The American Healthcare System
The USA is ranked 37th in the world in respect to overall healthcare systems (WHO) while we spend by far the greatest amount per capita and yet have 30 million uninsured and many more underinsured. The ACA was very successful in increasing accessibility and protecting individuals from a private market that denied and capped coverage. It brought us a little closer to universal coverage but it continues to rely upon the utilization of a private market structure that values profit over performance and personal health.
As of 2013, U.S. government's paid for nearly two-thirds (64.3%, $1.9 trillion) of all healthcare expenditures in our nation. Direct payment programs (ex. Medicare, Medicaid, VA) cover about 48% of outlays. Government payment of public employee health plans account for 6.4% and the US loses tax revenue through employer health plan subsidies of 10.1% total healthcare costs. The ACA increased total expenditures by direct subsidies as 8 million joined the Market Place and many received tax subsidies. Early assessments of new enrollments estimate by 2024 the government share will be 67.3%. Governments in the U.S. already assume by far the majority of financial responsibility for our existing healthcare system.
Our current healthcare system is laced with inefficiencies due to administrative waste (profit, advertising, multiplicity of plans, lack of simplicity), improper incentives to doctors and consumers, and misdirection of the control of care. Under our current system, there is little democratic control of our healthcare sector. While government may administer 64% of all healthcare in America it is the strength of lobbying and campaign donations by private corporations in Health Insurance, Pharmaceuticals, Medical Device Providers and large HealthCare Provider Networks that dictate patterns of care, availability and access to care, the costs of care and the prices of treatments and diagnostics used to provide your care.
These companies obviously act with their stockholders, not patients, in mind. Their motivation is profit oriented and the wealth they derive comes at the expense of the American people! Republicans like to say that you should have freedom to choose your doctor but you know well enough by now that both you and your doctor have limited freedom due to the rules of the private health insurance companies. Insurance companies and other corporations should not dictate or direct medical care based upon their desire to maximize profits. A modern and democratic healthcare system should be founded upon the universal and efficient provision of quality care!