Statue of Liberty

Life, Liberty and the Pursuit of Health Care


Even though the United States does not officially have “socialized” health care, a large proportion of our medical care is funded by the federal government. Even though I know that, I was still surprised by statistics in a recent article, which stated that  the federal government accounts for

40% of healthcare  spending

$1.3 trillion /year

Covering 100 million individuals

Through 4 federal agencies

Department of Health and Human Services 

Department of Defense

Veterans Administration

Department  of Homeland Security

(JAMA (Journal of the American Medical Association), June 21, 2016)

The  United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens.  People who oppose the ACA ,aka Obama Care, dislike or even fear government involvement in medical care; they consider it interference, control, or even nationalization of the United States healthcare system.


a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha)


I think many people, even physicians, don’t realize or forget, how involved the government already is in healthcare. As far back as the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.



American soldiers serving in Afghanistan
American soldiers serving in Afghanistan


2015 marked the 50th anniversary of two other government healthcare programs- Medicare and Medicaid.

Medicaid provides insurance coverage for adults and children who are unemployed or low income.

Medicare covers disabled children and adults  and persons 65 years and older.



Disabled children and adults may qualify for Medicare.


The numbers are rather staggering.

  • Together these programs cover at least 30% of Americans.
  • Together they comprise 25% of all federal spending.
  • Together they pay 40% of total U.S. health care spending.

An infographic from the Kaiser Family Foundation and JAMA explains this further.



Children may be eligible for Medicaid if their families cannot obtain health insurance for them.

You may not be eligible for either of these programs now, but chances are eventually you or someone close to you will.

  • Anyone can become disabled from a serious illness or freak accident.
  • You or your spouse may lose your job and your employer sponsored health insurance.
  • Your child may have a disability that will prevent them from working when they grow up.
  • We may all live long enough to qualify for Medicare on the basis of age alone.  Your parents or grandparents are near or already at Medicare age.



Senior adults age 65 and older use Medicare.
Senior adults age 65 and older use Medicare.


It’s important to understand how Medicare works, since it’s not automatic; even if you qualify, you need to sign up to be covered (with a few exceptions). The rules are summarized here. Or consider an easy to understand book here. 

Several government agencies regulate, monitor,  promote and/or support  both public and private healthcare including-

Food and Drug Administration- FDA

Centers for Disease Control and Prevention- CDC

National Institutes of Health- NIH

Occupational Safety and Health administration-OSHA

Drug Enforcement Agency-DEA

medication capsules
The FDA regulates the development and sale of medications and medical devices and the DEA regulates dangerous and controlled drugs.

Congress has enacted several important laws that  concern health care such as

 The Affordable Care Act- ACA

Health Insurance Portability and Accountability Act-HIPPA

Emergency Medical Treatment and Labor Act- EMTALA

Health Information Technology  for Economic and Clinical Health- HITECH

Americans with Disabilities Act-ADA

Family Medical Leave Act-FMLA

air ambulance landing at a hospital
EMTALA requires all hospitals to offer emergency treatment to any patient who arrives, regardless of ability to pay for that care

In the Declaration of Independence, the founders of the United States  created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the pursuit of Happiness” as well as  to promote “Safety and Happiness” . 

In the Constitution they vowed to “promote the general Welfare” .

I wonder if they envisioned that would eventually include so much effort and money providing and regulating health care, most of which was not  even imagined at that time? 



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