Why is health insurance so controversial in the US?

Health insurance in the USA is a very comprehensive issue which is difficult to overlook or explain.This is partly due to the much greater independence of the individual states compared to Germany. The German Wikipedia has a comprehensive entry on this: Health System of the United States – Wikipedia

Generally speaking, one could say that the part of the population with well-paid jobs is well to very well secured, also in comparison with Germany (Source: Gallup [1).

Annual income <-36,000 – 22.8% uninsured

Annual income >-90,000 – 3.5% uninsured

For the low-skilled and unemployed, it is very important to know which state they live in.

The ‘Medicaid expansion’ introduced by the Affordable Care Act (ACA, ‘Obamacare’) extends Medicaid coverage (usually intended only for people in need) to additional low-income people. The costs are shared between the state and the federal government. The decision on the introduction of enlargement rests with the states. Fourteen states are currently opposed to the introduction in their state (mostly conservative/’Republican’-led states). [2

A few dates:

  • The introduction of the ACA led to a rise in the number of health insurers by about 20 million.

Since the change of government in 2017, the number of uninsured has risen again. [3 [4

  • At the end of 2017, about 12.2% of U.S. adults had no health insurance (source: Gallup [5).
    • Another 38 million had poor/inadequate health insurance.

    [6 ‘Insufficient’ usually refers to contracts with sometimes very high deductible/high co-payment or with uncovered treatments which should actually be standard.

  • Over 65-year-olds are covered by Medicare. [7
  • The Emergency Medical Treatment and Active Labor Act (EMTALA) has been in place since 1986.
  • [8 [9[10 “Under this law, hospitals must accept every patient who is admitted as an emergency, even if they have no insurance cover and cannot pay for the treatment.” Some uninsured use this opportunity to get treatments that otherwise could not afford

  • In the health sector, the US spends by far the most money (in terms of gross national product).
  • In 2015, it was 16.8% of GNP. Still, the benefits are worse than in some other nations that spend less money.

  • A lot of Americans have employer insurance.
  • In the case of higher-skilled jobs, the entire CT contribution is often taken over by the employer. Or at least generously subsidized. (Source: Gallup [11 )

    • A large number of working people, especially in less-skilled occupations, have few or no paid sick days.

    If really necessary take leave or unpaid time to recover must be taken. As a result, some people are also dragging themselves into work sick and may be infecting employees because they cannot afford to stay at home.

  • ‘Medical Bankruptcy’ – Insolvency due to invoices for doctor visits/treatments.
  • It probably doesn’t exist in most industrialized nations. In the US, according to a 2014 study, [12at least 18% of all insolvencies, i.e. more than 200,000 each year).

  • Treatments and medicines cost much more than in other Western countries.
  • Reasons for resisting improvements:

    • By far the main reason is that the profiteers of the current state are pumping a lot of money into national disinformation campaigns and lobbying & bribery in Washington, D.C., to maintain (or even make worse) the status quo.

    This misinformation falls on fertile ground. Individual examples of health care problems in other countries are presented as representative and evidence of their inferiority. And the linking of the CT systems of these countries with the catchphrase ‘socialism’ is still good for causing immediate rejection by some sections of the population. (Similar disinformation campaigns can also be seen in Germany in discussions about citizens’ insurance).

  • Many Americans have good to very good health insurances, which would also perform well compared to private insurance in Germany.
  • Many of these individuals see little advantage in a change that would most likely go with a certain deterioration in very good insurance. (Again analogous to the resistance of the PKV and privately insured persons in Germany re: Citizens’ Insurance).

  • Quite a few in the US claim that the private market/capitalism is the best way to reduce costs and that involving the public sector only makes everything inefficient.
  • However, price regulation through supply and demand only works in a flexible market. I don’t buy the Ferrari or the yacht if I can’t or don’t want to afford it. The demand for health care is not flexible and therefore almost any price can be charged. “Your child has cancer? $1 million please. What, to sell your house has brought in only ‘500,000? So, well, we’re making them a special offer, we’re only asking for a $600,000 for treatment.” A purely private health insurance system for all residents would only work with very strong and detailed regulation.

  • Health insurance can (in my opinion) only work with coercion to insure (otherwise some save the insurance premium and go to the emergency room in case of illness and let others pay the bill).
  • Such coercion is contrary to the American spirit. Although I don’t remember that a lot of people complain about the car insurance obligation. The renunciation of compulsory insurance would only work if you then simply left the people who decide against insurance. I don’t think any country, not even the USA, does that (see EMTALA [13).

  • Because many people in the US believe in the pioneering spirit and their own independence/individuality, the slogan is often ‘everyone takes care of themselves’.
  • This is not only expressed by the fact that some accuse the needy of not working hard enough. But also for some because they really want to take care of themselves and would not seek help. And therefore do not want to pay for health insurance. Certainly not to ‘pay others the cost of treatment’. In my opinion, the population in the US is more of a collection of individuals than a society/community/’society’ of the kind that exists in most other industrialized nations (there ?…). Life is more about individual responsibility. May also be due to the size of the country, combined with the population and diversity of ethnicities. Perhaps well comparable to the EU as a whole.

    But as mentioned above, the absolute main reason why nothing has improved so far is the influence of those who benefit from the current state of affairs: Which firms profit most from America’s health-care system

    Billions in profit can be used to finance many lies and bribery campaigns.


    [1 U.S. Uninsured Rate Steady at 12.2% in Fourth Quarter of 2017

    [2 Status of State Action on the Medicaid Expansion Decision

    [3 Patient Protection and Affordable Care Act – Wikipedia

    [4 Key Facts about the Uninsured Population

    [5 U.S. Uninsured Rate Steady at 12.2% in Fourth Quarter of 2017

    [6 PBS- Healthcare Crisis: The Uninsured

    [7 Medicare – Wikipedia

    [8 Emergency Medical Treatment and Active Labor Act – Wikipedia

    [9 Emergency Medical Treatment & Labor Act (EMTALA)

    [10 United States Health Care System – Wikipedia

    [11 U.S. Uninsured Rate Steady at 12.2% in Fourth Quarter of 2017

    [12 https://repository.library.north…

    [13 United States Health Care System – Wikipedia

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