Summary

The United States spends more than twice as much as any other high-income nation on healthcare, yet we consistently rank last in health outcomes among our peers. A lack of resources does not cause these statistics; in fact, the U.S. is the global leader in medical technological innovation. The problem, rather, is a broken system built on decades of lobbying by pharmaceutical giants and a partisan weaponization of policy that has left millions of Americans uninsured. 

When I tell people I am studying public health, they often ask what it is. I tell them it’s the everyday effort to keep our society healthy. More specifically, I study the gap between what our healthcare system promises and what it actually delivers. In the United States, that gap is enormous. In 2021, the U.S. spent 17.8% of its GDP on healthcare, more than twice the OECD average. And yet, Americans’ rates of life expectancy, infant mortality, and chronic disease management are worse than those of citizens of countries that spend far less (The Commonwealth Fund, 2023). 

This is not a mystery. It is a choice. 

Every other high-income nation has found a way to guarantee coverage for its citizens. Switzerland mandates private insurance, the United Kingdom runs a publicly funded system, and Germany relies on a hybrid model. Despite their differences, the results are consistent, near-universal coverage, lower costs, and better health outcomes. Seemingly unreceptive, the United States continues to treat healthcare as a political pawn rather than a human right, and ordinary Americans bear the consequences.

A recent example of this dysfunction occurred during the government shutdown that began last October, when the question centered on whether Congress should extend enhanced premium tax credits introduced during COVID-19. The subsidies provided by the American Rescue Plan Act and the Inflation Reduction Act made insurance affordable for millions of families, including those earning above 400% of the Federal Poverty Level. Their expiration was projected to trigger a 114% increase in healthcare costs for roughly 20 million households and push seven million Americans into the ranks of the uninsured (The Washington Post). 

The deal that ended the shutdown excluded the extension, and overnight, seven million families felt that decision in both their bank accounts and bodies. 

Conservatives argue that subsidies artificially inflate insurance prices by shielding companies from competitive pressure. There is some merit to examining how subsidies interact with market pricing, but abandoning millions of families mid-crisis is not reform; it is retreat. The real structural problem conservatives and progressives alike rarely address directly is the lobbying apparatus. PhRMA spent $28.2 million on federal lobbying in just the first three quarters of 2025. Combined with the broader pharmaceutical and health industries, the total reached $332 million by August (KFF, 2025). These are not investments in innovation, but rather ensuring that the pricing structures, market advantages, and legislative gaps that generate billions in profit remain untouched. A 2022 study found that U.S. prescription drug prices are nearly three times higher than those in other OECD nations. Unlike peer countries, the U.S. has no single negotiating body to challenge pharmaceutical pricing. Instead, we outsource that function to fragmented health plans that lack the leverage to push back. As a result, doctors are incentivized to prescribe expensive drugs over equally effective, cheaper ones, and it is inevitably the patients who absorb the costs.

What makes this especially frustrating is that Americans, across party lines, want change. A poll by Economists/YouGov found that 68% of Americans support Medicare negotiating drug prices directly with manufacturers. That number includes 65% of Republicans and 79% of Democrats. The policy consensus among the public exists, meaning the obstruction is institutional. 

The Affordable Care Act was a genuine step forward. Still, it was designed to patch onto a broken system rather than replace it, so its political vulnerabilities continue to be exploited. The 2012 Supreme Court ruling in National Federation of Independent Business v. Sebelius declared the federal government’s efforts to compel Medicaid expansion unconstitutional, leaving millions of low-income Americans in states that refused to expand coverage trapped in a coverage gap: too poor to afford private insurance, yet ineligible for Medicaid (National Constitution Center). 

The path forward does not require a constitutional amendment guaranteeing health as a civil right. What we can change, however, are three things: empowering Medicare to negotiate drug prices directly, reinstating and making permanent the enhanced premium tax credits under the ACA, and closing the Medicaid coverage gap in holdout states. None of these are radical proposals; in fact, all three enjoy majority public support. What they lack is political protection from the industries that profit from the current dysfunction. 

I am a first-year student with a sophomore academic standing in public health and political science. I came into this field because I have watched what happens when a system fails the people it is supposed to serve. The statistics about healthcare spending are more than data points to me. They represent real people rationing insulin, skipping checkups they cannot afford, and going bankrupt over treatable conditions. The sooner our political system reflects what the American public already believes that the sooner we can begin to close the gap between what our system promises and what it delivers.

Acknowledgement

The Institute for Youth in Policy would like to acknowledge Andrew Baum for editing this op-ed.

Bibliography 

Choi, Matthew, and Dan Merica. "Health-Care Subsidies Are at the Heart of the Government Shutdown." The Washington Post, October 2, 2025.  https://www.washingtonpost.com/politics/2025/10/02/health-care-subsidies-heart-govern ment-shutdown/. 

The Commonwealth Fund. "Mirror, Mirror 2023: A Portrait of the Failing U.S. Health System." Commonwealth Fund, 2023. https://www.commonwealthfund.org/publications/fund-reports/2023/jan/mirror-mirror-20 23. 

Fredrickson, Caroline, and Ilan Wurman. "National Federation of Independent Business v. Sebelius (2012)." National Constitution Center, November 24, 2025.  https://constitutioncenter.org/the-constitution/supreme-court-case-library/nfib-v-sebelius.

KFF. "Summary of the Affordable Care Act." KFF, 2025. https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/.

Orth, Taylor. "Bipartisan Majorities Support Allowing Medicare to Negotiate Drug Prices." YouGov, September 6, 2023. 

Papanicolas, Irene, Liana R. Woskie, and Ashish K. Jha. "Health Care Spending in the United States and Other High-Income Countries." JAMA 319, no. 10 (2018): 1024–1039. "What Happens If Affordable Care Act Subsidies Aren't Extended?" WCNC, October 1, 2025. https://www.youtube.com/watch?v=F1VEMIklJb8.