Health care in the United States

Health care in the United States
Sorens (talk) / Julia Sorenson · CC BY-SA 3.0 · source
Name	Health care in the United States
Caption	Hospitals and clinics across the United States
Established	18th century
Jurisdiction	United States

Contents

Health care in the United States is the system of medical services, institutions, and payment mechanisms that provide prevention, diagnosis, treatment, and rehabilitation to people in the United States. It involves a wide range of actors including U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Johns Hopkins Hospital, Mayo Clinic, Harvard Medical School, and private insurers such as UnitedHealth Group, Anthem, Inc., and Aetna. The system evolved through interactions among federal actors like the Social Security Act, state agencies such as the California Department of Public Health, academic centers like University of Pennsylvania Health System, and advocacy organizations including the American Medical Association and Kaiser Family Foundation.

History

U.S. health care developed from early colonial hospitals such as Pennsylvania Hospital and philanthropic efforts like the American Red Cross into modern institutions shaped by landmark events. The Civil War accelerated military medicine innovations that later influenced Johns Hopkins Hospital and medical education reforms led by figures like Abraham Flexner and institutions such as the Flexner Report-inspired Harvard Medical School and Columbia University College of Physicians and Surgeons. The Social Security Act of 1935 and subsequent amendments created frameworks leading to Medicare and Medicaid, while the introduction of employer-sponsored coverage during World War II expanded private insurance markets dominated by companies such as Blue Cross Blue Shield. Major legal and policy turning points included the Hill–Burton Act, the Patient Protection and Affordable Care Act, and judicial decisions such as National Federation of Independent Business v. Sebelius.

Service delivery spans public and private settings including academic medical centers like Massachusetts General Hospital, community hospitals such as Cleveland Clinic, outpatient networks like Mayo Clinic Health System, and federally funded facilities including Veterans Health Administration and Indian Health Service. Care is provided by licensed professionals trained at institutions like Johns Hopkins School of Medicine and Stanford University School of Medicine, credentialed by organizations such as the American Board of Medical Specialties and unions including the Service Employees International Union. Health systems are organized around models practiced at Kaiser Permanente and independent physician groups participating in payment reforms promoted by Centers for Medicare & Medicaid Services initiatives such as the Accountable Care Organization model.

Financing combines public programs — Medicare, Medicaid, and the Children's Health Insurance Program — with private insurance markets dominated by firms like Cigna, Humana, and Kaiser Permanente. Employment-based coverage traces to arrangements during World War II and collective bargaining involving unions such as the United Auto Workers. The Patient Protection and Affordable Care Act created health insurance exchanges influenced by organizations including the Kaiser Family Foundation and attracted participation from insurers like Anthem, Inc.. Pharmaceutical spending is driven by manufacturers represented by Pharmaceutical Research and Manufacturers of America, while payment systems employ coding standards maintained by American Medical Association through the Current Procedural Terminology system.

Regulatory authority is split among federal agencies such as the Food and Drug Administration, Centers for Disease Control and Prevention, and Centers for Medicare & Medicaid Services, state health departments like the New York State Department of Health, and professional bodies including the American Medical Association. Major laws affecting practice and coverage include the Health Insurance Portability and Accountability Act and provisions of the Patient Protection and Affordable Care Act. Litigation before courts such as the Supreme Court of the United States has shaped policy, as have political actors including presidents Franklin D. Roosevelt, Lyndon B. Johnson, Bill Clinton, Barack Obama, and members of Congress such as Ted Kennedy and Nancy Pelosi.

Public health infrastructure includes agencies like the Centers for Disease Control and Prevention and programs run by institutions such as the Robert Wood Johnson Foundation and Johns Hopkins Bloomberg School of Public Health. Major public health responses have involved collaborations with World Health Organization during pandemics like 2009 flu pandemic and the COVID-19 pandemic, mobilizing hospitals such as Mount Sinai Hospital and research at National Institutes of Health. Population outcomes are tracked by entities including the Centers for Disease Control and Prevention and studies from universities like University of Michigan and Yale University, revealing disparities examined by organizations such as the Kaiser Family Foundation and advocates like the Urban Institute.

Costs are influenced by pricing practices of hospital systems including HCA Healthcare, pharmaceutical pricing by Pfizer and Johnson & Johnson, and negotiated rates from insurers like UnitedHealth Group. Out-of-pocket burdens and uninsured populations were central to debates around the Patient Protection and Affordable Care Act and policy proposals from actors such as Bernie Sanders and Elizabeth Warren. Access is mediated by programs like Community Health Centers funded under the Health Resources and Services Administration and legal protections such as the Emergency Medical Treatment and Labor Act affecting facilities like NewYork-Presbyterian Hospital.

Contemporary debates focus on proposals ranging from single-payer models championed by politicians like Bernie Sanders and organizations such as the Democratic Socialists of America to incremental reforms supported by stakeholders including Blue Cross Blue Shield Association, academic commentators from Harvard T.H. Chan School of Public Health, and think tanks like the Brookings Institution and Heritage Foundation. Other contested issues include drug pricing reforms advocated by Elizabeth Warren and industry responses from Pharmaceutical Research and Manufacturers of America, telemedicine adoption accelerated by platforms partnered with American Telemedicine Association, and workforce shortages addressed by programs at Association of American Medical Colleges and American Nurses Association.