- The United States has been virtually alone among developed nations in not implementing a universal healthcare system. However, the U.S. health system does have significant publicly funded components. Medicare and Medicaid coverage is financed from taxation, but care is generally provided by privately owned hospitals or physicians in private practice. Medicare is a federal government program providing coverage to people age 65 or older. Medicaid is a federal and state program providing coverage to low-income and disabled persons. The Department of Veterans Affairs directly provides health care to U.S. military veterans through a nationwide network of government hospitals. However, a significant number of people exist who do not obtain health insurance through their employer, are unable to afford individual coverage or elect not to purchase it, and are not elderly or poor enough to qualify for Medicare or Medicaid coverage. Currently, it is estimated that 17% of the U.S. population is uninsured. A few states have taken serious steps toward universal health care coverage, most notably Minnesota. Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy.
Aspects of the United States health system
Whether publicly funded healthcare can adequately deliver health care more cost effectively than the free market is a matter of much debate. Of all developed nations, the healthcare system of the United States has the highest degree of privatization. Consequently, it is frequently cited by those favoring or opposing universal healthcare.
The cost and quality of care in the United States are frequently the two major issues of discussion. Although the United States is below the average for developed countries in health measures such as infant mortality, maternal death, life expectancy, or cancer survival rates, relevant statistics include people not covered by any insurance and those covered by the system get what is arguably the best health care in the world. Access to advanced medical treatments and technologies is greater than in most other developed nations and waiting times are substantially shorter for treatment by specialists. Also many foreign citizens visit the U.S. to obtain treatments unavailable or available only with long waiting lists in their home countries.
The United States does spend more on health care, as an absolute dollar amount and per capita, than any other nation. It also spends a greater fraction of its national budget on health care than Canada, Germany, France, or Japan. In 2001 the United States spent $4,887USD per person on health care, more than double the rate of any other G7 country except Japan, which spent $2,627 per capita annually. Risk factors specific to the U.S. population, such as a relatively high prevalence of obesity, may partially explain increased health care spending; however, many other industrialized nations do share these problems to some extent. Although the U.S. Medicare coverage of prescription drugs is scheduled to begin in 2006, most patented prescription drugs are significantly more costly in the United States than in most other countries. Factors involved are the absence of U. S. government price controls, enforcement of intellectual property rights limiting the availability of generic drugs until after patent expiration, and the monopoly purchasing power seen in national single-payer systems. Many U.S. citizens obtain their medications, directly or indirectly, from foreign sources, to take advantage of lower prices.
The United States system does have substantial public components. Of every dollar spent on health care in the United States, 44 cents comes from some level of government. The elderly are covered by Medicare, the poor (those with assets of less than $2,000) are covered by Medicaid, merchant seamen are covered by the Public Health System, and retired railway workers and military veterans are also covered by the government. Government also affects private sector medicine through licensing and regulatory barriers to entry into health professions.
Most experts believe that the U.S. system is best described as exhibiting greater inequality than others, with covered people receiving a very high quality of care and the uninsured and underinsured receiving a lower standard of care. It is not clear that the lower standard of care received by the uninsured and underinsured in the United States is actually lower than that of other nations that provide complete publicly funded health care. Facilities, such as emergency rooms, hospitals, and urgent care facilities are often required to treat everyone by law.
Cost-cutting in the private sector
Some health economists assert that traditional private plans are not very good at limiting spending to cost-effective procedures and schedules, and that consumers exploiting this would view the transition to a public system as a reduction in their compensation or benefits.
Other health economists believe that with the growth of health maintenance organizations and other cost-cutting entities, private plans now limit spend, with consequences for paperwork and some needed treatments. A number of high-profile instances of Medicaid fraud have been uncovered among health care providers and medical device suppliers.
Market failure issues
Various healthcare analysts have asserted that market failure occurs in healthcare markets , but some have suggested that it is result of too much government involvement rather than too little.
The consumers of health care often lack basic information compared to the medical professionals they buy it from, and fully informed choices (particularly in emergencies) are often not plausible. Demand is likely to be inelastic. The medical profession potentially may set rates that are well above ideal market value, and they are controlled by licensing requirements, with some degree of monopoly or oligopoly control over prices. Monopolies are made more likely by the variety of specialists and the importance of geographic proximity. Private insurance has been perhaps the only stabilizing force as they pay a contractually fixed cost for a given procedure. With no more than one or two heart specialists or brain surgeons to choose from, competition for patients between such experts is limited so contractually pre-arranged pricing helps reduce supply-limited pricing.
Preventive medicine issues
There is much conflicting information about the role of preventive medicine in controlling medical costs and the improving the health of citizens. Advocates of publicly funded medicine claim that preventive care saves money and prolongs life, but opponents assert that it does neither .
Difficulties of analysis
Cost-benefit analyses of various health care systems are frequently mentioned by advocates and opponents of publicly funded healthcare programs. Others caution that these analyses are difficult to do accurately due to the multifactoral nature of health, healthcare delivery, and healthcare financing, as well as the lack of consensus on what is "best" for a nation or its people.
