Editing Economy of the United States (section)

==Health care==
[[File:Health Insurance Coverage in the U.S. 2016 - v1.png|thumb|right|300px|U.S. health insurance coverage by source in 2016. CBO estimated ACA/Obamacare was responsible for 23 million persons covered via exchanges and Medicaid expansion.<ref name="CBO_Subsidy2016">{{cite web|url=https://www.cbo.gov/publication/51385|title=Federal Subsidies for Health Insurance Coverage for People Under Age 65|publisher=CBO|date=March 24, 2016}}</ref>]]
[[File:OECD life expectacy and health spending per capita 2013 v1.png|thumb|right|300px|Chart showing life expectancy at birth and health care spending per capita for OECD countries as of 2015. The U.S. is an outlier, with much higher spending but below average life expectancy.<ref>{{cite web| url = http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm| title = OECD Health at a Glance 2015{{snd}}Table 3.3| date = November 7, 2023}}</ref>]]
[[File:Healthcare costs to GDP OECD 2015 v1.png|thumb|right|300px|Bar chart comparing healthcare costs as percentage of GDP across OECD countries]]
[[File:U.S. healthcare coverage 2008-2026.png|thumb|right|300px|U.S. uninsured number (millions) and rate (%), including historical data through 2016 and two CBO forecasts (2016/Obama policy and 2018/Trump policy) through 2026. Two key reasons for more uninsured under President Trump include: 1) Eliminating the individual mandate to have health insurance; and 2) Stopping cost sharing reduction payments.<ref>{{cite web|url=https://www.cbo.gov/publication/53826|title=Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028|date=May 23, 2018|access-date=June 17, 2018}}</ref>]]

{{Main|Health care in the United States}}
{{Update|uninsured statistics|date=October 2016}}

===Coverage===
{{Further|Health insurance coverage in the United States}}
The American system is a mix of public and private insurance. The government provides insurance coverage for approximately 53 million elderly via [[Medicare (United States)|Medicare]], 62 million lower-income persons via [[Medicaid]], and 15 million military veterans via the [[Veteran's Administration]]. About 178 million employed by companies receive subsidized health insurance through their employer, while 52 million other persons directly purchase insurance either via the subsidized marketplace exchanges developed as part of the [[Affordable Care Act]] or directly from insurers. The private sector delivers healthcare services, with the exception of the Veteran's Administration, where doctors are employed by the government.<ref name="Census2016">{{cite web|url=https://www.census.gov/library/publications/2017/demo/p60-260.html|title=Health Insurance Coverage in the United States: 2016|website=census.gov}}</ref>

Multiple surveys indicate the number of uninsured fell between 2013 and 2016 due to expanded [[Medicaid]] eligibility and health insurance exchanges established due to the [[Patient Protection and Affordable Care Act]], also known as the "ACA" or "Obamacare". According to the [[United States Census Bureau]], in 2012 there were 45.6 million people in the US (14.8% of the under-65 population) who were without health insurance. This figure fell by 18.3 million (40%) to 27.3 million (8.6% of the under-65 population) by 2016.<ref name="Census_HistTable">{{cite web|url=https://www.census.gov/data/tables/time-series/demo/health-insurance/historical-series/hic.html|title=Health Insurance Historical Tables –HIC Series|publisher=Census}}</ref>

However, under President Trump these gains in healthcare coverage have begun to reverse. The [[Commonwealth Fund]] estimated in May 2018 that the number of uninsured increased by four million from early 2016 to early 2018. The rate of those uninsured increased from 12.7% in 2016 to 15.5%. The impact was greater among lower-income adults, who had a higher uninsured rate than higher-income adults. Regionally, the South and West had higher uninsured rates than the North and East. Further, those 18 states that have not expanded Medicaid had a higher uninsured rate than those that did.<ref>{{cite journal |url=http://www.commonwealthfund.org/publications/blog/2018/apr/health-coverage-erosion |title=Commonwealth Fund – First Look at Health Insurance Coverage in 2018 Finds ACA Gains Beginning to Reverse |year=2018 |doi=10.26099/aacp-5268 |last1=Collins |first1=Sara R. |last2=Gunja |first2=Munira Z. |last3=Doty |first3=Michelle M. |last4=Bhupal |first4=Herman K. |publisher=Commonwealth Fund}}</ref>

According to [[Physicians for a National Health Program]], this lack of insurance causes roughly 48,000 unnecessary deaths per year.<ref name=uninsureddeaths>{{cite web |last= Woolhandler |first= S. |date= September 12, 2012 |title= Despite slight drop in uninsured, last year's figure points to 48,000 preventable deaths |publisher= Physicians for a National Health Program |url= http://www.pnhp.org/news/2012/september/despite-slight-drop-in-uninsured-last-year%E2%80%99s-figure-points-to-48000-preventable- |access-date= September 26, 2012 |display-authors= etal |archive-url= https://web.archive.org/web/20120924021844/http://www.pnhp.org/news/2012/september/despite-slight-drop-in-uninsured-last-year%E2%80%99s-figure-points-to-48000-preventable- |archive-date=September 24, 2012 |url-status=dead}}</ref> The group's methodology has been criticized by [[John C. Goodman]] for not looking at cause of death or tracking insurance status changes over time, including the time of death.<ref>{{cite journal|last=Goodman|first=John|title=Does Lack Of Insurance Cause Premature Death?|journal=Health Affairs Forefront |url=https://www.healthaffairs.org/do/10.1377/forefront.20090921.002196|publisher=Health Affairs|date=September 21, 2009|doi=10.1377/forefront.20090921.002196}}</ref> A 2009 study by former [[Bill Clinton|Clinton]] policy adviser Richard Kronick found no increased mortality from being uninsured after certain risk factors were controlled for.<ref>{{cite journal|last1=Kronick|first1=Richard|title=Health Insurance Coverage and Mortality Revisited|journal=Health Services Research|date=August 2009|volume=44|issue=4|pages=1211–31|doi=10.1111/j.1475-6773.2009.00973.x|pmid=19453392|pmc=2739025}}<!--|access-date=August 15, 2014--></ref>

===Outcomes===
The U.S. lags in overall healthcare performance but is [[Biomedical research in the United States|a global leader in medical innovation]]. America solely developed or contributed significantly to nine of the top ten most important medical innovations since 1975 as ranked by a 2001 poll of physicians, while the EU and Switzerland together contributed to five. Since 1966, Americans have received more [[List of Nobel laureates in Physiology or Medicine|Nobel Prizes in Medicine]] than the rest of the world combined. From 1989 to 2002, four times more money was invested in private biotechnology companies in America than in Europe.<ref>{{cite news |last= Cowen |first=Tyler |title=Poor U.S. Scores in Health Care Don't Measure Nobels and Innovation |url= https://www.nytimes.com/2006/10/05/business/05scene.html?_r=1& |access-date=October 9, 2012 |newspaper=The New York Times |date=October 5, 2006}}</ref><ref>{{cite web |author1=Whitman, Glen |author2=Raad, Raymond |title=Bending the Productivity Curve: Why America Leads the World in Medical Innovation |url= http://www.cato.org/publications/policy-analysis/bending-productivity-curve-why-america-leads-world-medical-innovation |publisher=The Cato Institute |access-date=October 9, 2012}}</ref>

Of 17 high-income countries studied by the [[National Institutes of Health]] in 2013, the United States ranked at or near the top in obesity rate, frequency of automobile use and accidents, homicides, [[infant mortality]] rate, incidence of heart and lung disease, sexually transmitted infections, adolescent pregnancies, recreational drug or alcohol deaths, injuries, and rates of disability. Together, such lifestyle and societal factors place the U.S. at the bottom of that list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country, though Americans who reach age 75 live longer than those who reach that age in peer nations.<ref name=nihbph>{{cite book|url=http://books.nap.edu/openbook.php?record_id=13497 |title="U.S. Health in International Perspective: Shorter Lives, Poorer Health" (2013) National Institutes of Health Committee on Population, Board on Population Health and Public Health Practice |year=2013 |publisher=Books.nap.edu |doi=10.17226/13497 |pmid=24006554 |isbn=978-0-309-26414-3 |access-date=October 20, 2013|author1=National Research Council (US) |last2=Woolf |first2=S. H. |last3=Aron |first3=L. }}</ref> One consumption choice causing several of the maladies described above are cigarettes. Americans smoked 258 billion cigarettes in 2016.<ref name="CDCTobaccoFree">{{cite web|url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm|title=Economic Trends in Tobacco|last=CDCTobaccoFree|date=May 4, 2018|website=Centers for Disease Control and Prevention|language=en-us|access-date=June 3, 2019 }}</ref> Cigarettes cost the United States $326{{spaces}}billion each year in direct healthcare costs ($170{{spaces}}billion) and lost productivity ($156{{spaces}}billion).<ref name="CDCTobaccoFree" />

A comprehensive 2007 study by European doctors found the five-year [[cancer]] survival rate was significantly higher in the U.S. than in all 21 European nations studied, 66.3% for men versus the European mean of 47.3% and 62.9% versus 52.8% for women.<ref>{{cite news|last=Martin|first=Nicole|title=UK cancer survival rate lowest in Europe|url=https://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html |archive-url=https://ghostarchive.org/archive/20220111/https://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html |archive-date=January 11, 2022 |url-access=subscription |url-status=live|access-date=August 19, 2013|newspaper=The Daily Telegraph|date=August 21, 2007}}{{cbignore}}</ref><ref>{{cite journal|last=Verdecchia|first=A|author2=Francisci, S |author3=Brenner, H |author4=Gatta, G |author5=Micheli, A |author6=Mangone, L |author7=Kunkler, I |author8= EUROCARE-4 Working, Group |title=Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data|journal=The Lancet Oncology|date=September 2007|volume=8|issue=9|pages=784–96|pmid=17714993|doi=10.1016/s1470-2045(07)70246-2}}</ref> Americans undergo cancer screenings at significantly higher rates than people in other developed countries, and access [[Magnetic resonance imaging|MRI]] and [[CT scan]]s at the highest rate of any OECD nation.<ref name=Atlas>{{cite book|last=MD|first=Scott W. Atlas|title=In excellent health : setting the record straight on America's health care and charting a path for future reform|year=2011|publisher=Hoover Institution Press, Stanford University|location=Stanford, California|isbn=978-0817914448|pages=199–205|url=https://books.google.com/books?id=0qExi2-3m5IC}}</ref> People in the U.S. diagnosed with [[Hypercholesterolemia|high cholesterol]] or [[hypertension]] access pharmaceutical treatments at higher rates than those diagnosed in other developed nations, and are more likely to successfully control the conditions.<ref>Atlas 2011, pp. 205–07</ref><ref>{{cite journal|last=Wolf-Maier|first=K.|title=Hypertension Treatment and Control in Five European Countries, Canada, and the United States|journal=Hypertension|date=November 24, 2003|volume=43|issue=1|pages=10–17|doi=10.1161/01.HYP.0000103630.72812.10|pmid=14638619|doi-access=free}}</ref> [[Diabetes mellitus|Diabetics]] are more likely to receive treatment and meet treatment targets in the U.S. than in Canada, England, or Scotland.<ref>Atlas 2011, pp. 150–56</ref><ref>{{cite journal |first1=June E. |last1=O'Neill |first2=Dave M. |last2=O'Neill |title=Health Status, Health Care and Inequality: Canada vs. the U.S |journal=Forum for Health Economics & Policy |volume=10 |issue=1 |doi=10.2202/1558-9544.1094 |year=2008 |s2cid=73172486 |url=http://www.nber.org/papers/w13429.pdf}}</ref>

According to a 2018 study of 2016 data by the [[Institute for Health Metrics and Evaluation]], the U.S. was ranked 27th in the world for healthcare and education, down from 6th in 1990.<ref>{{cite news |last=McDonald |first=Andy |date=September 28, 2018 |title=U.S. Drops To 27th In The World For Education And Health Care|url=https://www.huffingtonpost.com/entry/whelp-the-us-now-ranks-27th-in-the-world-on-education-and-healthcare_us_5bae5d02e4b0425e3c23508f|work=The Huffington Post |access-date=October 6, 2018}}</ref>

===Cost===
{{Further|Health care prices in the United States}}

U.S. healthcare costs are considerably higher than other countries as a share of GDP, among other measures. According to the OECD, U.S. healthcare costs in 2015 were 16.9% GDP, over 5% GDP higher than the next most expensive OECD country.<ref name="OECD1">{{cite web| url = http://stats.oecd.org/Index.aspx?DataSetCode=SHA| title = OECD Statistical Database{{snd}}Health expenditure and financing}}</ref> A gap of 5% GDP represents $1{{spaces}}trillion, about $3,000 per person or one-third higher relative to the next most expensive country.<ref name="CDC1">{{cite web|url=https://www.cdc.gov/nchs/fastats/health-expenditures.htm|title=FastStats|date=July 18, 2017|website=cdc.gov}}</ref>

The high cost of health care in the United States is attributed variously to technological advance, administration costs, drug pricing, suppliers charging more for medical equipment, the receiving of more medical care than people in other countries, the high wages of doctors, government regulations, the impact of lawsuits, and third party payment systems insulating consumers from the full cost of treatments.<ref>{{cite web|last1=Conover|first1=Christopher J.|title=Health Care Regulation A $169 Billion Hidden Tax|url=http://www.cato.org/sites/cato.org/files/pubs/pdf/pa527.pdf|publisher=Cato Institute|access-date=September 2, 2014|date=October 4, 2004}}</ref><ref name=Cutler>{{cite web|title=Why Does Health Care Cost so Much in America? Ask Harvard's David Cutler|url=https://www.pbs.org/newshour/making-sense/why-does-health-care-cost-so-m/|website=Public Broadcasting Service|date=November 19, 2013}}</ref><ref>{{cite web|last1=Lawler|first1=Joseph|title=Health Care Economist John Goodman on Market-Based Health Care|url=http://www.realclearpolicy.com/blog/2012/09/19/health_care_economist_john_goodman_on_health_care_markets_290.html|publisher=Real Clear Policy|access-date=September 2, 2014|date=September 19, 2012}}</ref> The lowest prices for pharmaceuticals, medical devices, and payments to physicians are in government plans. Americans tend to receive more medical care than people do in other countries, which is a notable contributor to higher costs. In the United States, a person is more likely to receive open heart surgery after a heart attack than in other countries. Medicaid pays less than Medicare for many prescription drugs due to the fact Medicaid discounts are set by law, whereas Medicare prices are negotiated by private insurers and drug companies.<ref name=Cutler /><ref>{{cite news|title=Medicaid Pays Less Than Medicare for Many Prescription Drugs, U.S. Report Finds|work=The New York Times |date=August 16, 2011 |url=https://www.nytimes.com/2011/08/16/us/16drug.html|last1=Pear |first1=Robert }}</ref> Government plans often pay less than overhead, resulting in healthcare providers shifting the cost to the privately insured through higher prices.<ref>{{cite journal|last1=Dobson|first1=A.|last2=DaVanzo|first2=J.|last3=Sen|first3=N.|title=The Cost-Shift Payment 'Hydraulic': Foundation, History, And Implications|journal=Health Affairs|date=January 1, 2006|volume=25|issue=1|pages=22–33|doi=10.1377/hlthaff.25.1.22|pmid=16403741|doi-access=free}}<!--|access-date=September 2, 2014--></ref><ref>{{cite web|last1=Pope|first1=Christopher|title=Legislating Low Prices: Cutting Costs or Care?|url=http://www.heritage.org/research/reports/2013/08/legislating-low-prices-cutting-costs-or-care|archive-url=https://web.archive.org/web/20130812075359/http://www.heritage.org/research/reports/2013/08/legislating-low-prices-cutting-costs-or-care|url-status=unfit|archive-date=August 12, 2013|publisher=The Heritage Foundation|access-date=September 2, 2014|date=August 9, 2013}}</ref>