Health care in the United States is complicated.
In 2020, 91.4 percent of the U.S. population was covered under some form of health insurance, with a mix of private- and public-provided insurance. Private insurance is most common at 66.5 percent, compared to 34.8 percent of people covered under public programs. Most people receive insurance through their employers (54.4 percent), Medicare (18.4 percent) and Medicaid (17.8 percent).
The United States is one of the few wealthy countries that doesn’t offer universal health care, although other countries that do also provide private health insurance options. It also spends more on health care, on average, than any other country in the Organization of Economic Cooperation and Development, coming out to $10,948 per person in 2019. The next highest was Switzerland, clocking in at $7,138.
U.S. households spent 8.1 percent of their total spending on health care in 2018 compared to 5.9 percent in 2004, according to the federal government. That translated into an average increase from $2,574 to $4,968.
This varies by income bracket, with people in the bottom 40 percent paying less in absolute dollars but a higher percentage of their income than people in the top 60 percent of income earners. Those who pay the smallest percentage of their income on health expenses are in the top 20 percent of earners in the country.
Expenses also vary with age — the older you are, the more you spend.
The cost of health insurance makes up the lion’s share of overall health spending, followed by spending on actual medical services, then drugs and finally supplies.
All of this private and public spending has not, however, translated to better overall health outcomes.
According to the Commonwealth Fund, a private foundation that focuses on health care, people in the United States accessed certain preventative measures more than European countries, but have lower life expectancy and higher suicide rates.
In general, the United States has a higher number of preventable hospitalizations and avoidable deaths than its peer countries.
Notable efforts to expand health care coverage are a story of the past 80 years.
In 1965, President Lyndon B. Johnson signed legislation creating Medicare and Medicaid, federal programs that help cover seniors and low-income households, respectively. However, gaps in those programs still left many vulnerable people uninsured or unable to access certain benefits.
Medicare covers people who are aged 65 or older, but notably leaves out vision and dental coverage. Attempts to change that were stripped out of recent federal legislation, although coverage for hearing aids was added.
Many adults weren’t eligible for Medicaid at all, even those with low incomes.
The 2009 Affordable Care Act overhauled several aspects of both programs, most notably expanding Medicaid coverage to adults making less than 133 percent of the federal poverty limit. It also allowed people under the age of 26 to stay on their parents’ insurance plans, as the country was just beginning to recover from the 2007-08 financial collapse.
But having coverage isn’t the end of the story.
The private sector is byzantine, and even people with coverage can find themselves saddled with massive medical debt. Stanford economist Neale Mahoney estimated that Americans carry $140 billion in outstanding medical debt, according to a 2021 publication.
In this week’s cover story, Real Change volunteer Victor Sanchez illustrated different experiences of the American health care system, but far from all of them. Click on the image above to see panels from Mark and Angela's stories.
Read more of the Jan. 26-Feb. 1, 2022 issue.