About Public Healthcare

Public healthcare is found around the world, whether it's health services that are totally managed by the government or if it's insurance that is paid for by the government. The exception is the United States, where healthcare is overwhelmingly privately managed and only partially funded by tax dollars. However, the two major public healthcare programs in the United States are Medicare, a federal program which pays for healthcare for the elderly, and Medicaid, a federal-state partnership that pays for healthcare for the poor and disabled.

Significance

• Public healthcare is a major expenditure in the U.S., more per capita than in other industrial countries, even though it covers less than half the population. The Centers for Medicare and Medicaid Services project that by 2017, the U.S. will spend $4.3 trillion, or $13,000 per person, on healthcare. In 2006 less than half of healthcare (45%) was paid for by government insurance, mainly Medicare for the elderly and Medicaid for the poor or disabled. Fifteen percent of the U.S. population lacks any health insurance and may have trouble finding healthcare. The World Health Organization reports that mortality rates, infant mortality and life expectancy are worse in the U.S. than in industrial countries that have universal healthcare.

Features

• In the U.S., there is no public healthcare in which health services are completely paid for, sponsored and provided by the government. Medicare and Medicaid pay for healthcare services for eligible populations including the elderly, poor and disabled. Medicaid funding and services vary from state to state. Local health departments may offer basic public health services like vaccinations. School health clinics may provide services to students, which may be paid for by government or private insurance. Public healthcare takes a variety of forms worldwide and these models have been looked at as possible directions for the U.S. These models range from government provision of healthcare, like the United Kingdom's National Health Service, to Canada's system of universal government-funded insurance, also called Medicare, that pays private healthcare providers.

Benefits

• Public healthcare assures that everyone has access to at least some level of health services. If healthcare is funded by taxes, it's not tied to a job the way private insurance tends to be. People keep their coverage if they move or change jobs. Industrial countries with public healthcare systems spend less per person on healthcare than the U.S.

Considerations

• In the U.S., not all doctors accept Medicaid reimbursement, and both Medicare and Medicaid cover a limited list of services. Patients with private insurance may have greater access to "cutting edge" technologies and more choice of healthcare providers. Patients tend to wait for services longer in public healthcare systems. In part, this is because there are fewer healthcare providers. Canada has experienced physician strikes and departures, for more profitable practices in the U.S.

Potential

• Healthcare costs in the U.S. continue to rise at about twice the rate of general inflation. The aging population uses more and more expensive health services. The financial burden in privately-funded systems like the U.S. is being shifted from employers to consumers. Healthcare reform has been on the public policy agenda since the 1980s, with few significant changes. Some states are expanding public healthcare funding in response to rising numbers of uninsured, but the budget impact will threaten other services unless costs are contained.