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Traditionally held American cultural beliefs and values,
technological advances, social changes, economic constraints,
and political opportunism are the main historical factors that have
shaped health care delivery. Because of these factors, health care
in the United States is mainly a private industry, but it also
receives a fairly substantial amount of nancing from the
government. However, government nancing is used mainly to
help the very poor, the elderly, and the disabled to receive health
care services. Working middle-class Americans must depend on
private health insurance, which most people obtain through their
places of employment. Those who cannot a#ord the price of
premiums and who do not qualify for government insurance
programs are left without any health insurance.
Major changes driven by social, cultural, technological, economic,
and political forces will be instrumental in shaping the future of
medical services in the United States. These forces interact in a
complex manner; therefore, it is not always easy to attribute a
change in health policy or the creation of a new program to any
single factor.
Could a social or economic crisis usher in a national health care
program? There is always a possibility that, given the right set of
conditions, a national health care program will become a reality in
the United States. Fundamental changes in the nancing and
delivery of health care can occur only when the sizeable middle
class develops a mindset based on social justice principles.
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