The Healthcare Policy Debate
Why the US is the only wealthy democracy without universal health coverage, how the Affordable Care Act changed the landscape, and the ongoing battle over the government's role in healthcare.
American Healthcare Exceptionalism
The United States spends more on healthcare than any other country, roughly $4.5 trillion per year or about 17% of GDP, yet is the only wealthy democracy that does not guarantee health coverage to all residents. Before the Affordable Care Act, roughly 50 million Americans were uninsured. After the ACA, that number fell to about 27 million, still far more than zero.
American health outcomes do not match American spending. Life expectancy in the US is lower than in every other G7 country. Infant mortality is higher. Medical debt is the leading cause of personal bankruptcy. The system's complexity, with employer-based insurance, Medicare for seniors, Medicaid for the poor, the ACA marketplace for individuals, and the uninsured falling through gaps, is unique among developed nations and a product of historical accident rather than rational design.