How U.S. Health Care Reform Works

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President Obama, pictured here speaking with health care providers at Children's National Medical Center, has made health care reform a priority for 2009.

U.S. President Barack Obama has said on multiple occasions that if he were to design a health insurance system from scratch, then he would implement a single-payer system. In this type of system, health care is paid for all citizens by the government. Obama's oft-repeated quote might make some citizens think that his push for health care reform in 2009 is a mere cover for government takeover of the health care system. We'll become like Canada or Britain, according to critics, where there are high taxes and long lines to see a doctor.

But while Obama has publicly pined for a health care do-over, he has also said repeatedly that he understands that the United States isn't starting from scratch. People have doctors and health insurance that they like, and it would be impossible and disruptive to dismantle such a massive system. Instead, Obama promises that if health care reform is achieved, we will be left with a system that isn't Canadian or British, but "uniquely American."

The United States already has a pretty unique system in place, one that was built on something of an accident. Private insurers didn't believe that much money could be made in health care until World War II. Prior to that point, early health care systems were essentially nonprofits that charged customers the same low rates regarding of age or health condition. But in the 1940s, to curb wartime inflation, the government implemented price controls and froze wages. What remained unfrozen and untaxed were fringe benefits that a worker received, so employers, desperate for decent labor, offered health insurance as a workplace perk. As a result, the United States ended up with a system in which most citizens receive their health insurance through their employer. While employer-based health insurance may occur in other countries, no other country relies on the system to the extent that the United States does.

Liberal politicians since the time of Harry S. Truman have wanted to change this system in order to provide coverage to more people. These efforts have largely failed, with the notable exception of Lyndon B. Johnson's passage of Medicare and Medicaid, which provide health insurance for seniors and for those with low incomes, respectively. One reason for these failures may be the powerful lobbyist organizations in Washington, such as those representing insurance companies, pharmaceutical companies and doctors [source: Krugman, Wells]. But it may be that Americans just don't see the need for reform; a 2009 CNN poll found that approximately eight in 10 Americans are satisfied with their health insurance [source: Steinhauser]. So how is Barack Obama making his case that now is the time to fix this system? And just what is this "uniquely American" system going to look like?