America's health care safety net system, once a patchwork of public and private solutions for the uninsured, faces unprecedented deterioration. Historical analysis spanning three decades since Medicare and Medicaid's 1965 establishment reveals how fragmented financing streams—combining employer-sponsored coverage, government programs, and provider charity care—created an implicit safety net that is now unraveling. Through policy analysis and examination of economic trends, this research demonstrates how the "Purchaser Revolution" of the 1990s fundamentally altered power relationships in American health care. Aggressive cost-containment measures by large purchasers, coupled with the conversion of non-profit hospitals and insurance plans to for-profit status, has systematically weakened traditional safety net mechanisms. Employment-based insurance coverage has declined due to economic shifts toward service-sector and part-time employment, while traditional providers of charity care have simultaneously reduced their commitment to uncompensated care. These converging trends portend a troubling future: an increase in uninsured Americans alongside the erosion of the very infrastructure designed to serve them, potentially creating unprecedented barriers to health care access beyond emergency services.