Like a blemish on the face of a beauty queen, the increasing number of uninsured citizens continues to mar America's otherwise glamorous healthcare delivery system.
Although the U.S. is the top spender and sets the world's standards with advanced treatment of disease and injury, it still fails to insure one in seven of its residents.
"Forty-three million uninsured Americans is by far the biggest disgrace of our healthcare system," says Ron Pollack, director of the consumer advocacy group Families USA.
Many American presidents in the 20th century have sought to address the problem, but all have failed to reverse the trend. Lyndon Johnson was successful in establishing the Medicare and Medicaid programs to cover senior citizens and indigent mothers and children. Bill Clinton signed legislation to create the State Children's Health Insurance Program to extend insurance to children of the working poor.
"I don't think the issue is a novel issue today; it is something that picks up even greater importance because the number has grown," Pollack says.
Pegged at 42.6 million in 1999, the number of uninsured has increased by nearly 10 million in the past decade.
Last year, a pair of normally opposing groups, Families USA and the Health Insurance Association of America, joined in advocating a mixture of tax credits and expansion of existing public programs to reduce the number of people without health insurance.
Nearly $100 billion was earmarked in this year's federal budget to address the uninsured problem over the next 10 years, but many wonder if the funds will be available since a revenue-draining tax cut was enacted.