Defining U.S. Healthcare

The U.S. is the only developed country, except for South Korea, that does not provide healthcare for all its citizens. What is unique about the U.S. system is that the private element dominates the public one. For example, the Kaiser Foundation reported that 61% of non-elderly Americans in 2006 received insurance through their employers; 14% were enrolled in public insurance programs like Medicaid; and 18% were uninsured. Those over age 65 were usually enrolled in Medicare.
Here is how the system is organized:

Private Health Insurance

• Employer-sponsored Insurance: The main way Americans receive health insurance coverage is through their employers. Companies provide this as part of their benefits package. These plans are administered by insurance companies both for-profit (Aetna, Cigna, State Farm, for example), and not-for-profit (Blue Cross/Blue Shield).
Some large companies choose to “self-insure,” that is they pay the health costs directly while choosing a third-party (usually an insurer) to administer the plan. Employer-sponsored plans are financed partly by the employers who pay most of the premium, and partly by employees who pay the remainder.
• Individual Health Insurance: This option covers individuals for whom insurance is not provided through their employers, those who are self-employed, and retirees. Plans are provided by private insurance companies. Insured individuals pay the full health insurance premium.

Public Health Insurance

• Medicare: This is a program provided by the federal government which covers individuals aged 65 and older, and disabled individuals as well. It is funded through federal income tax, as well as taxes on employers and employees, and premium payments by those enrolled. Medicare covers hospital services, physician services and prescription drug benefits.
• Medicaid: This program is designed for low-income individuals and those who are disabled. States are required by law to provide coverage for children, the elderly, the disabled, parents and poor pregnant women. Adults without children are not covered, as well as poor individuals who earn too much. A comprehensive set of benefits is offered by the program, including prescription drugs. However, in spite of this, many of those enrolled still have problems finding providers that accept Medicaid, because of its low rate of reimbursement.
• Other Public Systems: These include the Veteran’s Administration (VA), which provides healthcare for military veterans in VA hospitals and clinics, which are government-owned, and the State Children’s Health Insurance Program (S-CHIP), which covers children whose families earn too much to qualify for Medicaid, but too little to purchase private health insurance.