The Healthcare System of the United States

Summary

The US healthcare system is a mix of private and public components, with private sector dominance in hospital and physician services. Approximately 60% of Americans receive health insurance through employers, while 15% are covered by Medicare, primarily for the elderly. Medicaid, a state-based program, caters to the poorest, yet has strict eligibility. The Veterans Health Administration and TRICARE serve specific groups. Despite covering only one-third of the population, the government pays for two-thirds of the healthcare bill, highlighting the complexity and high cost of the system.

Takeaways

• 🏥 The U.S. healthcare system is a mix of private and public components.
• 🌐 Most hospitals are private, with about 70% being non-profit.
• 👩‍⚕️ Physicians predominantly work for private organizations.
• 💊 Pharmaceutical and medical device companies, as well as medical research, are largely privately funded.
• 🤑 The U.S. has high out-of-pocket expenses for healthcare, with many lacking insurance coverage.
• 💼 Approximately 60% of Americans receive health insurance through their employers.
• 👵 Medicare is a federal social insurance program for the elderly, covering hospital stays and outpatient services.
• 🔄 Medicare Part D is for prescription drugs and is administered by private companies but funded by the government.
• 🏡 Medicaid is a state-based program intended for the poorest, with varying coverage and eligibility across states.
• 💼 The Veterans Health Administration and TRICARE provide healthcare for veterans and military personnel, respectively.
• 💸 The U.S. government pays for about two-thirds of the healthcare bill despite covering only one-third of the population.

Q & A

What is the primary difference between the US healthcare system and those of other countries?

The primary difference is that the US healthcare system is a mixture of both private and public components, unlike some other countries which may lean more heavily on one sector.

What percentage of hospitals in the United States are nonprofit?

Approximately 70% of hospitals in the United States are nonprofit, with the remaining being for-profit.

How is medical research funding divided between public and private sources in the US?

Medical research is funded by both public and private sources, but with a little more coming from the private sector. The US accounts for the majority of medical R&D spending globally.

What was the percentage of uninsured people in the United States before recent reforms?

Before recent reforms, about 15% of people in the United States were uninsured, meaning they had to pay for healthcare out of pocket.

How do most US citizens typically receive their health insurance?

About 60% of US citizens receive health insurance from their employers, with plans that generally do not vary in cost based on age, gender, or medical history.

What is Medicare and how does it differ from private insurance?

Medicare is a national social insurance program administered by the federal government, primarily for elderly individuals. It is similar to a single-payer system but is more complex and includes parts like Medicare Part A for hospitalization, Part B for outpatient services, Part C or Medicare Advantage, and Part D for prescription drugs.

What is Medicaid and how does it differ from Medicare?

Medicaid is a state-based program designed to provide healthcare coverage for the poorest individuals. It differs from Medicare in that it is not exclusively for the elderly and is means-tested, with coverage varying by state.

What is the Veterans Health Administration and how does it operate?

The Veterans Health Administration is a government-run system that provides healthcare to veterans. It operates differently from private insurance and is separate from other public health insurance programs like Medicare and Medicaid.

How does the US government's financial involvement in healthcare compare to its coverage of the population?

While the government covers about one-third of the population through programs like Medicare and Medicaid, it pays for approximately two-thirds of the healthcare bill in the United States.

What was the impact of the Supreme Court decision on the Medicaid expansion under the Affordable Care Act?

The Supreme Court decision made the Medicaid expansion optional, leading to many states refusing it and leaving an additional 5 million low-income individuals without insurance.

What are the main goals of the Affordable Care Act in relation to healthcare coverage?

The main goals of the Affordable Care Act are to provide insurance to those who don't get it through their jobs, expand Medicaid, and offer community-rated, guaranteed-issue insurance to a portion of the population.

How does the US healthcare spending compare to the quality of care provided?

Despite high healthcare spending in the US, the quality of care is not as expected, given the amount invested, indicating a potential for inefficiencies or areas for improvement.

Outlines

00:00

🏥 U.S. Healthcare System Overview

The U.S. healthcare system is a blend of private and public components. The private sector predominantly provides care, with approximately 70% of hospitals being nonprofit and the rest for-profit. Physicians typically work for private organizations. The U.S. spends a significant amount on medical research, largely funded by private entities. However, the U.S. stands out in how it provides access to healthcare, with about 15% of the population uninsured and facing high costs. Employer-based insurance covers around 60% of citizens, offering a range of benefits with varying out-of-pocket expenses. Medicare, a federal social insurance program, is complex, covering hospitalization (Part A), outpatient services (Part B with a 20% coinsurance), and prescription drugs (Part D). Medicare Advantage (Part C) allows private companies to offer Medicare-like benefits. Medicaid, a state-based program, aims to cover the poorest, including children, pregnant women, parents, elderly, and those with disabilities, but with varying state implementations and strict eligibility.

05:01

💼 Challenges and Costs in U.S. Healthcare

The U.S. healthcare system faces significant challenges, particularly regarding access and affordability. Before the Affordable Care Act, many states had very restrictive Medicaid eligibility, leaving out even the poorest adults without children. The Act aimed to extend Medicaid to all below 138% of the poverty line, but its optional nature due to a Supreme Court decision led to many states refusing it, leaving millions uninsured. The Veterans Health Administration and TRICARE provide government-run and military health insurance, respectively. Despite two-thirds of Americans receiving private insurance, the government pays about two-thirds of the healthcare bill. The U.S. spends disproportionately on healthcare compared to other countries, with quality not matching the high costs. The Affordable Care Act aims to extend coverage to approximately 30 million more people, focusing on those without job-based insurance, Medicaid, or community-rated guaranteed-issue insurance.

Keywords

💡Healthcare Triage

Healthcare Triage refers to the process of prioritizing healthcare needs and resources. In the context of the video, it symbolizes the attempt to dissect and understand the complex U.S. healthcare system. The script uses this term to introduce the series of videos that will tackle different healthcare systems, starting with the U.S.

💡Private Sector

The private sector in healthcare refers to hospitals, medical practices, and insurance companies that operate for profit. The video mentions that almost all care in the U.S. is provided by the private sector, with about 70% of hospitals being nonprofit and the rest for-profit, illustrating the dominance of private entities in the U.S. healthcare landscape.

💡Public Sector

The public sector in healthcare includes government-run programs and services. The video discusses how the U.S. healthcare system is a mix of both private and public components, with the public sector playing a significant role in providing insurance through Medicare and Medicaid.

💡Uninsured

Uninsured individuals are those who lack health insurance coverage. The video highlights that about 15% of Americans were uninsured, which means they would have to pay for healthcare out-of-pocket, underscoring a significant issue in the U.S. healthcare system where care is expensive.

💡Employer-Provided Insurance

Employer-provided insurance is a benefit offered by employers to their employees. The script explains that about 60% of U.S. citizens get their health insurance from their employers, which usually does not vary in cost based on age, gender, or medical history, and covers a range of healthcare services.

💡Medicare

Medicare is a national social insurance program in the U.S., primarily for elderly individuals. The video describes Medicare as the closest thing to a single-payer system in the U.S., covering hospitalization (Part A), outpatient services (Part B), and prescription drugs (Part D). It's complex, with different parts and supplementary options.

💡Medicaid

Medicaid is a state and federal program that provides health coverage for low-income individuals and families. The video explains that Medicaid is more generous in some states than others and is intended to cover the poorest, including children, pregnant women, and the elderly or disabled.

💡Medicare Advantage

Medicare Advantage (Part C) allows private companies to offer Medicare-like benefits. The video mentions that these plans can sometimes offer better benefits for less money than traditional Medicare, and about a quarter of Medicare beneficiaries choose such plans.

💡Supplemental Security Income

Supplemental Security Income (SSI) is a federal income supplement program funded by general tax revenues. The video uses SSI as part of the criteria for Medicaid eligibility, particularly for the elderly and those with disabilities.

💡Affordable Care Act (ACA)

The Affordable Care Act, also known as Obamacare, is a comprehensive healthcare reform law aimed at expanding health insurance coverage. The video discusses how the ACA was intended to provide insurance for more people, including a Medicaid expansion for those making less than 138% of the poverty line.

💡Veterans Health Administration

The Veterans Health Administration is a government-run healthcare system for veterans. The video includes it as part of the U.S. healthcare system, highlighting that it is a fully public system, in contrast to the predominantly private sector.

Highlights

The US healthcare system is a mix of private and public components.

Almost all care is provided by the private sector, with some hospitals run by the government.

About 70% of hospitals are nonprofit, with the rest being for-profit.

Most physicians work for private organizations, not the public sector.

Pharmaceutical and medical device companies, as well as medical research, are largely privately funded.

The US spends the majority of the world's R&D on medical research.

Access to healthcare is where the US differs significantly from other countries.

Until recently, about 15% of Americans were uninsured.

Uninsured individuals had to pay for healthcare out of pocket due to high costs.

60% of US citizens get health insurance from their employers.

Employer-based plans usually don't vary by age, gender, or medical history.

Medicare is a national social insurance program for the elderly, administered by the federal government.

Medicare Part A covers hospitalization and is mostly free for those over 65.

Medicare Part B covers outpatient services with a 20% coinsurance.

Medicare Part C allows private companies to offer Medicare-like benefits.

Medicare Part D covers prescription drugs through private insurance companies.

Medicaid is a state-based program intended for the poorest, with varying state implementations.

Medicaid expansion under the Affordable Care Act aimed to cover more low-income individuals but is optional and many states have refused it.

The Veterans Health Administration and TRICARE provide healthcare to veterans and military personnel.

While two-thirds of people get insurance from private companies, the government pays for two-thirds of the healthcare bill.

The US healthcare spending is disproportionate to the quality of care received.

Obamacare aimed to provide insurance to more people but impacts a relatively small percentage of the population.

Transcripts

whenever I talk about health policy

especially as we try to reform it here

in the United States I get a lot of

requests to talk about how exactly

health care works in different countries

lots of countries it's not that I don't

think those are great questions I do

it's that summarizing a healthcare

system in just a few minutes isn't easy

but we don't shirk from difficult tasks

here and so we're going to start

tackling countries one by one starting

with the United States here on

healthcare triage the United States

healthcare system is similar to that of

many other countries and that it's a

mixture of both private and public

components let's start with the easy

stuff almost all care is provided for by

the private sector although some

hospitals are run by the government

most are run by private organizations

about 70% of hospitals are nonprofit

leaving the rest in for-profit hands

most physicians therefore also work for

private organizations and are not

employed by the public sector other

components of the health care system are

also in the private sector including

pharmaceutical and medical device

companies research is paid for by both

public and private sources with a little

bit more coming from the private side

added together however US spending on

medical research accounts for the vast

majority of R&D spending in the world

but where countries differ the most is

in how they give citizens access to

their systems in this area the United

States is somewhat of an anachronism

until recently about 15% of people in

the United States were uninsured this

meant that if they needed care they'd

have to pay for it out of their own

pocket and unless you've been living

under a rock you should know that health

care in the United States is really

really expensive so that's a problem it

means that a lot of people don't get the

care they need and it means that we're

failing a large number of people who

live in the United States about 60% of

US citizens get health insurance from

their employer these plans usually don't

charge people different amounts based

upon factors such as age gender or past

medical history they range of benefits

but for the most part they cover

preventive care care if he gets sick and

prescription drugs plans vary in terms

of how much people have to pay

out-of-pocket for them but we already

did a video on how private insurance

works and you really should have watched

that already about 15% of Americans are

covered

Medicare and most of them are elderly

people Medicare is a national social

insurance program run and administered

by the federal government it's the

closest thing we have to what most

people refer to as a single-payer system

where all people are covered by one type

of insurance but Medicare is pretty

complicated

first there's Medicare Part A which

covers you if you're hospitalized it's

pretty much free to most people over the

age of 65 and almost no one doesn't get

it Medicare Part B covers outpatient

services and is sometimes deferred by

people who are still getting insurance

from their jobs it is a pretty low

deductible and then has coinsurance of

20%

it covers tons of stuff including pretty

much all tests or procedures you might

get outside the hospital as well as lots

of medical equipment that you might use

there are private supplemental Medigap

policies that are offered by private

companies that often cover the co-pays

or coinsurance or add in extra benefits

almost everyone buys one of these two so

that elderly individuals wind up paying

much less for their health care than

you'd expect Medicare Part C or Medicare

Advantage is an opportunity for private

companies to offer Medicare like

benefits better than the government can

if they do and they do it for less money

they get to keep the extra in profit

Medicare beneficiaries can opt in to

Medicare Advantage plans instead of

traditional Medicare they sometimes have

different benefits that appeal to them

and about a quarter of them choose such

a plan now Medicare Part D contains the

prescription drug plans they're actually

designed and run by private insurance

companies but they're approved and paid

for by the federal government individual

Medicare beneficiaries pick the Part D

plan they like depending on what drugs

they think they might need

that's Medicare cost us about five

hundred thirty six billion dollars last

year the other big government program is

Medicaid unlike Medicare Medicaid is a

state-based program basically it's

supposed to provide health care coverage

for the poorest among us there are some

minimal federal guidelines that are set

for Medicaid and then each state gets to

implement it as it sees fit some states

are more generous and some less so

generally Medicaid is meant to cover

those at the low end of the

socio-economic spectrum the government

defines poor this way while you look at

that remember this amazing fact a single

parent with a child who makes minimum

wage earns more than the poverty level

that's how low the line is regardless

traditional Medicaid must cover kid

under 6 years of age to 133 percent of

the poverty line and kids 6 to 18 to a

hundred percent of the poverty line the

state children's health insurance plan

RS chip ups this to about 300 percent of

the poverty line in most states Medicaid

also covers pregnant women up to 133

percent of the poverty line and parents

the 1996 welfare levels finally it

covers the elderly and those with

disabilities who receive Supplemental

Security income the first important

thing to note is that adults without

children aren't mentioned at all and in

most states they can't get medicaid let

me say that again in most states even

the poorest adults without children even

those who make nothing at all don't get

medica and it gets worse

those 1996 welfare levels can be super

low so low that for instance in Arkansas

couple with two children making three

thousand eight hundred and twenty

dollars a year is too rich for Medicaid

granted some states are more generous

but in many of them parents have to be

very very poor in order to get medicaid

the Medicaid expansion in the Affordable

Care Act was supposed to fix this it was

supposed to give Medicaid to everyone

who makes less than 138 percent of the

poverty line regardless of whether or

not they have kids it would have finally

made Medicaid the universal program for

the poor that many already believe it to

be but because of the Supreme Court

decision that made the Medicaid

expansion optional lots of states are

refusing it leaving an additional 5

million people with low incomes with no

insurance this year in 2009 Medicaid

cover more than 60 million Americans

about one in three children are covered

by Medicaid and one in three births is

covered by Medicaid a lot of Americans

are in poverty in 2011 Medicaid cost us

about four hundred fourteen billion

dollars there's also the Veterans Health

Administration which is totally a

government-run system that provides care

to veterans and TRICARE the military

health insurance program that applies to

some veterans military personnel and

retirees and dependents TRICARE works

more like private insurance think that

sounds complicated

it is interestingly while about

two-thirds or so people get their

insurance from private companies only

about one third of spending comes from

the private sector in other words the

government has to cover about one-third

of people in the United States but has

to pay about two-thirds of the bill tell

me again now the government isn't

the short end of the stick the money

involved in health care in the United

States is simply unbelievable you may

remember this video of John's which

talks about how out of control our

spending is go watch it again it's based

in part in a series I did on my blog and

the link for that is in the video info

section below I've also added a link to

a series on quality in our system which

is well not what you'd hope for given

all that spending Obamacare will change

some of what I said but not by much

basically we hope to get some people who

didn't get insurance with their jobs

Medicaid or community rated

guaranteed-issue insurance like employed

people get with respect to the

Affordable Care Act we're only talking

about 30 million people or so we're

about 10% of our population and for more

info on that go watch our first episode

so that's the US healthcare system is

neaten packaged as I can make it in

under 10 minutes

it's private insurance for most Medicare

and Medicaid for some and VA or TRICARE

for a few how does this compare to other

countries keep watching future episodes

to find out