How the American Healthcare System Actually Works

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The U.S. doesn't have one healthcare system. It's a patchwork of competing models where your experience depends on how you get coverage.

Here's how it all works.

For most people, it's tied to your job. Your employer provides subsidized insurance, offering broad access to care, but with deductibles and the risk of financial shock if you lose your job or get a surprise out-of-network bill.

For seniors and the poor, the government acts as the single payer. Medicare (for retirees) is a popular, efficient program. Medicaid (for low-income individuals) is a crucial safety net, though lower payouts to doctors can limit provider choices. For vetrans, the VA (a fully socialized system) provides comprehensive care, but can be plagued by wait times and bureaucracy.

Everyone else navigates a for-profit arena. Hospitals and insurers battle over prices, using inflated "list prices" as a starting point. Drug companies set high costs that are negotiated down by middlemen (the PBM), often leaving the uninsured facing those impossible rates.

The American system prioritizes choice and innovation over universality and equity. You can get world-class care, but your access to it is determined by your employment status, age, income, or sheer ability to pay.

The system isn't so much broken as it is perfectly designed for its core premise: healthcare is not a universal right, but a product you acquire through the system you qualify for.

- YZ

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