I believe some Americans are aware they just do not care because they feel like the government
should offer universal healthcare. The ones that are not aware are so wrapped up in what they
must pay in co-pays, out-of-pocket costs, and deductibles. According to the tax policy center, the
federal government spent nearly $1.2 trillion in the fiscal year 2019. In addition, income tax
expenditures for health care totalled $234 billion. The federal government spent nearly $1.2
trillion on health care in the fiscal year 2019 (Tax policy center,2021). Most Americans do not
realize that the percentage split of what they are responsible for, the government pays the rest to
try to keep costs down for the consumer. Also, consumers are not aware of the incurred costs
because of the affordable care act. It was created to make sure the uninsured had access to
affordable health care at a lower cost but it’s at the expense of the government. According to Sam
hananel, the affordable care act new authorities create a clear path for payment and delivery
reform to lower costs and improve quality (Hananel, 2010). I believe that the government shields
its consumers from the high costs of healthcare by creating mandates to help all that are insured
and uninsured. The government cannot financially afford universal healthcare because it would be
the United States in major debt so they created ways that could save money for the consumer
even if that meant that take on the cost.
Ryan (2008) reported that the explosive growth in healthcare spending in the U.S. is not a sign
that the healthcare market has somehow failed. Rather, rising cost is a predictable outcome of
vast distortions imposed on the market over decades, driven primarily by the federal tax code. b
One reason U.S. citizens are unaware of what healthcare costs are the federal tax exclusion for
employer-provided coverage which incentivized most Americans to rely on their employer for
health coverage (Ryan, 2008). b Ryan (2008) noted that another major distortion in the market is
the huge amount of spending by the government on Medicare and Medicaid. Over half of health
care spending in the U.S. in 2019, approximately $1.4 trillion, was government spending through
the Medicare and Medicaid programs which cover thirty eight percent of the population
(Congressional Research Service, 2021). In contrast, health care spending in the private sector,
covering sixty nine percent of the population, totalled approximately $1.2 trillion (Congressional
Research Service, 2021).
Whether privately or publicly insured, people are separated from understanding the full cost their
healthcare because they are only exposed to small portions of it at a time. For example, people
can generally quote what their copay is for a doctor visit or what their deductible is. b However,
those values are only the portion they pay. b The remaining balance is paid by someone else, and
pricing is opaque. b Insurance companies negotiate rates with providers and rates can differ
between insurance carriers. For example, Cigna may negotiate a rate of $125 for a primary care
visit with a doctor. b That same visit with that same doctor may be paid at a rate of $110 by
another insurance carrier. b Medicare and Medicaid price services at a certain level but depending
on where the provider is geographically located, their reimbursement rate may be adjusted up or
down from the national baseline. Further veiling costs for publicly funded insurance is the
government budgeting process. b Not only is the budgeting process itself complicated, but the math
on Medicare reimbursement to providers is convoluted. The public does not have line of sight to
how the Centers for Medicare and Medicaid Services sets rates for provider reimbursement.
Finally, most people do not fully understand health insurance. As noted above, most people can
quote their copay for office visits, or their deductible, but Kliff (2013) explained that most people
do not know what terms like copay, coinsurance, deductible, max out of pocket mean and how
they relate to the total cost of health care. It is difficult for people to understand because it is
inherently complicated, and, even if understood, it is still difficult to figure out the actual cost
(Kliff, 2013). b Datapath (2022) wrote that with other industries, customers can easily access
comparisons of features, benefits, and costs to guide their purchasing decisions, but the
healthcare industry presents a huge array of confusing choices, contact points, and service flows
without any upfront pricing information. b To make better decisions, healthcare consumers are
increasingly expecting more transparency, better information, and a partner relationship with
healthcare providers, versus the historical paradigm of a one-way dialogue from provider to
patient.
With the large amount of money spent each year on healthcare paid for by the American
government, it is interesting to consider how many are unaware or uneducated regarding these
expenditures. There are likely a multitude of reasons that explain the lack of awareness regarding
government healthcare spending. In 2020, total spending for U.S. healthcare was approximately
$4.1 trillion (CMS.gov, 2021); that is an incredibly large number that some may have difficulty
comprehending in terms of dollars spent. Of that spending, approximately $1.5 trillion was spent
through Medicare and Medicaid, with federal government spending in healthcare growing by 36%
in 2020 (CMS.gov, 2021). Much of that growth has been attributed to the COVID-19 pandemic
(CMS.gov, 2021). Considering the current political situation in the United States, it is possible that
Americans are paying attention to items that are deemed more news-worthy, more shocking, or
more polarizing. Americans may be more upset about things they can see, like tax dollars spent on
vaccine development or the enormous defense budget, than things that have already been going
on behind the scenes all along.
We may also have a situation where the average American does not realize the average healthcare
costs in terms of age groups, regardless of payer. Information from CMS regarding 2014 data
indicates a larger portion of healthcare payments for females in comparison to their male
counterparts and advises that, per capita, healthcare expenditures were nearly nine times greater
for adults over the age of 85 than for children (CMS, n.d.). Healthcare spending for older adults
over the age of 65 was approximately $11,000 greater than the per capita average of the entire
population (CMS.gov, n.d.); with Medicare eligibility beginning at age 65, it is easy to see how the
government could be responsible for a large portion of these expenses (Backman, 2021) but the
average layperson could continue to be unaware of the healthcare costs the government is
responsible for.
As health care reform moves forward, many Americans are not aware of the large costs incurred
by the government because many times these costs are contingent upon multiple factors such as
the patient’s income, the service, health care insurance and plans. "The percentage of national
income that is absorbed by health care has grown over the past half-century, from 5% in 1960 to
18% in 2017, reducing what is available for anything else from 95% in 1960 to 82% today. The
costs of health care contribute to the long-term stagnation in wages; to fewer good jobs,
especially for less educated workers; and to rising income inequality" (Deaton & Deaths of Despair
and the Future of Capitalism, 2020). For a patient, the cost in considered their out of pocket pay,
not factoring in what the institution pays for the equipment or the amount for hospitals and
providers incur to deliver various services (Arora et al., 2015). Many times, Americans pay for
health insurance through their job which comes out of their pay checks. Most of the taxes that we
pay goes toward health care costs. "Health costs also affect federal and state governments, which
pay for Medicare and Medicaid. Governments must collect more taxes; provide less of something
else, such as infrastructure or public education; or run deficits that shift the burden to future
taxpayers" (Deaton & Deaths of Despair and the Future of Capitalism, 2020). This is why
Americans are not aware of exact costs because there are so many different variables that play a
role in the costs of healthcare and how it paid for.
The high cost of the health care systems always affects the sick as well as the common people. As
compared to the past decades, American workers have increased their salaries, but it does not
reduce their net pay, and it remains the same as the health insurance has increased over time
(Papanicolas et al., 2018). There are several reasons for the high cost of the health care system in
America, which includes multiple systems create waste, increase in the drug price, nurses and
doctors are paid more, the practice of defensive medicine in U.S. healthcare, hospitals are
becoming profit centers, and U.S. prices differ (Knox, 2018).
For instance, in March 2010, the nation's health reform law was enacted and named the “The
Affordable Care Act." This law has proposed to reform both public and private health insurance
systems (Health Reform. Health reform, 2021). According to Barack Obama, J.D., significant
progress has been seen with 'The Affordable Care Act' that has aimed to solve long-standing
challenges experiencing the health care system of the U.S. associated with quality of care, access,
and affordability (Obama, 2016). However, The Affordable Care Act is threatened with repeal. In
2019, the ACA's individual mandate began with a 2018 tax law repeals, which has many uninsured
millions of Americans and increased insurance premiums. The Affordable Care Act is very
important for Americans because millions still require health insurance, health disparities, poor
health outcomes, unstable spending, and lack of emphasis on prevention (Health Reform. Health
reform, 2021). Even, till now many citizens of America are not aware of the large costs incurred by
the American government. Hence, the government needs to spread awareness about the recent
changes in the health care system or health care policy.
Additionally, the government should give focus on the people situated in the U.S. regardless of
health condition, where they should have affordable, comprehensive, and understandable health
coverage. Also, the policymakers need to ensure that all U.S. people should receive patient-
centred health care high-quality and affordable health care. The government should eliminate
geographic disparities, race, gender, and sex in health and health care. Moreover, the healthcare
workforce of the U.S. should continue to diversify and grow via a sustained national commitment
to public health’s culturally competent and clinical training and medical education (Warner et al.,
2020). Apart from this, public health infrastructure should be efficient and strengthened to
support the elimination of systemic inequities in the system of health care and to engage more
stakeholders in various healthcare sectors. If the people of America get aware of the health care
policy, they can utilize the facilities at the right time. Also, the government should consider the
high cost of health care services for the betterment of American citizens.
American healthcare spending is divided between individuals, employers, and the government.
The majority of government healthcare spending goes towards personal health care, including
trips to the doctor and for prescription drugs. A smaller portion is spent on research and public
health activities, including programs that encourage people to eat healthier or get vaccinated.
Healthcare spending has increased in recent decades. “In 1970, the United States spent 7.2
percent of GDP on health care. By 2010, that had risen to 17.9 percent “(Kliff, 2014). b More money
spent on healthcare means fewer dollars are going to other things. With the increased spending
on Medicare and Medicaid, this requires the government to cut programs, raise taxes, or increase
the deficit.
The Institute of Medicine estimates that the U.S spend about $210 billion on unnecessary care,
with doctors delivering care that is not recommended by medical guidelines. This unnecessary care
can be harmful to patients as well, especially if it involved surgery. Private health insurance plans
accounted for $917 billion in healthcare spending in 2012(see graphs), which was a third of all
medical dollars spend that year. Hospitals and doctors are the biggest recipients of healthcare
spending with $882 billion on hospitals, and $752 billion on doctors, which together is 60% of all
healthcare spending.
I personally believe that Americans are unaware of the part that the government plays in
delivering healthcare. They assume that their insurance company covers all the other costs that
they themselves do not pay. This lack of knowledge can also be contributed to the very complex
healthcare system that we have. Where there are many insurance plans, reimbursements, costs,
and more.
Health care reform has been a sour taste in the mouths of Americans, for years our politicians
have campaigned for office on the notion of fixing health care in the US. Well other than the
Affordable Care Act (ACA) or as it is also known as Obamacare, we have not really seen any form
for reform in the US. This to me is one of the reasons that American are unaware of the cost
associated with health care at the government level and it is because one can say it is always a
bunch of broken promises. I also feel that many Americans have their own expenses when it
comes to health care that they do not bother to look at the government level. I found an
interesting poll conducted by the West Health Institute and NORC at the University of Chicago.
They polled to see how Americans felt about the cost of health and how the cost affects their
medical decisions and personal finances. In the study conducted, many Americans noted that they
went without health care due to cost.
40 percent of those surveyed said they skipped a recommended medical test or treatment in the
last 12 months due to cost, and 32 percent were unable to fill a prescription or took less of a
medication because of the cost (NORC, 2018).
Over half of Americans say they have received a medical bill for a cost they thought was covered
by their health insurance in the past 12 months, and a similar proportion report receiving a
medical bill saying the amount they owed was higher than expected (NORC, 2018).
Thirty percent report they have had difficulty paying for necessities, like food, heat, and housing,
36 percent say they have had to use up all or most of their savings, 32 percent report borrowing
money or increasing credit card debt, and 41 percent believe they decreased contributions to a
savings plan because of healthcare expenses (NORC, 2018).
About half of Americans disapprove of the way their representative in Congress is handling the
cost of healthcare, whereas just 15 percent approve, and a third neither approve nor disapprove
(NORC, 2018).
As noted in the study, Americans have issues paying bills and worrying about their own health
care that they do not have time to worry about how the federal government is spending money.
Many do not think the government is doing enough to care for them and their health care.
There are a few reasons why many Americans are not aware of the large costs incurred by the
government in providing health care. First, the government does not provide an overview of these
costs that is easily accessible to the public. Second, the government does not typically include the
cost of health care in its annual budget, which makes it difficult to track and understand the full
extent of these expenses. Finally, the government does not always provide accurate information
on the cost of health care, which can make it difficult to understand the full extent of these
expenses. "Health care spending is determined by prices and utilization and both of those, in turn,
reflect a wide range of market features, such as the extent of provider and insurer competition
and local practice patterns (Reducing health care spending: What tools can state leverage?
Commonwealth Fund,2021). " b b All of these factors combine to create a situation where many
Americans are not aware of the large costs incurred by the government in providing health care.
This lack of awareness can make it difficult for the public to understand and debate the merits of
health care reform.
Reducing health care spending: What tools can state leverage? Commonwealth Fund. (2021,
August 18). Retrieved February 11, 2022, from
https://www.commonwealthfund.org/publications/fund-reports/2021/aug/reducing-health-care-
spending-what-tools-can-states-leverage
NORC. (2018). Issue Brief: AMERICANS’ VIEWS OF HEALTHCARE COSTS, COVERAGE, AND POLICY.
West Health Institute:
https://www.norc.org/PDFs/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy/WHI%20H
ealthcare%20Costs%20Coverage%20and%20Policy%20Issue%20Brief.pdf
Knox, R. (2018, March 13). Why are U.S. health costs the world's highest? study affirms 'it's the
prices, stupid'. WBUR News. Retrieved February 9, 2022, from
https://www.wbur.org/news/2018/03/13/us-health-costs-high-jha
Health Reform. Health reform. (2021). Retrieved February 9, 2022, from https://apha.org/topics-
and-issues/health-
reform#:~:text=The%20Affordable%20Care%20Act%20is,law%20enacted%20in%20March%202010.
&text=And%20a%202018%20tax%20law,millions%20of%20Americans%20becoming%20uninsured.
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018) Health care spending in the United States and
other high-income countries [published online March 13, 2018]. JAMA.
Obama, B. (2016). United States health care reform: progress to date and next steps. Jama, 316(5),
525-532.
Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C., ... &
American Heart Association Advocacy Coordinating Committee. (2020). Advancing healthcare
reform: the American Heart Association’s 2020 statement of principles for adequate, accessible,
and affordable health care: a presidential advisory from the American Heart Association.
Circulation, 141(10), e601-e614.
Kliff, S. (2014, April 30th). “Health-Care spending.” Retrieved from
https://www.vox.com/2014/4/30/18077016/health-care-spending
Arora, V., Moriates, C., & Shah, N. (2015, November 1). The challenge of understanding health
care costs and charges. Journal of Ethics | American Medical Association. Retrieved February 7,
2022, from https://journalofethics.ama-assn.org/article/challenge-understanding-health-care-costs-
and-charges/2015-11
Deaton, A. C. and A., & Deaths of Despair and the Future of Capitalism. (2020, February 20).
Unequal access to health care costs us all. Time. Retrieved February 7, 2022, from
https://time.com/5785945/health-care-problems-america/
Backman, M. (2021, July 16). Do I need to sign up for Medicare at 65 if I’m still working?
MedicareResources.org. https://www.medicareresources.org/faqs/do-i-need-to-sign-up-for-
medicare-at-65-if-im-still-
working/#:~:text=Medicare%20eligibility%20starts%20at%20age,over%20the%20course%20of%20re
tirement.
NHE fact sheet. CMS.gov. (2021, December 15). https://www.cms.gov/Research-Statistics-Data-
and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-
Sheet#:~:text=Historical%20NHE%2C%202020%3A&text=Medicaid%20spending%20grew%209.2%25
%20to,16%20percent%20of%20total%20NHE.&text=Out%20of%20pocket%20spending%20declined,
the%205.9%25%20growth%20in%202019.
U.S. personal health care spending by age and gender – 2014 highlights. CMS.gov. (n.d.).
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/Downloads/AgeandGenderHighlights.pdf
Congressional Research Service. (2021). U.A. health care coverage and spending. Washington, DC:
Congressional Research Service. Retrieved February 13, 2022, from
https://crsreports.congress.gov/product/pdf/IF/IF10830
DataPath. (2022). What is healthcare consumerism and how does it affect healthcare? Retrieved
February 13, 2022, from DataPath: https://dpath.com/what-is-healthcare-consumerism/
Kliff, S. (2013, August 8). Do you understand health insurance? Most people do not. Retrieved
February 13, 2022, from Washington Post:
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/08/08/do-you-understand-health-
insurance-most-people-dont/
Ryan, P. (2008, February 26). Health Spending: The problem is government, not the market.
HealthAffiars, p. digital. doi:10.1377/forefront.20080226.000333
WhiteHouse.gov. (2021, May). Budget Concepts. Retrieved February 13, 2022, from
WhiteHouse.gov: https://www.whitehouse.gov/wp-
content/uploads/2021/05/ap_6_concepts_fy22.pdf
Hananel Director, S., Hananel, S., Shepherd Director, M., Director, J. P. D., Waldrop, T., Gaba, C.,
Rap Fogel, N., Chalhoub, T., O’Connell, J., Edmund, M., Graves-Fitzsimmons, G., & Chatterji, R.
(2020, October 16). How health reform saves consumers and taxpayers money. Center for
American Progress. Retrieved February 9, 2022, from
https://www.americanprogress.org/article/how-health-reform-saves-consumers-and-taxpayers-
money/
Tax policy center. How much does the federal government spend on Health Care? Tax Policy
Center. (n.d.). Retrieved February 9, 2022, from https://www.taxpolicycenter.org/briefing-
book/how-much-does-federal-government-spend-health-care
