There are several reasons as to why Americans are not aware of the costs incurred by the
government. A survey conducted by Policy Genius highlights this issue in America; "a survey of
2,000 American health insurance consumers found that 96% of Americans overestimate their
understanding of health insurance concepts." (Policy Genius, para. 3, 2017). The complex nature of
the American Healthcare system creates a situation where consumers are not aware of what they
are paying for, and who is paying for their services. The patient essentially becomes a product for
payers. Providers bill payers directly for their services, and the patient is oblivious to the whole
process. This, along with the numerous laws that effect reimbursement rates for different services
furthers this confusion that the population has. In my career, I currently work with patients and
insurance billing in the urgent care setting. There is always confusion on how copays work, what
services certain insurances cover, etc. I notice this confusion first hand!
Americans often do not receive a bill for their care services, as providers bill the insurance directly.
As the patient does not see the actual bill, the patient becomes unaware of how much health care
costs. The compete unawareness to costs leads to a misunderstanding on how much the
government is involved. In 2020, the government spent $4.1 trillion, or $12,530 per citizen (CMS,
para. 2, 2021) person. The complexity of the healthcare system leads to confusion on the
reimbursement process, which the government is heavily involved in.
It is important that people educate themselves on the healthcare system and what health
insurance pays for, as reimbursement is always shifting. Insurance providers may one day not
cover a certain prescription or service that a patient needs, and this payment then falls on the
patient. Knowledge on reimbursement prevents can this from happening!
While health care reform is moving forward, there are still many Americans who are unaware of
the high costs incurred by the government. I believe this is because Americans observe and worry
about their own rising health care costs associated with the increasing price of health care services
and medicine, so they do not feel or think that the government is expending enough money on
healthcare. They think, “If I’m spending THIS much on my own health care, then the government
must not be spending THAT much.” In fact, it has been observed that most Americans want the
government to spend more money on health care. In 2006, a survey taken by Americans exhibited
that 70% of people said that the government was spending too little on healthcare, while only
11% of Americans thought the government was spending too much. In 2003, when Americans
were asked which of eight segments of the U.S. economy, they felt should be the highest priorities
for future spending growth, health care was at the top of the list, with education and defence to
follow (Blendon, Brodie, Benson, Altman, & Buhr, 2006).
What concerns Americans the most is what is felt by Americans—they do not feel the high costs
incurred by the government because of health care reform because they are feeling, every day,
the high costs and negative impacts of their own direct payments for health care, which have
continued to rise. Americans are feeling heightened anxiety that they will eventually be unable to
afford health care services in the future, or even be able to pay their medical bills today. In 2021,
it was cited that Americans were subjected to at least $140 billion in outstanding medical debt. In
2020, 17.8% of people with a credit report had medical debt in collections and 13% had accrued
debt in the prior year that was not in collections. Of those who had medical debt, the average
amount was $2,424 (Crawford, 2021). Therefore, although the U.S. spends more money on health
care than any other country in the world, reaching $4.1 trillion in 2020, Americans do not feel the
costs incurred by the government because they are feeling the pains of their own personal rising
health care costs (CMS, 2021).
The large costs of healthcare are largely unknown by the population. Much of it is typically
communicated over a political platform or by some candidate looking for election/re-election. I
personally believe there are several reasons for this. The main reasons being a lack of
accountability and lack of education regarding the matter. Unfortunately, we have fallen into a
scenario in which people often look to major news media outlets to get some type of information.
As we all know, mainstream media is not necessarily the most ideal form of delivery of set
information. In today's landscape, Government has not been successful in educating the mass
population. The Affordable Care Act (ACA) find by President Barack Obama was supposed to have
widespread reform among insurance companies, pricing transparency, and identify different
disparities within the healthcare system. It is arguable that the law did not do its job due to
different components of it being ruled unconstitutional by the United States Supreme Court. In
addition to political challenges, it has been difficult for any type of progression to take place
following the passage of this legislation.
On the topic of general misinformation, it seems that politicians and their constituents usually take
a partisan approach when it comes to healthcare costs. There are definite inconsistencies within
verbal testimony in addition, we have always been unable to communicate healthcare costs across
the board because they continue to fluctuate in terms of pricing. Each state also has an impact on
pricing which results in varying costs throughout the country. A resident in New Jersey, I will likely
be paying something different than a resident of Oklahoma or Texas. The economies are different
as well as the tax base. This creates the illusion that we are getting different services at a
drastically different price. Is why we need government intervention in the form of education so
that a large portion of Americans can understand the differences regarding pricing disparities. At
the end of the day, it all comes down to general education. The best consumer is an informed
one. Being educated about those differences make all the difference in having citizen
participation. Misinformation continues to be spread throughout both sides of the political aisle
and the people who execute those costs and coverages should be brought to the forefront, given
a platform, an outline exactly what it is we as the consumer should know. The answer is not to a
single issue but rather a complex history.
Government Healthcare spending has only gone up the past few years, and during Covid, the
increase was even worse! According to Brookings (2020), the US spends more on healthcare than
any other countries. Government expenditures on healthcare has grown from 11.9% in 1990, to
24% in 2018, and this is mostly due to the increased population enrolling government insurance.
Although, the government spends a lot of money on healthcare, many Americans are not aware of
the actual costs and my personal belief on this is because there are many people out there that do
not qualify for government benefits, but, spend a large amount of money for healthcare from their
pockets. These are the people that do not realize the costs the government incurs. b As 2018, about
80% of people held some kind of health insurance, whether it was private, or government based,
however, these people still incurred very large out of pocket costs for their medical care. b 1 in 50
Americans still had out of pocket costs that exceeded $5000, and 1 in 200 people had out of costs
that exceeded $10,000 (Nunn, Parsons, Shambaugh, 2020). When we see the costs of healthcare,
and the out-of-pocket expenses that many people have, even with insurance, we start to think,
that perhaps the government is not doing enough, or needs to make some changes. In my opinion,
this is why people do not realize the government costs, because individual costs are still very high.
The affordable care act (ACA) enacted in 2010 in the United States brought health care reforms to
improve the accessibility, affordability, and quality of health care. Since the law was passed, there
has been a decrease in the rate of the uninsured population by 43% with increased accessibility to
care, reduction in health care debts by people qualifying for Medicaid coverage, etc. This law
provided federal support for states to expand their Medicaid programs to cover more low-income
adults. Young adults could stay on a parent’s plan until age 26 years of age (Obama,2016). But
these reforms targeted only people in certain income groups. The ACA subsidies cost about $50
billion annually resulting in about $25,000 spent by the government on each new enrolled
individual (Blasé, 2020).
But for the average American who has a basic paying job that hardly meets his needs, affording
health insurance is a challenge. Even though they may have insurance coverage through the
employer, they pay high premiums and still end up with high deductibles, out-of-pocket costs, and
high prescription prices. My health insurance offered through my employer is a high deductible
insurance plan. My out-of-pocket costs and deductible will be close to 8,000 plus the premiums.
How affordable are these plans to the average American? They will not be able to understand how
much the Government is spending on health care when they are struggling to afford the
necessities of life including their health coverage.
The high cost of many insurance plans has affected accessibility to affordable health care. The
average American family spends about $8200 on health care premiums and out-of-pocket costs
leading to financial debt (Taylor, 2019). In my opinion, the government should focus on health
care reforms that target all Americans and provide universal coverage and equal accessibility to
health care.
The U.S. spends a considerable amount on healthcare than other countries without seeing
improvements in patient outcomes. How is that possible? Health care costs directly hurt those
without insurance, while those who are insured must pay co-payments, deductibles, and employee
contributions. Health costs also affect federal and state governments, which pay for Medicare and
Medicaid. Governments must collect more taxes; provide less of something else. (Wager, Ortaliza
& Cox, 2022). On average the average young family in the U.S. spends $8,200 per year, or 11% of
their income, on health care – not including employer contributions – but if someone in the family
becomes ill the health spending increase to 15% of the family income. U.S. health care spending
grew 9.7 percent in 2020, reaching $4.1 trillion or $12,530 per person. b As a share of the nation's
Gross Domestic Product, health spending accounted for 19.7 percent. (CMS,2021).
A large majority of blacks and Hispanics (85% and 84%) say the government should be responsible
for coverage, while non-Hispanic whites are split on the issue (49% agree, 49% disagree). And
while about three-quarters of those with family incomes of less than $30,000 per year (74%) say
the government should ensure coverage, only about half (53%) of those with incomes of $75,000
or higher say the same. (Balik, 2017) The majority of people stating the government should ensure
coverage, are the ones who need it most and are more prone to chronic illness. Lower-income
families do not have the ability to obtain insurance through their employers and at times make
too much to be covered by Medicaid. Healthcare reforms were supposed to aid with the cost of
healthcare, however with the cost of healthcare continuing to rise, how can people really afford
health coverage.
Preventative care has become an important topic with healthcare, insurance carriers, and
healthcare agencies. With preventative care, health expenditures can significantly decrease by
preventing admissions into hospitals and utilizing emergency care resources. People who do not
have access to preventative care will use the emergency room as their primary source of health
management. Thus, further driving the cost of healthcare for all tax payers.
Many Americans are not aware of the large costs incurred by the government for health care
because they view the health care situation from their own personal perspective. For most
Americans, personal expenditures on health care are significant, and many have had their savings
depleted, have increased credit card debt, have had to make a difficult choice between paying
health care bills or buying necessities, or have had medical debt sent to a collection agency due to
substantial medical bills (norc, n.d.). For most people, out-of-pocket costs are too high and the
quality of medical services for the amount spent is too low (norc, n.d.). In addition, most
Americans think that the government should cover more of the population under Medicare or
Medicaid (norc, n.d.).
As a result, most people are not looking at health care from the government’s perspective. Annual
government spending on health care is approximately $3.5 trillion and has outpaced GDP growth
year after year (Martin et al., 2019). To make matters worse, the implementation of the
Affordable Care Act and its subsequent expansions of Medicare and Medicaid have dramatically
increased the government’s health care spending and projections show that the government will
be paying nearly 50% of all health care costs in this country within 10 years (khn, n.d.). This type
of spending is unsustainable without drastic tax increases or significant service reductions.
As the older population in America continues to grow, federal spending for Medicare is expected
to increase substantially while most health care consumers pay only a third of the total annual
health care bill (khn.org). I believe that Americans spend more time obsessing over co-pays and
out-of-pocket expenses than the burden of health care costs on the government. We often hear of
support for universal health care or “Medicare for all”, but the truth is that most Americans do not
fully understand the finances needed to implement such a system (khn, n.d.). Not until a
discussion about mandatory contributions into a universal health care system and subsequent tax
increases will Americans finally realize just how much money is needed to maintain our health
care system.
Martin, A. B., Hartman, M., Washington, B., Catlin, A., & National Health Expenditure Accounts
Team. (2019). National health care spending in 2017: growth slows to post–Great Recession rates;
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