The Fine Print of America’s Healthcare Industry

On December 4, 2024, the CEO of UnitedHealthcare, Brian Thompson, was assassinated in a violent display of frustration toward the US healthcare system—one of the most expensive in the world. The incident spotlighted growing patient discontent with current insurance providers amid rising healthcare costs in recent years. Millions of Americans remain uninsured for vital services and are forced to pay immense costs out-of-pocket. Despite spending more on healthcare than any other country, many Americans still do not have healthcare insurance coverage. The US has yet to adopt a universal healthcare coverage system, although variations of such a system already exist in 73 out of the 195 countries in the world. Why does the US continue to delay the inevitable?

Illustration by Aleena Gao

Written by Michael Qin & Cham Yu

Edited by Catherine Qin

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The US is home to an intricate healthcare financing system between government entities, private health insurers, healthcare providers, and employers. Government-financed programs provide a public insurance option for Americans who meet its strict eligibility criteria. For example, in California, individuals must earn below 138% of the poverty level to qualify for Medi-Cal coverage, the state’s Medicaid program. Across the nation, 36.3% of Americans are covered under public insurance, while 65.4% are enrolled under private health insurance. Unfortunately, 8% of Americans still do not have health insurance coverage in 2023 and pay all healthcare costs out-of-pocket. The federal government does not provide universal healthcare and solely relies on state and limited federal programs like Medicare and Medicaid.

Established in 1965, Medicare is a public insurance option for seniors and those with certain disabilities. Its medical insurance premium is only $185 per month compared to an average of $477 for private insurance options. Only 18.9% of Americans are enrolled in Medicare, as most adults are not eligible for the program. Medicaid, in contrast, is a public health insurance option administered by state authorities and provides health coverage to low-income families, seniors, and those with disabilities. Medicaid and Medicare can be enrolled concurrently by eligible populations, like seniors, where Medicaid would cover any extra incurred costs that Medicare did not fully cover. The program was significantly expanded with the enactment of the Affordable Care Act in 2010, also known as Obamacare. Obamacare authorized federal funding to state authorities that expanded Medicaid’s eligibility to anyone with income up to 138% of the poverty level. Congressional Republicans held numerous votes to replace Obamacare in the 2010s and the legislation’s individual mandate—a requirement that all Americans have health insurance—was eventually revoked. 41 states have already expanded Medicaid by increasing its insurable population since the Supreme Court affirmed the constitutionality of Obamacare in 2012.

With an estimated 65.4% of Americans enrolling in private health insurance, public insurance programs like Obamacare also provide healthcare coverage to millions of vulnerable Americans, yet are still limited in scope. Healthcare costs have steadily increased over time despite increased insurance coverage. According to the Peterson-KFF Healthcare system tracker, the price of medical care has increased by 121.3% since 2000, while prices for consumer goods rose by only 86%, meaning that patients are paying more of their income on healthcare than in previous years.

The lack of universal coverage has led to unaffordable insurance premiums for most Americans, which increases the cost of living and a slower increase in life expectancy. The US should adopt alternatives to the existing healthcare system, including public insurance coverage for all Americans, to ensure Americans retain high-quality health insurance with minimal premiums. Companies in the healthcare system have sought to maintain monopolies over the medicine market, such as drugmaker Eli Lilly’s dominance over the insulin market. Monopolies restrict the supply of goods by eliminating competition, driving up medicine prices, and in return, increasing healthcare costs. By reforming the existing system of monopolistic private insurance practices, universal healthcare coverage can substantially reduce patients’ medical costs.

Unfortunately, the lack of universal coverage and rising costs have soured Americans’ opinions on the existing healthcare system. Average family coverages still topped $24,000 annually—almost one-fifth of the median American family income. A long-running Gallup poll of 24 years, updated last month, found that a majority of Americans view the current system negatively, and believe the federal government should be responsible for individual healthcare coverage. Unfortunately, private insurance providers continue increasing premiums and denying coverage for vulnerable Americans, even when assistance is most needed. A 2023 study by STAT News revealed that UnitedHealthcare used a computer algorithm that systematically denied insurance claims made by seniors and disabled patients. While independent investigators have concluded that UnitedHealthcare denies around one-third of its insurance claims, the company has since rebuked these allegations and claimed an official approval rate of 90%. The continued increase of insurance costs will only further impact the financial stability of vulnerable patients until a viable public insurance option is created.

Political Status of Healthcare

Healthcare reform remains politically contentious in the US despite rising medical costs for patients over the years. After World War II, President Harry S. Truman became the first president to propose the idea of national health insurance, a step closer to the direction of universal health coverage. The plan intended for certain taxes to be levied in exchange for insurance coverage. However, the American Medical Association lobbied against Truman’s proposal, developing the now-popular narrative that state-funded healthcare is synonymous with socialism. The campaign was a setback for the program, especially during the prevalent anti-communist sentiment from the Cold War. Despite decades later, this false perception remained consistent. The focus was no longer on government funded options but rather was shifted to private insurance, laying the foundation for what most insured Americans use today.

Currently, the political discourse surrounding healthcare policy has become increasingly polarized, with the Democrats and Republicans holding immensely different policy positions. Democrats view healthcare access as a right of all Americans and favor government involvement to ensure all Americans receive adequate healthcare coverage that is affordable and equitable. On the other hand, Republicans prefer minimal government intervention and laissez-faire solutions that largely promote private healthcare insurance, allowing Americans to choose their own insurance with more flexibility. Although healthcare reform is necessary to achieve universal healthcare coverage, discrepancies between party stances have halted efforts for effective healthcare reform.

Alternative Solutions

Unlike the US, most governments in other developed countries have adopted public health insurance options to reduce patients’ costs. Anglosphere countries with political systems similar to those of the United States, such as the United Kingdom and Canada, boast large public sectors in healthcare insurance. Most prominently, the United Kingdom’s National Health Service (NHS) represents more than 80% of healthcare spending in the country. The NHS provides free treatment, hospital care, and medication for UK residents, but requires a fee for large expenditures. It runs hospitals, ambulance services, and employs nearly all doctors in England. The NHS accounts for $180 billion in government spending and is funded through taxation. While the UK has significantly higher federal income tax rates, they are less than that of California despite providing far wider public insurance options. Universal coverage is empirically achievable even with modest taxation policies when agency processes are streamlined to minimize bureaucratic inefficiencies.

However, the NHS has experienced long wait times and a chronic shortage of physicians in recent years. These obstacles, although substantial, have not prevented the NHS from providing low-cost public insurance for the public. The average price of a vial of insulin in 2018 was $98.70 in the US and only $7.52 in the UK, with high medicine prices translating to higher healthcare costs for US patients compared to the UK. A study by the University of California San Francisco found that adopting a single-payer healthcare system—a form of mandatory public insurance—in the US will reduce drug prices by up to 27% through simplifying the billing process and enabling the government to negotiate lower prices with healthcare providers. Implementing universal health coverage can eliminate the need for private providers and reduce insurance premium costs nationwide.

Two major alternatives to the current health insurance system are under heated debate in the US. Many Democrats, including former President Joe Biden, support a public health insurance option for all Americans, where public insurance will compete with other private health insurance entities. Meanwhile, Medicare for All, or single-payer healthcare insurance, is a proposal that would require every American to enroll in a mandatory public health insurance program. Due to unified Republican opposition in Congress, both options are unlikely to be implemented. In particular, President Trump’s administration has prioritized reductions in government spending, rolled back Biden-era programs that enabled more Medicare drug negotiations, and pushed for deregulation and transparency in healthcare costs.

Major healthcare reform, which requires significant increases in government spending, is almost an exclusively partisan proposal. House Republicans have continued to propose healthcare legislation that directly restricts Medicaid spending to balance the federal budget. While these proposals can eliminate excess federal spending, they are likely to raise healthcare costs and decrease the government’s ability to provide high-quality health insurance for many Americans.

Recent National & State Level Reforms

With political disagreements preventing substantial changes to health regulations, minimal progress has been made in Congress in recent years. States like California, however, continue to expand Medi-Cal access while resisting the face of federal budget cuts. Congressional Democrats have also proposed healthcare legislation like the Health Care Affordability Act of 2025, which will distribute tax credits to some Medicaid patients. These efforts will expand on the Inflation Reduction Act of 2022, which enabled Medicare to negotiate drug prices and cap the out-of-pocket cost of insulin at $35. While competitive public insurance can lower prices for patients, the US healthcare system is crucial for millions of Americans—yet it remains expensive and inaccessible for many Americans.

Progress is often caught in the middle of partisan gridlock, preventing the implementation of popular policies on the federal level. Government officials and legislators should continue to explore alternatives, namely a public insurance option, to the current healthcare system. Although substantive healthcare reform will face partisan opposition, millions of Americans remain uninsured, and the pressing need for change is all too evident. The real question is whether we will take the necessary steps to make it a tangible reality.