How come The U.S. government’s budget for health care is very high when all I’ve heard is it has a privatised health care system? How does it all work / what does it do?

32 comments

  1. Our Healthcare is a joke…..absolute garbage. One medical issue or accident can and will bankrupt you if you’re not wealthy. Those of us that have insurance still have to pay a co-pay and oftentimes unless it’s a doctor visit, whatever you’re going in for isn’t covered or barely covered and the patient responsibility is extremely expensive.

  2. The only people saying that the US has entirely privatized Healthcare are either trying to pull one over on you, or idiots who fell for the former. What we actually have is essentially the worst of both privatized and government systems.

  3. Our healthcare system is not completely privatized. Medicare, Medicaid, and Obamacare are government healthcare programs that many Americans use.

  4. The worst healthcare in the US is completely government ran and funded. The Veterans Administration medical system.

    Medicine with all the customer service focus of the IRS.

  6. There is no actual “system.” Instead, there is a crazy quilt of Federal government funded or partially Federally funded programs like Medicare (seniors), Medicaid (low income people), Veterans Administration, etc., then private insurance that is typically through employers, and in theory, states are supposed to offer a “Public Option,” a mix of Federal, State, and citizen funding, through private insurance companies. The Public Option was a key feature of the Affordable Care Act (ACA aka ObamaCare), but many states refused to go along.

    td, dr; Costs are higher because there is no real “system.”

  7. We have several different healthcare systems. Elderly folks are covered by medicare, and the very poor by medicaid. The military also has their own health system. All of these are government funded.

    Kids are also covered by a program called CHIP, though I don’t know if that funding comes from medicare/medicaid, or if that is funded separately.

  8. The government funds several significant programs for medical care. Older Americans (65+) get Medicare which pays 80% of medical costs. It’s funded through payroll deductions. Medicaid is a program for poor people. Finally, if you served in the U S military, you get free health care from the Veterans Administration. The Veteran’s Administration program is so badly run it’s often used as an argument against national healthcare. I’m on Medicare and find it well managed and incredibly helpful.

  11. In addition to what has been said about Medicaid, Medicare and the VA, there’s also the Indian Health Service (yes its actually called that) which provide health care on reservations. And many governments own hospitals, usually a city/county in a major metro area.

  12. The main problem is that private hospitals and pharmaceutical companies have jacked the prices up so high that even if the government spends the same per person as Germany (random example), we wouldn’t be close to covering the healthcare costs.

  13. The government doesn’t own any hospitals or other medical facilities apart from the military, and there’s government insurance programs to provide insurance for the elderly and the poor, and subsidize private insurance for those unable to get it through their employer.

  14. >system

    Our system is there is no system.. amongst other problems with no centralized system, regardless of public or private, there are an absurd amount of cracks for money to disappear into.

  15. Saying that America has a private health system is somewhat misleading, there is LOTS of Government involvement in our HC system.

    For starters, we have Medicare (for the Elderly) and Medicaid (for the poor). Veterans get healthcare through the Veteran’s Administration (VA). There’s also the Indian Health Service (IHS).

    It’s also worth noting that, by law, hospitals cannot turn away patients, regardless of whether they actually have the ability to pay for anything (it’s part of the Emergency Medical Treatment and Labor Act, or EMTALA). A homeless person who doesn’t have $1 to their name can show up to the ER with a major injury/illness and they are required to treat them. You don’t even have to be a citizen; an illegal immigrant can show up to the ER and they are required to treat them.

    As you can imagine, even if they were to bill the patient afterwards, they will likely never see that money, so many hospitals require compensation by the Government to stay afloat.

  17. Americans pay for 3 separate healthcare systems and are only allowed to use one at a time. Medicare which is federal government healthcare. Medicaid which is state government healthcare. Private healthcare which is funded by the individual aside from the taxes they already paid to Medicaid and Medicare.

    You hear a lot about the private healthcare system because it’s an abysmal failure. The overwhelming majority of Americans can’t afford to keep or use their private healthcare. It’s a system that results in people being unable to treat serious and/or chronic health conditions or even find out if they have them.

    This results in far worse outcomes. Financially people end up in debt or bankruptcy. Sometimes their health deteriorates to the point where they become disabled or under employed.

    Then they get to use the best healthcare America has to offer, Medicare and Medicaid.

    You don’t hear too much about government healthcare because it works great!!!!! People get diagnosed, they get treatment and their out of pocket costs are very very little.

    Put here’s the catch, we have some psychopaths in government that put resource restrictions on having access to government healthcare so if your health improves with the treatment you’re able to receive under government healthcare and you want to be a more productive citizen, create a more stable financial future for yourself, give more in taxes, pay more to Medicare and Medicaid, be less dependent on government aid…then the first thing they do is revoke the healthcare that makes that possible.

    And hey look, if Russia and China can influence Americans to commit treason, then I invite other industrialized countries to influence Americans to vote to have government healthcare. Come on, help us out.

  18. Americans pay for 3 separate healthcare systems and are only allowed to use one at a time. Medicare which is federal government healthcare. Medicaid which is state government healthcare. Private healthcare which is funded by the individual aside from the taxes they already paid to Medicaid and Medicare.

    You hear a lot about the private healthcare system because it’s an abysmal failure. The overwhelming majority of Americans can’t afford to keep or use their private healthcare. It’s a system that results in people being unable to treat serious and/or chronic health conditions or even find out if they have them.

    This results in far worse outcomes. Financially people end up in debt or bankruptcy. Sometimes their health deteriorates to the point where they become disabled or under employed.

    Then they get to use the best healthcare America has to offer, Medicare and Medicaid.

    You don’t hear too much about government healthcare because it works great!!!!! People get diagnosed, they get treatment and their out of pocket costs are very very little.

    Put here’s the catch, we have some psychopaths in government that put resource restrictions on having access to government healthcare so if your health improves with the treatment you’re able to receive under government healthcare and you want to be a more productive citizen, create a more stable financial future for yourself, give more in taxes, pay more to Medicare and Medicaid, be less dependent on government aid…then the first thing they do is revoke the healthcare that makes that possible.

    And hey look, if Russia and China can influence Americans to commit treason, then I invite other industrialized countries to influence Americans to vote to have government healthcare. Come on, help us out.

  19. Because the US government provides a lot of healthcare to certain people in the country, mainly through Medicare (for old people) and Medicaid (for low income people). This is very expensive because healthcare is very expensive in the US. Why is healthcare so expensive in the US? [This short video](https://www.youtube.com/watch?v=qSjGouBmo0M) can help explain it. Basically, there are lots of reasons that all add up, perhaps the biggest being that as others have pointed out, there isn’t much of a healthcare insurance “system” at all. This leads to health insurance companies having not much leverage against hospitals and drug companies to negotiate prices. And since the government doesn’t set prices it’s a free-for-all. And since there is no system, all of this is terribly inefficient and there’s tons of overhead. I went to see a doctor once and the woman at the reception who’s job it is didn’t recognize my insurance and so she just took a scan of it and was going to have to call my insurance company.

  20. Low income, kids, military personal, civilian govt employees & retirees get their health insurance from Govt. Govt offer different private companies plans and you choose from one of them. I changed mine few days ago to MetroPlus Gold. November is enrollment month for NYC employees to make changes to their health plan.

  21. Between medicare (old people), medicaid (disabled or destitute people), CHIP (medicaid but for kids), the VA (military vets) and marketplace benefits (subsidies for buying private care with a lower income) a pretty large chunk of the US is on one form of public health or another.

    We also don’t have the kind of price controls most developed nations do so our per person costs are completely out of control.

  22. Abroad there’s seems to be an idea that the US government doesn’t fund healthcare at all. That’s not true. There are medical programs and assistance available to the needy and elderly, like Medicare, medicaid and other programs.

    My parents are retired. Medicare pays for 80% of their medical bills. Their supplemental pays for the other 20%.

    My dad has been fighting brain cancer for the past 2.5 years. I think he’s approaching 2mil$ in total cost which is covered.

  23. Uninsured people are required by law to be given care if they come in to the ED. They leave without paying. The hospital gets money from the government to cover these costs. Also, public insurance is the majority of the patient’s primary insurance, so the government pays for that too. And also, despite charging insurance for the services given, insurance doesn’t always pay what hospitals ask for. So even if your insurance covers something, when the hospital bills for that thing they don’t actually pay for it, they pay for part of it and the hospital covers the rest.

    Source: I work in an American not-for-profit hospital.

  26. We actually have *at least* six separate health care insurance systems in this country.

    (1) Medicare, which covers the elderly and some other individuals under some circumstances.

    (2) Medicaid, which covers the poor.

    (3) The [VA system](https://www.va.gov/health-care/).

    (4) The [(American) Indian Health Service](https://www.ihs.gov).

    (5) Employer-provided insurance through group insurance plans.

    (6) Private insurance purchased by individuals.

    The first four items on this list are provided by and funded either by the United States Federal Government or the individual States.

    —-

    Beyond that, the United States spends money on health research–such as through the [National Institutes for Health,](https://www.nih.gov) and on health monitoring and regulation, such as through the [Food and Drug Administration](https://www.fda.gov) or the [Centers for Disease Control.](https://www.cdc.gov) And of course don’t forget the [Centers for Medicare & Medicaid Services](https://www.cms.gov), which, amongst other things, [regulates and inspects hospitals and care givers.](https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance)

  27. It’s interesting to me how every answer says essentially the same thing, that we have Medicare, Medicaid and VA benefits, CHIPS, IHS, etc…but I don’t think any of them pointed out that the federal government also subsidizes healthcare premiums (at about 72%) for government employees, including their families, through the federal employee health benefits program, and this covers approximately 9 million people, including members of Congress and other politicians.

    The VA program-Tricare-could be considered a universal health care program since it covers everyone in the military and their families. My daughter was on Tricare for a long time as part of her survivor benefits since her father was killed in the line of duty. It works amazingly well. In the 20 years she was on it I think I had to call them twice regarding a payment and our co-pays were completely manageable. (Since I was not married to her father I did not get covered under Tricare when he passed, so I got the unique opportunity to compare Tricare alongside my own employer sponsored insurance and let me tell you Tricare wins hands down)

  29. The American Healthcare system is far removed from privatized.

    Profits =/= not involved with the government

  30. Most health care in the US is paid for by the government in one way or another. The government does all of the following:

    * Provides Medicare, a health insurance program that covers nearly everyone age 65 and older. It also covers those with severe disabilities or end-stage renal disease.

    * Provides Medicaid, a health insurance program for the poor. The Medicaid expansion extended it to everyone with income less than 138% of the poverty line, but some states opted out and have more restrictive eligibility.

    * Directly runs the Veterans Health Administration which provides health care for military veterans.

    * Pays for health insurance for government employees.

    * Requires private employers to provide affordable health insurance to their workers, with some exceptions (“employer mandate”).

    * Exempts employer provided health insurance from income and payroll taxes, which functions as a subsidy.

    * Pays subsidies for individual purchasers of health insurance if it would otherwise be unaffordable based on income.

    * Pays further subsidies toward the deductibles/copayments for individual health insurance for those with income 100% to 250% of the poverty line (“cost sharing reduction”).

    * Regulates private insurance in numerous ways, including requiring broad coverage, setting limits on out-of-pocket maximums, prohibiting benefit caps, prohibited underwriting beyond limited use of age and smoking status, etc.

    Nonetheless there is still plenty that is privatized:

    * Most health care providers are private, even for patients who use government insurance.

    * Most people have private insurance, even though it is usually subsidized and/or mandated by the government.

    * Medicare beneficiaries can choose to purchase private Medigap plans to cover Medicare deductible/copayment amounts.

    * Medicare beneficiaries can also choose to enroll in private Medicare Advantage plans, in which case the government pays a private insurance company to provide coverage which replaces traditional Medicare.

    * Government employees usually get private insurance even though it is arranged through the government as the employer.

  31. A lot of people have responded discussing the true healthcare system in the US (Medicare, Medicaid, VA, Indian Health Service, Military Health System), but there’s many additional ways the US funds healthcare.

    We also fund the Federally Qualified Health Center program which primarily provide care to low income patients and those without insurance. They receive funding from the government and then offer care for free or at a low cost to these patients.

    There’s also the public health system. Each state and county (and most large cities) have a Department of Public Health that are responsible for managing population health. These were the entities that we primarily responsible for monitoring and mitigating COVID-19. They also are responsible for tracking certain diseases, such as HIV/AIDS and other sexually-tramsmitted infections. Public Health Departments also typically do campaigns to encourage vaccinations and sometimes are the ones who support people with a mental health crisis. It varies by state/locality but Public Health Departments may also have leading roles in efforts relating to suicide prevention, harm reduction efforts from drugs, and a variety of public education campaigns.

    We also fund school-based mental health resources that provide counseling in schools to kids who may need this type of support.

    Additionally, depending on where you’re looking there may be some non-healthcare spending that gets lumped in because the Department of Health and Human Services is the agency that oversees the majority of the civilian healthcare system, but also has divisions that oversee the human services (e.g. child care subsidies, refugee resettlement, and subsidies for heating costs in the winter).

    Bottom line is that the “system” is incredibly fragmented and decentralized. Its a bit of a misnomer to even call it a system IMO.

  32. While in general healthcare is private, there are government programs for seniors (Medicare), for the poor (medicaid), for veterans (VA).

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