Connect with us

health and wellness

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

Published

7 months ago

on

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.

Discover more from Daily News

Subscribe to get the latest posts sent to your email.

Related Topics:
Continue Reading
Advertisement Sports Research

health and wellness

Study Links Agent Orange Exposure to Higher Risk of Rare Melanoma

A study revealed that U.S. veterans exposed to Agent Orange are at increased risk of developing acral melanoma, a rare skin cancer located in areas not typically exposed to sunlight. With higher odds of diagnosis and poorer prognosis, early detection in veterans is vital for effective treatment and improved outcomes.

Published

2 days ago

on

February 16, 2026

By

Study Links Agent Orange Exposure to Higher Risk of Rare Melanoma

(Feature Impact) A new study found U.S. veterans exposed to Agent Orange face a higher risk of developing a rare and often overlooked form of melanoma that appears on the hands and feet, and under the nails.

Researchers reported in “JAMA Dermatology” that veterans with documented exposure to the herbicide had significantly higher odds of developing acral melanoma, a subtype of skin cancer that forms on the palms, soles and nail beds.

Unlike most melanomas, which are associated with ultraviolet radiation, acral melanoma develops in areas not typically exposed to the sun. It can resemble a bruise under a toenail or a dark patch on the bottom of a foot – locations that are easily missed and not commonly associated with skin cancer.

Because of its unusual appearance and location, acral melanoma is often diagnosed at later stages, when treatment is more difficult and survival rates are lower.

The researchers analyzed 20 years of Veterans Health Administration data, comparing more than 1,200 veterans diagnosed with acral melanoma with more than 5,000 veterans without melanoma. Veterans exposed to Agent Orange had about 30% higher odds of developing the disease.

The findings suggest Agent Orange may be an underrecognized risk factor for acral melanoma, particularly for veterans who may not view themselves as at risk for skin cancer because of limited sun exposure or darker skin tones.

“Identifying exposures that may increase risk can help inform earlier recognition and, ultimately, earlier diagnosis when treatment is most effective,” said Marc Hurlbert, chief executive officer of the Melanoma Research Alliance and a principal investigator on the study.

Senior author Dr. Rebecca I. Hartman of Brigham and Women’s Hospital said acral melanoma behaves differently from other melanomas and often responds less well to current therapies.

“Acral melanoma has a poorer prognosis than the more common cutaneous melanoma because it is often diagnosed at later stages,” Hartman said. “Identifying risk factors is critical to improving detection and outcomes.”

Agent Orange was used extensively during the Vietnam War and exposure has been linked to several cancers and chronic illnesses. These findings add to evidence the herbicide may also affect the skin in ways not reflected in traditional melanoma awareness efforts.

Acral melanoma has also been associated with sex, race and ethnicity, and prior skin lesions. Researchers said the study supports treating the disease as distinct from sun-driven melanomas that dominate public education campaigns.

Advertisement
Get More From A Face Cleanser And Spa-like Massage

For veterans, the research highlights the importance of examining less visible areas of the body, including the bottoms of the feet, between the toes and under the nails. Changes in nail color, dark streaks or unexplained spots on the palms or soles should be evaluated by a health care provider, especially for those with known Agent Orange exposure.

Researchers said the findings could help guide future screening strategies for higher-risk populations and encourage further study of why acral melanoma differs biologically from other skin cancers.

Find more information at curemelanoma.org.

Photo courtesy of Shutterstock

collect?v=1&tid=UA 482330 7&cid=1955551e 1975 5e52 0cdb 8516071094cd&sc=start&t=pageview&dl=http%3A%2F%2Ftrack.familyfeatures

SOURCE:

Melanoma Research Alliance

Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.

Discover more from Daily News

Subscribe to get the latest posts sent to your email.

Continue Reading

health and wellness

Progress, Not Perfection: How Healthy Habits Can Stack Up One Step at a Time

The article emphasizes that achieving better health relies on progress, not perfection. It advocates for realistic goals and highlights tools like My Life Check for personalized health assessments. Small, manageable changes in diet, exercise, sleep, and stress management can significantly impact overall well-being, making healthy habits more attainable and sustainable.

Published

2 days ago

on

February 16, 2026

By

Healthy Habits .

Progress, Not Perfection: How Healthy Habits Can Stack Up One Step at a Time

(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.

17763 B detail embed2

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.

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.

Healthy Habits for Everyday Life

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.

Advertisement
Get More From A Face Cleanser And Spa-like Massage

Smart Tip: Aim for an overall healthy eating pattern that includes whole foods, fruits and vegetables, lean protein, nuts, seeds and cooking in non-tropical oils such as olive and canola.

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.

Smart Tip:Adults should get 150 minutes of moderate physical activity (or 75 minutes of vigorous activity) per week. Kids should aim for 60 minutes every day, including play and structured activities.

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.

Smart Tip: Most adults need 7-9 hours of sleep each night. Children require more. Adequate sleep promotes healing, improves brain function and reduces the risk for chronic diseases.

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.

Smart Tip:The first step to stress management is awareness. Step “away from yourself” for a moment. Objectively ask yourself, “Is my stress level too high?” If so, look at what might be causing that stress.

Ideas for Incremental Changes

  • Dedicate 15 minutes at the beginning or end of the day to focus on self-care, whether it’s unwinding with some music, writing down your goals or reflecting on the highlights of the day.
  • Aim to add an extra serving of fruits or veggies each day, such as creating a savory veggie omelet or exploring new smoothie blends that let you pack in the produce on the go.
  • Give your cabinets a quick update and put the smaller plates front and center. When you use a smaller plate, you can fill it while still sticking to recommended serving sizes.
  • If you’re not a fan of the gym, think about how your hobbies can play a role in your physical activity. Even gardening counts as physical activity, so get creative to get moving with an activity you truly enjoy.
  • Establish a bedtime routine that allows you to ease into sleep more easily. Once you feel the impact of better-quality rest, you may find yourself more motivated to make a regular bedtime a priority.

Photos courtesy of Shutterstock

collect?v=1&tid=UA 482330 7&cid=1955551e 1975 5e52 0cdb 8516071094cd&sc=start&t=pageview&dl=http%3A%2F%2Ftrack.familyfeatures

SOURCE:

American Heart Association

Advertisement
Get More From A Face Cleanser And Spa-like Massage

Discover more from Daily News

Subscribe to get the latest posts sent to your email.

Continue Reading

health and wellness

4 Tips to Maximize Nutritional Goals While On a GLP-1

GLP-1 medications for weight loss have gained popularity, with new research emphasizing the importance of nutrition and lifestyle. Prioritizing protein and fiber can combat common side effects like nausea and constipation, while staying hydrated and eating smaller meals enhances tolerance. Adopting these habits may improve weight loss results for GLP-1 users.

Published

4 days ago

on

February 14, 2026

By

17794 detail intro

(Feature Impact) The first GLP-1 (Glucagon-Like Peptide-1) medication was approved for weight loss use more than a decade ago with new more effective versions being approved by the FDA over the past few years. As the use of these medications continues to rise, new research highlights the important role nutrition and lifestyle habits can play in supporting muscle, metabolism and long-term weight loss when using the medication.

Whether you’re new to GLP‑1s or navigating the next phase of your journey, small nutrition shifts powered by protein, fiber and hydration can help you feel strong, confident and supported.

Common side effects experienced by GLP-1 users are often digestive and include nausea, constipation, stomach pain, bloating and more. A pilot clinical trial by Atkins suggests pairing GLP‑1 use with targeted macronutrients, especially protein and fiber, may support healthier body composition and a lower-carb diet with higher protein and fiber intake is well tolerated.

Feast On Fiber
Digestive slow‑downs, including constipation, are among the most common GLP‑1 side effects. Prioritizing fiber not only helps food move comfortably through the body, it supports your gut health and steady energy. Many fibers are prebiotics, meaning they promote the growth of beneficial gut bacteria. Prioritize foods like apples, melon, berries, cruciferous vegetables and leafy greens to boost fiber intake.

Prioritize Protein
When your appetite changes, structure helps. Anchoring your day with reliable protein sources helps make nutrition easy. Prioritizing protein may help prevent lean muscle loss, and nutrient dense protein sources can help you get enough essential nutrients to support overall health. Supporting a protein- and fiber-rich diet can start with a solution like Atkins High Protein Shakes, which are packed with 30 grams of protein and 7 grams of prebiotic fiber and provide more than 20 essential vitamins and minerals.

Designed to be an ally for your nutritional goals, they’re gluten-free, low-glycemic and keto-friendly with 3 grams of net carbs and 1 gram of sugar per serving. Experts recommend making sure you’re consuming enough protein to help limit lean muscle loss when using a GLP-1 to lose weight.

Hydrate to Help Prevent Side Effects
GLP-1 users in particular are encouraged to prioritize fluids. Staying hydrated can help with both constipation and nausea, two common side effects. Drinking water helps support kidney and liver function, which are vital for weight loss and overall health. Adequate fluids help food move through your body, combat fatigue and replenish losses from potential nausea or constipation, preventing complications and improving tolerance to GLP-1s.

Eat Small, Frequent Meals
Large meals can feel uncomfortable when digestion slows. Instead, focus on smaller, more frequent eating moments that give your body a steady supply of nutrients without overwhelming your system.

For an easy, GLP‑1‑friendly option, try Atkins High Protein Bars, which are high in protein and fiber while minimizing net carbs. Available in flavors like Cookie Fusion, Chocolate Peanut Butter and Brownie Delight, they’re a satisfying way to stay fueled between meals and a simple solution when appetite cues are muted. The snacks are designed to take the guesswork out of choosing high‑protein, low‑carb options that support your goals.

Living well on a GLP‑1 is about support, confidence and clarity. Consuming adequate amounts of protein and fiber, staying hydrated and maintaining daily structure can help you feel energized and empowered every step of the way. By following nutritional guidelines and making mindful lifestyle choices, GLP-1 users can experience better outcomes on their weight loss journeys.

To explore products that prioritize protein and fiber that can be a part of anyone’s daily diet, visit Atkins.com.

Advertisement
Get More From A Face Cleanser And Spa-like Massage

Photo courtesy of Shutterstock

collect?v=1&tid=UA 482330 7&cid=1955551e 1975 5e52 0cdb 8516071094cd&sc=start&t=pageview&dl=http%3A%2F%2Ftrack.familyfeatures

SOURCE:
Atkins

Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.

Discover more from Daily News

Subscribe to get the latest posts sent to your email.

Continue Reading

Trending