Healthcare in the United States

This article is part of a series on
Healthcare reform in the United States
History Debate
Legislation Preceding Social Security Amendments of 1965 EMTALA (1986) HIPAA (1996) Medicare Modernization Act (2003) PSQIA (2005) Superseded Affordable Health Care for America (H.R. 3962) America's Affordable Health Choices (H.R. 3200) Baucus Health Bill (S. 1796) Proposed American Health Care Act (2017) Medicare for All Act (2021, H.R. 1976) Healthy Americans Act (2007, 2009) Health Security Act (H.R. 3600) Latest enacted Affordable Care Act (H.R. 3590) Health Care and Education Reconciliation Act (H.R. 4872)
Reforms Obama administration proposals Public opinion Reform advocacy groups Rationing Insurance coverage
Systems Free market Health insurance exchange Nationalized insurance Publicly-funded Single-payer Canadian vs. American Two-tier Universal
Third-party payment models All-payer rate setting Capitation Fee-for-service Global payment
United States portal Health care portal
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Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance.^[2][3][4][5] The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP;^[2] however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations.^[6] Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.

The U.S. healthcare system has been the subject of significant political debate and reform efforts, particularly in the areas of healthcare costs, insurance coverage, and the quality of care. Legislation such as the Affordable Care Act of 2010 has sought to address some of these issues, though challenges remain. Uninsured rates have fluctuated over time, and disparities in access to care exist based on factors such as income, race, and geographical location.^{[7][8][9][10]} The private insurance model predominates, and employer-sponsored insurance is a common way for individuals to obtain coverage.^[2][11][12]

The complex nature of the system, as well as its high costs, has led to ongoing discussions about the future of healthcare in the United States. At the same time, the United States is a global leader in medical [innovation]], measured either in terms of revenue or the number of new drugs and medical devices introduced.^[13][14] The Foundation for Research on Equal Opportunity concluded that the United States dominates science and technology, which "was on full display during the COVID-19 pandemic, as the U.S. government [delivered] coronavirus vaccines far faster than anyone had ever done before", but lags behind in fiscal sustainability, with "[government] spending ... growing at an unsustainable rate".^[15]

In the early 20th century, advances in medical technology and a focus on public health contributed to a shift in healthcare.^[16] The American Medical Association (AMA) worked to standardize medical education, and the introduction of employer-sponsored insurance plans marked the beginning of the modern health insurance system.^[17] More people were starting to get involved in healthcare like state actors, other professionals/practitioners, patients and clients, the judiciary, and business interests and employers.^[18] They had interest in medical regulations of professionals to ensure that services were provided by trained and educated people to minimize harm.^[19] The post–World War II era saw a significant expansion in healthcare where more opportunities were offered to increase accessibility of services. The passage of the Hill–Burton Act in 1946 provided federal funding for hospital construction, and Medicare and Medicaid were established in 1965 to provide healthcare coverage to the elderly and low-income populations, respectively.^[20][21]