include environmental modifications, assistive devices, and vision rehabilitation services to improve daily living and maintain independence.

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Millions of Americans are living with low vision, a visual impairment that can turn everyday moments into unexpected challenges. Consider this information to make the most of your vision and improve your quality of life.

(Family Features) Millions of Americans are living with low vision, a visual impairment that can turn everyday moments – recognizing a friend’s face across the street, reading a recipe or checking a text message – into unexpected challenges.

Low vision isn’t a natural part of getting older, though the conditions that cause it do become more common with age.

Whether low vision is affecting you or a loved one, Low Vision Awareness Month is a perfect time to have your eyes examined for signs of eye diseases and to take steps to make daily life easier if you are experiencing low vision.

Consider this information from the National Eye Institute to make the most of your vision and improve your quality of life.

Understanding low vision
You may have low vision if you can’t see well enough to read, drive, recognize faces, distinguish colors or see screens clearly.

Many different eye conditions can cause low vision, but the most common causes are age-related macular degeneration, cataracts, glaucoma and diabetic retinopathy, a condition that can cause vision loss in people with diabetes.

The most common types of low vision are:

  • Central vision loss (not being able to see things in the center of your vision)
  • Peripheral vision loss (not being able to see things out of the corners of your eyes)
  • Night blindness (not being able to see in low light)
  • Blurry or hazy vision

Diagnosing low vision
Your doctor can check for low vision as part of a simple, painless comprehensive dilated eye exam. He or she will ask you to read letters that are up close and far away and will check whether you can see things in the center and at the edges of your vision.

Then eye drops are used to widen your pupils and check for other eye problems – including conditions that could cause low vision.

Low vision is usually permanent, but glasses, medicine or surgery may help with daily activities or slow progression.

Living with low vision
If you have low vision, you aren’t alone. There are steps you can take to make life easier.

For minor vision loss, simple adjustments like using brighter lights, wearing anti-glare sunglasses and using magnifiers can help. Changing the settings on your phone and computer to increase contrast, make text larger or have the device read out loud may also help.

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If your vision loss is getting in the way of everyday activities, ask your eye doctor about vision rehabilitation. These services can give you skills and resources to help manage your daily life and keep your independence. Examples include:

  • Employment and job training
  • Environmental modifications, like improving lighting and contrast
  • Assistive devices and technologies, like magnifiers, filters and screen readers
  • Adaptive strategies for daily living and independent living skills training
  • Emotional support, like counseling or support groups
  • Transportation and household services

Finding the right vision rehabilitation services and support may take time, but working closely with your eye doctor or care team is an important first step. Discuss your needs and goals for living with your visual impairment so they can help identify the best services for you.

For additional resources and information on vision rehabilitation, visit nei.nih.gov/VisionRehab.

Photo courtesy of Shutterstock

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SOURCE:

National Eye Institute


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