update January 1, 2026
Since writing this post almost 10 years ago, I have done several updates and related posts. I recommend you read this more recent version and the one that follows. Keep exploring the Heart of health.
from 1776 to 2020-a vision for a “more perfect Union”
The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction. The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.
Keep readingEven 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
(stats from 2016)
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.
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.
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.
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.
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.
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 through the Deparment of Health and Human Services and other agencies.
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
Congressional laws that regulate health care
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
Sharing the HEART of health
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 government would eventually spend so much timet and money providing and regulating health care, most of which was not imagined at that time?
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Dr. Aletha
Key Predictions about 2026 Health Policy from an Expert
In this post I review some 2026 healthcare predictions for likely continuation of partisan gridlock, minimal congressional action, and increased focus on health care affordability amid midterm elections. Key issues to watch include ACA enrollment responses, Medicaid work requirements, rising insurance costs, and the impact of AI on consumer health care navigation.
watercress words by Dr Aletha 