Case Study

In Marion, North Carolina, the Buchanan family decided to go without health insurance for the first time in their lives, rather than pay $1800 per month. Although their income puts them in the top fifth of households, their insurance premium was three times the price of their mortgage. In addition, their high deductible meant having and using their health coverage would cost over $30,000 annually. Instead, they now pay about $200 per month for membership in a local doctors’ practice that allows them unlimited office visits and discounts on medications and lab testing 

In Phoenix, Arizona, the Bobbies and their son will remain uninsured, hoping this savings will help them pay for the special heart treatments their nine-year-old daughter needs. Their daughter qualified for Arizona’s Medicaid program, but the family was later told they made too much money to get low-cost state coverage. Before their daughter had turned three, medical costs amounted to over $1 million, and caused the Bobbies to lose their house and car. When coverage through the Affordable Care Act became available to them in 2014, the Bobbies were able to buy a policy for Sophia that costs just over $200 per month, but this did not solve their problems by any means; it is only affordable if the rest of the family remains uninsured (Bloomberg).


Why It Matters

The Constitution does not address healthcare as a specific right, but it promotes life, liberty and the pursuit of happiness, of which health is a crucial part. Evidence shows that, in comparison to people without health coverage, people with health insurance have fewer out of pocket medical costs, see the doctor more often, get more preventative care, and report that they feel healthier and less depressed. It is helpful to take a look at our current healthcare issues — specifically the rising cost of medical  insurance — to understand where we are and what can be done to improve access to healthcare and health insurance for all Americans.


Putting it in Context

History: The Origins of Health Insurance

According to author John Steele Gordon, modern medicine has been practiced for a very short amount of time: “More than 90 percent of the medicine being practiced today did not exist in 1950.” The ancient Greeks were the first to recognize disease had natural, not supernatural, causes, but great innovations in medicine were still centuries away. Tools such as the stethoscope, ideas such as germ theory, and medicines such as anesthesia paved the way for great advancements in the 1800s. 

The 19th century was a turning point for hospitals; originally for the poor, hospitals gradually became treatment centers as better sanitary procedures were introduced. With more use, however, came more costs, and hospitals quickly suffered financial problems. A way to finance running hospitals was through hospital insurance, a precursor to modern health insurance. Groups of hospitals quickly joined together to offer plans, and this became the model for the first health insurance company, Blue Cross, which opened in 1932.

During World War II, another healthcare development emerged: employer-paid health insurance, when the federal government instituted wage controls and companies began looking to provide non-cash benefits to compensate their employees. The IRS ruled employer-paid health insurance was a tax-deductible business expense, which made it attractive for employers to offer. Working Americans began to take the plans their employers provided, which sometimes meant Americans did not search for the most cost-effective plan. Additionally, subsidies for employers often destabilize the individual market.

Government became involved in healthcare during the 1960s, when President Johnson signed the bill that led to the introduction of Medicare and Medicaid; these programs were structured in much the same way as Blue Cross, but since the government was making the payments, healthcare providers were pleased because even more people could afford medical care. This also gave state governments the ability to influence policy decisions at hospitals, many of which were political rather than economic. 

The highly controversial 2010 Affordable Care Act (also known as the “ACA” or “Obamacare”) resulted in even greater government involvement in the healthcare system. The ACA allowed millions of Americans to purchase health insurance via new government exchanges or obtain coverage through Medicaid. Through the act, the government also introduced subsidies for people with annual incomes below 400 percent of the poverty line to offset the costs of insurance premiums for plans available on the state exchanges.  

All of these developments in healthcare came with a price tag: In 1930, Americans spent $2.8 billion on healthcare, approximately $23 per person and 3.5% of GDP. In 2018, that figure was $3.6 trillion —$11,172 per person and 17.7% of GDP. Adjusted for inflation, per capita medical costs in the U.S. are now 30 times higher than they were 90 years ago.

See this timeline from PBS for more on the history of U.S. healthcare.


Where do Americans get insurance?

For the most part, the U.S. has a third-party payer system, meaning health insurance plans (third parties) reimburse doctors for costs of services provided to patients. There are both public and private programs available to Americans.


Medicaid includes coverage by Medicaid, Medical Assistance, and Children’s Health Insurance Plan (CHIP). Medicaid is a state-run program, jointly financed by state and federal funds, that serves lower-income U.S. residents. CHIP is similar to Medicaid in structure but is specifically for children. Medicare includes coverage by Medicare and Medicare Advantage and is the largest federal health care program that serves almost 60 million elderly and disabled people in the U.S. There are four parts of Medicare:

  • Part A (Hospital) pays for your care in a hospital, skilled nursing facility, nursing home (as long as it’s not just for custodial care), hospice and certain types of home health services.
  • Part B (Medical) covers medically necessary services or supplies needed to diagnose and treat a medical condition. It also covers preventive services for illnesses such as the flu, including inpatient and outpatient physician services and some limited outpatient prescription drugs.
  • Part C (Medicare Advantage), also known as MA plans, is sold by private companies. MA plans come in two varieties – HMO plans and PPO plans – and take the place of Medicare Part A, Part B and, often, Part D coverage. Many offer extras such as vision, dental, hearing aids and wellness services.
  • Part D (Prescription Drugs) provides prescription drugs from a list (called a formulary). Each Medicare prescription drug plan has its own list. Most plans place drugs into different “tiers,” with each tier having a different cost.

Other public insurance sources include coverage for military service members and coverage from the Veterans Administration.


Employer-paid insurance includes coverage through a current or former employer or union, as a policyholder or dependent. In 1943 the IRS ruled that employees do not have to pay taxes on group health insurance premiums paid on their behalf by their corporate employers. This tax exclusion meant that the value of the healthcare benefit to the employee was greater than if a company offered the  employee the same amount of cash, which would have been taxable. Thus, more and more employers began offering health insurance plans as part of attractive compensation packages for their employees. 

For individuals whose employers do not offer insurance or who are self-employed, there is also the option to purchase private insurance. Non-group insurance includes coverage by policies purchased directly from a private insurance company.

Approximately 49% of Americans get their health insurance through their employers as of 2017, according to health care nonprofit Kaiser Family Foundation.


The Role of Government


Federal and state government is currently deeply involved in healthcare. Its spending, regulations, and its tax code all play a large role in structuring the current market. Much of government involvement in the healthcare system comes from the Department of Health & Human Services (HSS), which includes agencies such as the Centers for Medicare & Medicaid Services (CMS), the Center for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). 

At the state level in particular, states provide health insurance coverage for their respective state employees. In terms of the ACA marketplaces, 23 states have at least some control over their exchanges with either state-based, federally-supported, or partnership exchanges. 

Of the $3.5 trillion spent on healthcare in 2017, the U.S. government contributed about $1.5 trillion, mainly through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP). Medicare cost about $600 billion and Medicaid and CHIP cost just under $400 billion in 2017. Other spending by the federal government includes veterans’ and active-duty military health care as well as health insurance subsidies created by the ACA (CRFB).

Healthcare reform is a top issue going into the 2020 election. Proponents of centrally-planned government believe that the government should guarantee and subsidize universal coverage, consolidate providers into large organizations, and have experts manage federal spending in a way that drives efficiency throughout the healthcare system. Calls for “Medicare for All,” which would involve complete or majority control of the healthcare system by the government, have been making headlines in recent years. See more on Medicare for All below.

Free-market advocates favor increasing competition to make insurance more affordable so that people will voluntarily buy it and introduce more market-based approach to consumption. They believe centralization does not improve efficiency, and that government should take a more modest role and allow a functioning market to emerge. This creates a closer relationship between the consumption and payment of health services, and empowers consumers within that market. The Department of Health and Human Services under the Trump Administration released a report in December 2018 detailing efforts to reform the healthcare system by expanding choice and competition for American citizens, including effort that revises an ACA guideline to give states more leeway over their individual insurance markets.

For more on the history of the role of government in the healthcare system, see this CMS report


Current Challenges and Areas for Reform


Dave Ricks, Chairman and CEO of pharmaceutical company Lilly, explains that the U.S. healthcare system was designed “to treat mostly acute episodes of illness and to do it inside bricks-and-mortar facilities with lots of people and very little technology.” Today, the goal of the healthcare system is “to help people…live independently with illness over a long period of time” and manage chronic disease. But the design of the system has not changed to meet this new challenge.

A myriad of problems plague the U.S.  healthcare system in terms of access, quality of care, and cost. The U.S. spends more than almost any other country on health care, but often does not have better health outcomes. Instead, it consistently ranks lower than comparable countries (those with a similar GDP and GDP per capita) in terms of a number of health statistics including mortality and hospitalizations for noncommunicable diseases (such as diabetes or congestive heart failure). 

Where the U.S. does succeed is in innovation, research, and development: for example, the U.S. has more clinical trials than anywhere else in the world and is home to the most Nobel Laureates in physiology and medicine. This innovation contributes to the U.S. having lower mortality rates for breast, colorectal, and cervical cancers than in comparable countries.

Current barriers to health services in the U.S. include high costs, lack of coverage, and lack of services available, all of which inevitably lead to unmet health needs, financial burdens, preventable illnesses, and hospitalizations. As a policy solution, the ACA addressed access to care, and between 2010 and 2016 helped 20 million people gain access to health care. Still, millions of Americans lack coverage, such as the families from our earlier case studies, and there are disparities in terms of age, sex, ethnicity, income, and geographic location. According to the Kaiser Family Foundation, about 10 percent of the population (over 27 million Americans) were uninsured in 2017.



In 2017, the U.S. spent almost 18% of its GDP on healthcare; according to Peterson-Kaiser Health System Tracker, comparable countries including Germany, Sweden, Australia, and Canada spend on average half of what the U.S. spends on healthcare. Average prices for medical procedures ranging from appendectomies to bypass surgeries to MRI exams are also higher in the U.S. than elsewhere, as are average hospital costs per day and average costs of prescription drugs.

Costs also vary widely within the U.S.: an MRI of the lower back costs about $140 at an imaging center in Louisiana but costs over $7600 at a center in California. Such price differences are likely due to differences in demand for healthcare services or supply of providers, provider and insurer market power, and even health characteristics of the populations. You can compare healthcare prices and and use levels across the country with Health Cost Institute’s interactive Healthy Marketplace Index.

Author John Steele Gordon recommends reforming the present system to be more transparent by requiring providers to make their prices public. “Once prices are known and can be compared, competition…will immediately drive prices towards the low end,” he says. “Posting prices will also force hospitals to become more efficient and innovative, in order to stay competitive.” In June 2019, President Trump announced a new rule that would require hospitals to “disclose the rates for services and treatment they have negotiated with individual insurance companies.” Services such as x-rays, outpatient visits, and lab tests would be included, and the rule would cover all hospitals that accept Medicare, of which there are over 6000. Comments on the rule are due in September 2019 and would take effect in January 2020. 

The goal of making healthcare prices more transparent is well-supported, although some medical organizations including the Federation of American Hospitals and the American Hospital Association warn that revealing costs could “undercut the way insurers pay for hospital services” and lead some hospitals to increase rather than decrease their prices. Industry groups also argue that such a requirement is beyond the executive branch’s authority. In June 2019, a federal judge stated the Trump administration “overstepped its regulatory authority” and blocked a Trump administration rule that would have required drug makers to post list prices on television (WSJ).


Prescription Drugs

The prices in the U.S. for the world’s 20 top-selling medicines are, on average, 3 times higher than they are in Britain, 6 times higher than in Brazil, and 16 times higher than in the country with the lowest price (which was India in most cases). In countries such as Canada, Germany, and Japan, governments engage in negotiations with drug manufacturers to keep prices low. In the U.S., manufacturers claim high costs reflect the need “to reward high risk research” and “economic value provided by medicine” and note that the U.S. has higher survival rates for diseases such as cancer in comparison to the rest of the world.

Insurance plans handle negotiations for drug pricing in the U.S., but this does little to lower costs to consumers, leaving policyholders with extra payments. Drugmakers usually increase prices at the beginning of the year and halfway through, even as they face increased criticism from patients and doctors in recent years. Some of these drugs, like intravenous solutions, are used by hospitals and have been identified by the FDA to be in short supply. Between 2008 and 2016, costs for generic oral prescription drugs rose almost 10 percent annually, and injectable drug prices rose over 15 percent annually. In 2017, the government, consumers, and insurers spent $333 billion on prescription drugs (NPR). The Wall Street Journal explains how drug prices in the U.S. work. 



A Trump administration rule requiring drugmakers to put list prices for drugs in TV advertisements was blocked in July 2019. The administration responded shortly after with a plan to import drugs that are cheaper abroad, particularly insulin and drugs for rheumatoid arthritis, cancer, and cardiovascular disorders. One option would authorize states, drug manufacturers, or pharmacies to import certain drugs from Canada with FDA approval. Canada has not expressed agreement, as the plan to supply the American population could result in a shortage for Canadian patients. Additionally, U.S. manufacturers are not likely “to import overseas drugs into the U.S. and receive lower profits. Most other developed countries pay lower prices because they negotiate with drug companies – something barred by U.S. law” (Washington Post).

The House and Senate have both prepared bills that would address drug pricing, specifically in Medicare and Medicaid.

According to Lilly CEO Dave Ricks, pharmaceutical companies agree that there needs to be more attention towards reforming the drug delivery system in the U.S. They see pros and cons in the proposed reforms, and Ricks emphasizes the need to discern value and end cost-shifting. He explains, “Cost-shifting means the exact same service or product is priced at vastly different levels, depending on who is paying and on where the care is delivered.” In the U.S., a vial of insulin can cost anywhere from 10 cents on Medicaid to $300 on a high-deductible health plan, and hospitals markup medication an average of 250%. They believe technology could play a bigger role in expanding affordable access to drugs.

Doctors and Patients

The Trump Administration revealed a plan in April 2019 that would restructure how primary-care doctors are paid in order to reduce the high costs of Medicare. According to Seema Verma, administrator of the Centers for Medicare & Medicaid Services, the current fee-for-service method creates “perverse incentives to offer more care.” Department of Health and Human Services Secretary Alex Azar notes that previous secretaries under Democratic and Republican administrations have also considered alternative payment methods that value outcomes rather than frequent procedures.  

Most experts agree that patients in the U.S. are frequently overtreated, although one Johns Hopkins’s study also found overtreatment was not usually due to high incomes for doctors and hospitals; the two most common reasons cited for overtreatment were patient demand and fear of malpractice. Compared to patients in other countries, American patients “are more likely to push doctors to treat” and any attempts “to cut back on expensive treatments are met with patient indignation.”


Reform Options

The Affordable Care Act

The 2010 Affordable Care Act was introduced as a solution to many of the pressing problems of cost and access. The objective of the ACA was to offer access to health insurance to the nearly 48 million people in 2010 unable to get health insurance — or good health insurance — through employers. The following are a few main features of the law:

  • Millions could purchase health insurance via new government exchanges or obtain coverage through Medicaid, the government-run health-care program intended for the poor, which many states dramatically expanded via incentives in the ACA. 
  • For those who qualify, the government provides subsidies to offset the costs of insurance premiums for plans available on the exchanges.  
  • Insurance companies are required to offer health insurance to people with pre-existing conditions on the same terms as to others.  
  • All would be required to purchase health insurance; those who did not would have to pay a fine (effective 2019, this tax was eliminated when Congress passed the 2017 Tax Cuts and Jobs Act.)
  • A new tax on expensive employer-provided policies was instituted to control costs.  

The ACA got off to a rocky start, but as a result of the ACA, “the share of Americans without health insurance is near historic lows” after it extended coverage to almost 20 million people, meaning more Americans have access to health insurance. For example, before the ACA expansions in 2012, 72 percent of uninsured adults had been without coverage for over 2 years; in 2018, this number had decreased to 54 percent of uninsured adults.

Although uninsured rates are still at all-time lows, the number of uninsured Americans rose for the first time in a decade between 2017 and 2018. This is due declines in Medicaid coverage as rising wages leave fewer people eligible for Medicaid, and due to the fact that more people are foregoing insurance since the individual mandate tax was reduced to zero. What’s more, the ACA is just not working for many Americans as the cost of healthcare continues to rise faster than Americans’ incomes: “the cost for many people to buy a health plan – if they don’t get it from a job or the government – is higher than ever.” When insurance companies could no longer charge sick people more or refuse to cover them, costs for healthy people went up (Bloomberg). Even in the employer market, workers are taking on increasing shares of healthcare costs.

Increases in costs have left more people than ever underinsured thanks to high out-of-pocket expenses and deductibles. An estimated 44 million people were underinsured in 2018, up from 29 million in 2010. Compared to insured adults with adequate coverage, underinsured adults are more than twice as likely to not fill a prescription, to skip a recommended test, treatment, or follow-up appointment, and have medical debt.

While opponents of the ACA have not reached a consensus on a replacement plan, several policy prescriptions have attracted widespread support:

  • The ability to buy health insurance across state lines to create more market competition and choice in policies;
  • Secure renewal of health insurance that is guaranteed so people who have health insurance can keep it and not see premiums soar if they get sick;
  • Cost transparency so people can know the price of their insurance and medical services

For more on the ACA and where it stands today, see The Policy Circle’s Deep Dive into the ACA.

Medicare for All

During the 2018 midterm elections, healthcare ranked as one of the top issues for voters across the U.S. In the Democratic debates for the 2020 election, healthcare is again a primary issue as candidates present their plans, many of which are some version of Medicare for All. Medicare for All is the plan for universal health care that expands Medicare coverage to everyone and would be funded through taxes. However, visions for achieving this vary

One option is a single-payer health care system, meaning everyone is covered by one government-run health plan. In some cases, as in the bill presented by Sen. Bernie Sanders (I-VT) private insurance would be outlawed. Other ideas simply involve giving more people access by lowering the eligibility age for Medicare or offering a public option through Medicare or Medicaid buy-in. In these cases, private insurance would remain intact, as would Medicare Advantage, through which the government pays private companies to run Medicare plans.

Public Opinion

A Kaiser Family Foundation poll found 56 percent of Americans favor a national health plan through which Americans get insurance from a single government plan. However, that favorability fluctuates drastically depending on certain details. When they are told it will guarantee health insurance as a right, about 70 percent of Americans approve of Medicare for All. Approval falls sharply when Americans hear Medicare for All would result in higher taxes (37% approval), the elimination of private health insurance (37% approval), and delays in appointments, tests, and treatments (26%).


Some businesses support a national health program; small business owners in particular argue that “decoupling health care coverage from the workplace would benefit entrepreneurship” since rising healthcare costs put a particular strain on employers’ budgets and slow wage growth for employees. Survey data also shows support from younger physicians, who admit a single-payer system “would make it easier to deliver cost-effective, quality health care.” Many proponents of universal healthcare also look to examples from other countries, such as France (where citizens are required to purchase coverage sold through nonprofits), Germany (where public options run by the government coexist with private plans), and the UK (where insurance is provided by the tax-funded National Health System).


Private insurance companies, drug manufacturers, and hospital trade groups still actively oppose the single-payer option. The American Medical Association has also been outspoken, saying in a statement that it “supports building on the foundation of our current system to reach universal coverage through a pluralistic approach involving a strong competitive private market, employer-sponsored coverage, and a publicly financed safety net.” 

According to Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, “an expanded government plan would balloon uncontrollably.” Public programs have a lower prices for premiums because they frequently pay health-care providers less than private payers do. To make up for lost revenue, doctors and hospitals to charge higher prices to private insurers. This would likely result in higher premiums for those with private insurance, which would “crowd out private options, push consumers off private plans and reduce choice as private plans flee the market.” Instead, she advocates addressing “the drivers of costs by fostering a competitive and dynamic private market” instead of putting the burden on taxpayers.

Lilly CEO Dave Ricks also points out that when cost-shifting (meaning the exact same service or product is priced differently depending on who is paying and where care is delivered, as is the case with government-subsidized medicine compared to private plans) is at the basis of the healthcare system, “the end result is that our system is focused on recouping costs, rather than delivering value.” When prices are low because they have been depressed by government rules, “payers and providers aren’t very interested in adopting cost-saving measures,” which can impede innovation.

Employer-based and Private Insurance

The tax exclusion that gave employers the incentive to offer employees health insurance has created a number of problems over the past 60 years. According to healthcare policy expert Tom Miller at the American Enterprise Institute, the tax exclusion “has been criticized for raising – and hiding – the overall costs of health insurance and health care.” It also limits choices for individuals, and “dispenses its rewards disproportionately to higher-income workers in larger companies with better-paying jobs.” 

This is mainly because large companies have the most leverage when negotiating with insurance companies. Whereas only 40% of small companies with fewer than 25 employees offer health insurance, 97% of companies with over 100 employees offer coverage. For all companies, however, average health care prices for employer-sponsored coverage rose over 17% between 2013 and 2017, according to a Wall Street Journal report. In 2019, the average total cost of employer-provided health coverage rose to over $20,000 for a family plan (a 5% increase from 2018) and to about $7200 for individual plans (a 4% increase from 2018). On average, employers bore 71% of the costs. Individuals who are self-employed, unemployed, or not offered insurance by an employer have additional difficulties facing rising prices, steep premiums, and meager benefits.

For those who suffer from pre-existing health conditions that are serious and costly, the individual market is rarely an affordable option. This is, in part, because health insurance is regulated differently by each state, and employers and individuals alike must purchase plans that comply with state mandates–-creating monopolies of one or two insurance companies in many states. This patchwork regulation dramatically limits competition in the insurance market, causing high prices.

The Trump administration has addressed monopolization and competition through issuing a 2018 Department of Labor rule that “expanded access to affordable health coverage options for America’s small businesses and their employees through Association Health Plans” which work “by allowing small businesses, including self-employed workers, to band together by geography or industry to obtain healthcare coverage as if they were a single large employer.” The larger risk pools and economies of scale created by Association Health Plans give smaller businesses stronger negotiating power with providers. 

Another option is to give states a more prominent role in reforming their health insurance markets since states have a better understanding of local needs and are having trouble offering their own plans given current mandates. Idaho’s Blue Cross insurer, for example, tried to implement a plan that would help the state financially but would charge higher premiums for sick people or people with preexisting conditions. Federal officials struck the plan down but “encouraged Idaho to explore offering similar policies as short-term plans…” The problem with short term plans is that, although they tend to be less-expensive options, they lack the consumer protections that come with ACA plans. 

State budgets have been in trouble for at least a decade due to healthcare expenditures like Medicaid and retiree healthcare benefits. States pay for a portion of healthcare bills for retired public workers, promising hundreds of billions of dollars in retiree health benefits that have resulted in a nation-wide $600 billion dollar gap. This has prompted a number of states to start “testing how far they can reduce health benefits…as a way of coping with mounting liabilities and balancing budgets.” For example, In 2017, Kansas began charging retirees the full cost of health coverage in 2017. After this, 75% of former beneficiaries dropped out, and Kansas saw its health care liability fall from over $6 million to just over $500,000.

The Role of Technology

Telehealth is an area for opportunity that could help improve healthcare delivery and reduce costs.  According to the Health Resources Services Administration, “telehealth” is defined as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”

Telehealth includes clinical (e.g., a virtual exam) and non-clinical applications (e.g. training on how to use equipment or holding administrative meetings). Seema Verma has noted key ways that telehealth “is changing the very face of healthcare. Telehealth innovations could help usher in a new world of healthcare that is embraced by both patients and providers, that identifies new avenues of care delivery, and that improves the value of care by increasing its quality while lowering its cost.”

For example, Amazon’s Alexa “can track blood glucose levels, describe symptoms, access post-surgical care instructions, monitor home prescription deliveries and make same-day appointments at the nearest urgent care center.” The Apple Heart Study, a combined effort between Apple and Stanford University, uses data from Apple watches to improve technology detecting irregular heart conditions. Developments in telehealth could also reduce the burden on doctors, nurses, and medical practitioners, who often complain that entering medical information into electronic health records is currently time-consuming and takes away from interactions with patients.

Another example of digitization in practice is the Australian health system’s remote care coordination for Type 2 diabetes patients, which saw a drop in patients’ blood glucose levels by a full percentage point when managed remotely compared to only seeing a traditional doctor. Additionally, the annual cost of care per individual dropped by $900. Digital and pharmaceutical technologies “can move most chronic care from centralized hospitals, surgery centers and clinics into patients’ homes,” turning healthcare from a “high-cost destination” to a “low-cost delivery system” focused on value and empowering patients.

You can read more about telehealth in The Policy Circle’s Digital Landscape Brief.



Healthcare reform is one of the most contested issues in U.S. politics: costs are high, access is limited, and current laws and mandates do not work for everyone. Reform is inevitable, and will affect all Americans. It is important for lawmakers, businesses and employers, and individual citizens to be aware of the current state of healthcare and the reforms under consideration to come up with the best solution for Americans. 


What You Can Do/Ways to Get Involved

Many options for healthcare reform are being considered. It is essential that American citizens remain aware of the options so they can contribute to dialogue and make their voices heard. Here are some resources to explore:

  • Research your elected representatives’ positions on healthcare law and his or her vision for how to tackle the healthcare challenges facing Americans at large and your community specifically.
    • Start by searching on your state or municipality’s website for your local Department of Health using keywords such as healthcare or department of health.
    • You can also search for healthcare in your state on Ballotpedia.
    • At the national level, GovTrack tracks bills in the House and Senate.
  • Make your voice heard
    • Learn how to write to your representatives, set up a meeting with a legislator, and write a letter to the editor here.
    • You can find contact information for federal, state, and local government officials here

More resources:

Department of Health and Human Services
Centers for Medicare & Medicaid

Senate Committees

House Committees


Notable Organizations:

  • Network for Regional Healthcare Improvement is an organization representing other state and regional affiliated partners working to collaborate healthcare improvement across regions.
  • The Kaiser Family Foundation is a nonprofit organization that focuses on national health issues. 
  • The RAND Corporation is a nonpartisan, nonprofit organization that does research and analysis on areas including security, health, education, sustainability.
  • The Galen Institute is a non-profit public policy research organization that focuses on policies to create a patient-centered health sector that offers greater freedom and more affordable health care choices.


The Galen Institute President Grace-Marie Turner testified before Congress about the path to universal coverage in the U.S. Read the full transcript here.

The Pacific Research Institute’s CEO and health care expert Sally Pipes discussed the future of health care and how single payer systems actually function. Listen to the podcast here.

Education and Healthcare face similar debates, centered around what role the government and individuals should each play in making decisions and controlling resources in these service industries. First, both face “rising prices, consumer criticism,” and questions of quality. Additionally, both are subsidized by the government, who is not the consumer, which means consumers have little power over producers and producers have little incentives to cut costs.

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