Healthcare System

Health Care System

Medical Costs - Healthcare

Why health insurance is important: Protection from high medical costs

Our Existing Health Care System

Today, the country spends $3 trillion annually on healthcare or $9,523 per person. According to consulting firm Deloitte, America spends more per capita on healthcare than any other country in the world – more than 2.5 times than the U.K., 1.8 times the rate of Germany, and 1.6 times the amount Canada spends.

At the same time, the U.S. healthcare system ranks near the bottom of third-party rankings for objective measures like access, efficiency, and effectiveness. For example:

    • Bloomberg Health-Care Efficiency Index ranked the U.S. 50 of 55 nations in 2014 (the latest year for which figures were available).
    • The Commonwealth Fund is a private foundation established in 1918 to support independent research on healthcare issues. Since 2004, the foundation has ranked the U.S. last or near last on measures of access (due to cost), efficiency, and equity (lower-income individuals are least able to see a physician, take a recommended test or treatment, or fill a prescription when needed).
    • The Milken Institute School of Public Health at George Washington University ranked the U.S. eighth in life expectancy (behind such countries as Australia, France, and the U.K.), twelfth in immunization coverage for one-year-olds, and sixth in the number of physicians per 10,000 population.

Milken Institute School of Public Health at George Washington University - 254 Treatments and 172 Vaccines

Explore detailed information on each development:

A 2016 study by The Guardian concluded: “Though the system fosters excellence and innovation in places, the messy combination of underinsurance and overinsurance has left the U.S. with the highest healthcare costs in the developed world and some of the worst overall health outcomes.”

U.S. Health Care History, Problems & Solutions

2009 - Passage of the ACA

The debate over healthcare became especially vociferous in the early 21st Century. Democratic President Barak Obama introduced the Patient Protection and Affordable Care Act (ACA) in July 2009. The Act was based upon the healthcare program passed previously in Massachusetts by a Republican Governor and initially developed by a conservative think tank, The Heritage Foundation.

The Massachusetts Plan included:

    • A requirement that every resident obtain a minimum level of insurance
    • Free healthcare for those under less than 150% of the federal poverty level
    • A mandate that every employer with more than ten employees provides health care insurance

The Act became law in 2010, with votes along political party lines (all Republican members of the House of Representatives voted against the bill). A significant element in the selling of the Act to the public was the President’s promise: “If you like your private health insurance plan, you can keep your plan. Period.”

Provisions of the Act included new regulations such as new minimum coverage requirements (required coverage for pre-existing conditions, for example). As a consequence, many of the existing insurance plans for individual purchases did not meet minimum standards. Some insurance providers subsequently left different markets or raised premiums substantially.

While the ACA added millions of Americans to the insured rolls, it has been less effective in cutting the increasing cost of healthcare for the average citizen. According to the Congressional Budget Office, the average premium paid by a family or a single person more than doubled between 2001 and 2014, a rate exceeding growth in per capita income. Employers reacted to the increase in either cutting plan benefits or raising premiums, deductibles, and co-pays on employer-provided insurance (the Milliman Medical Index calculated that the average cost of annual health care for a family of four was $25,826 in 2016).

Opponents of the ACA assert that there is “overwhelming evidence that Obamacare caused premiums to increase substantially.” On the other hand, proponents claim that the ACA has been moderating premium rates that would have occurred without the Act. Brookings Instituteresearchers Loren Adler and Paul Ginsberg found that individual premiums were 10-21% under the premium projections before that Act.

Over the last six years of Obama’s term, Republicans attempted more than fifty times to repeal the Act. With the election of a Republican President in 2016, Republicans have repeatedly vowed to “repeal and replace” the Act during the first 100 days of the new President’s term. The question is what, if anything, will replace the ACA?

2018 - Health Insurance Premiums, Deductibles, Copays and Coinsurance

August 6, 2016 - Avoid a Big Medical Bill From the Emergency Room

February 9, 2018 - Here’s how to fight back when your insurance company doesn’t think you should have gone to the emergency room

2018 - Hospital and Surgery Costs - Hospital costs averaged $3,949 per day and each hospital stay cost an average of $15,734.

May 5, 2020 - Medicare Coverage and Costs Related to COVID-19 Testing and Treatment

June 19, 2020 - WHO Is Hoping For Hundreds of Millions of COVID-19 Vaccine Doses Before 2021

June 25 - 254 Treatments and 172 Vaccines

Explore detailed information on each development:

June 26 - Experts Confident Biden’s COVID-19 Response Could Speed Recovery

June 26 - A Coronavirus Treatment could be closer

June 26 - WHO, global partners launch $18B COVID-19 vaccine initiative

October 1, 2020 - Veklury (remdesivir) Now Available Directly from Distributor following Trump Administration’s Successful Allocations to States and U.S. TerritoriesThe cost of Veklury will not change in the transition from U.S. government oversight of allocation to direct commercial sales. Hospitals will continue to pay no more than Gilead’s wholesale acquisition price (WAC), approximately $3,200 per treatment course.

October 22, 2020 - Biden's Health Agenda - Biden's COVID plan includes taking major responsibility for the pandemic back from the states. His federal response would include more money for, and coordination of, testing and contact tracing; ensuring adequate protective equipment for health professionals; and assuring the public that new treatments and vaccines will be based on science, not politics.

Assuming Biden gets beyond the pandemic and recession, he could move onto some of his bigger health promises, including expanding eligibility for Medicare, creating a "public option" health plan and boosting premium subsidies for the ACA.

Many of Biden's proposals, including a public option and larger subsidies to help low- and middle-income people pay for insurance, are the very things that an overwhelmingly Democratic Congress could not pass as part of the original Affordable Care Act in 2010. Conservative Democratic senators objected to the plan.

Both Democrats and Republicans say they want to bring down drug prices

October 23, 2020 - Costco offering at-home coronavirus tests for $130-$140

October 24, 2020 - Where Are We in the COVID-19 Vaccine Race?

October 23, 2020 - AstraZenca restarts COVID-19 trials, J&J likely early next week

October 24, 2020 - Scientists develop new way to test for COVID-19 antibodies

October 24, 2020 - The FDA approved remdesivir to treat Covid-19. Scientists are questioning the evidence.

October 24, 2020 - Scientists make digital breakthrough in chemistry that could revolutionize the drug industry

October 27, 2020 - Three Western states join California in screening any FDA-approved coronavirus vaccine

October 28, 2020 - Fact check: Neither Biden nor Trump is calling for mandated COVID-19 vaccines

Dr. Moncef Slaoui, chief adviser of Operation Warp Speed, the U.S. effort to accelerate vaccine developments, told ABC News that approximately 20 million to 40 million doses of a vaccine — if authorized by the end of the year — would be distributed to a limited population. "Now, not every one in that population can be immunized in December, but the companies will continue to manufacture and produce vaccine doses — and in January, we plan to have about 60 to 80 million doses of those two vaccines," Slaoui said.

October 28, 2020 - Coronavirus Vaccine Race

October 28, 2020 - SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19

CONCLUSIONS: In this interim analysis of a phase 2 trial, one of three doses of neutralizing antibody LY-CoV555 appeared to accelerate the natural decline in viral load over time, whereas the other doses had not by day 11.

October 29, 2020 - Covid-19 antibody therapies show promising results in separate trials

Published results from Eli Lilly - The study was primarily testing to see if the therapy eliminated the virus by day 11. The vast majority of patients had eliminated or had little trace of the virus by then. While the hospitalization data was a secondary endpoint, study co-author Dr. Peter Chen characterized the difference as "dramatic" and "meaningful."

Regeneron said the treatment significantly reduced viral load and reduced the need for a patient to go to the hospital, emergency room, urgent care or doctor's office. The analysis involved nearly 800 patients. Patients on the treatment had on average a greater-than-10-fold reduction in viral load by day 5 than those taking a placebo, which does nothing. Patients with the higher viral load at baseline got a bigger benefit from the therapy. The therapy reduced Covid-19 related medical visits by 72% in patients with one risk factor for severe disease, the company said.

October 29, 2020 - These are the top coronavirus vaccines

Phase 3 Vaccines

Vaccines using nucleic acid (DNA and RNA)

Nucleic acid vaccines, developed by

Moderna; National Institutes of Health

Pfizer; BioNTech; Fosun Pharma

Vectored vaccines, developed by

AstraZeneca; University of Oxford

CanSino Biologics; Beijing Institute of Biotechnology; Canada's National Research Council; Petrovax

Gamaleya Research Institute*

Johnson & Johnson, Beth Israel Deaconess Medical Center

Subunit vaccines, developed by

AstraZeneca; University of Oxford

CanSino Biologics; Beijing Institute of Biotechnology; Canada's National Research Council; Petrovax

Gamaleya Research Institute*

Johnson & Johnson, Beth Israel Deaconess Medical Center

Institut Pasteur; Themis; University of Pittsburgh CVR; Merck Sharp & Dohme

Live attenuated or weakened virus vaccines, developed by

Beijing Institute of Biological Products; Sinopharm



October 29, 2020 - Next crop of COVID-19 vaccine developers take more traditional route

October 30, 2020 - Moderna will have 20M coronavirus vaccines ready by year's end

Biotech firm Moderna expects to have about 20 million doses of its experimental coronavirus vaccine dubbed mRNA-1273 ready to ship in the U.S. by the end of the year.

October 30, 2020 - COVID-19 Antibodies May Last Longer Than Researchers Thought

Previous research found that levels of antibodies in recovered patients start to wane about three months from when those patients first experience symptoms. But in a study published in Science this week, researchers at Icahn School of Medicine at Mt. Sinai report that antibodies may last as long as five months.

October 30, 2020 - T-cells from recovered COVID-19 patients show promise to protect vulnerable patients from infection Immunotherapy experts apply proven model to grow SARS-CoV-2-fighting T-cells from convalescent donors

October 30, 2020 - Biden/Harris plan seven points plan

Both Democrats and Republicans say they want to bring down drug prices

October 30, 2020 - U.S. signs up pharmacy chains as COVID-19 vaccination centres: WSJ

November 1, 2020 - Feds issue coverage plan for COVID-19 vaccine and treatments

Who is furthest along?

U.S. drugmaker Pfizer Inc with partner BioNTech SE, U.S. biotech Moderna Inc and Britain-based AstraZeneca Plc in conjunction with University of Oxford researchers could provide early analyses of data from their various large trials over the next two months. Johnson & Johnson is not far behind.

How will we know if the vaccine works?

The United States, the European Union, the United Kingdom and the World Health Organization have all set similar minimum standards for effectiveness. Vaccines must demonstrate at least 50% efficacy - meaning at least twice as many infections among volunteers who got a placebo than in the vaccine group. Independent panels oversee the trials to monitor for safety and effectiveness since the data is hidden from companies and researchers. These data safety monitoring boards take a peek at the interim results at pre-determined milestones, such as after a certain number of people have become infected. It the vaccine is looking significantly better than the placebo, the companies can apply for emergency use, and the study may be halted or continue to its intended conclusion. A trial also can be halted if the panel determines the vaccine to be unsafe.

Biden's Health Agenda

The Biden Plan calls for:

Restoring trust, credibility, and common purpose.

Mounting an effective national emergency response that saves lives, protects frontline workers, and minimizes the spread of COVID-19.

Eliminating cost barriers for prevention of and care for COVID-19.

Pursuing decisive economic measures to help hard-hit workers, families, and small businesses and to stabilize the American economy.

Rallying the world to confront this crisis while laying the foundation for the future.


Stop the political theater and willful misinformation that has heightened confusion and discrimination. Biden believes we must immediately put scientists and public health leaders front and center in communication with the American people in order to provide regular guidance and deliver timely public health updates, including by immediately establishing daily, expert-led press briefings. This communication is essential to combating the dangerous epidemic of fear, chaos, and stigmatization that can overtake communities faster than the virus. Acts of racism and xenophobia against the Asian American and Pacific Islander community must not be tolerated.

Ensure that public health decisions are made by public health professionals and not politicians, and officials engaged in the response do not fear retribution or public disparagement for performing their jobs.

Immediately restore the White House National Security Council Directorate for Global Health Security and Biodefense, which was established by the Obama-Biden Administration and eliminated by the Trump Administration in 2018.


Make Testing Widely Available and Free

Ensure that every person who needs a test can get one – and that testing for those who need it is free. Individuals should also not have to pay anything out of their own pockets for the visit at which the test is ordered, regardless of their immigration status. The Centers for Disease Control and Prevention (CDC) must draw on advice from outside scientists to clarify the criteria for testing, including consideration of prioritizing first responders and health care workers so they can return to addressing the crisis.

Establish at least ten mobile testing sites and drive-through facilities per state to speed testing and protect health care workers. Starting in large cities and rapidly expanding beyond, the CDC must work with private labs and manufacturers to ensure adequate production capacity, quality control, training, and technical assistance. The number of tests must be in the millions, not the thousands.

Provide a daily public White House report on how many tests have been done by the CDC, state and local health authorities, and private laboratories.

Expand CDC sentinel surveillance programs and other surveillance programs so that we can offer tests not only only to those who ask but also to those who may not know to ask, especially vulnerable populations like nursing home patients and people with underlying medical conditions. This must be done in collaboration with private sector health care entities.

Task the Centers for Medicare and Medicaid Services to help establish a diagnosis code for COVID-19 on an emergency basis so that surveillance can be done using claims data.

Surge Capacity for Prevention, Response, and Treatment

Task all relevant federal agencies to take immediate action to ensure that America’s hospital capacity can meet the growing need, including by:

Preparing to stand up multi-hundred-bed temporary hospitals in any city on short notice by deploying existing Federal Medical Stations in the strategic national stockpileand preemptively defining potential locations for their use as needed.

Directing the U.S. Department of Defense (DOD) to prepare for potential deployment of military resources, both the active and reserve components, and work with governors to prepare for potential deployment of National Guard resources, to provide medical facility capacity, logistical support, and additional medical personnel if necessary. This includes activating the Medical Reserve Corps, which consists of nearly 200,000 volunteer health care professionals who stand ready to serve across America; training and deploying additional surge capacity, including U.S. Department of Veterans Affairs/DOD medical equipment and U.S. Department of Health and Human Services (HHS) Disaster Assistance Medical Teams; and directing and assisting existing hospitals to surge care for 20% more patients than current capacity through flexible staffing, use of telemedicine support, and delaying elective procedures.

Instructing the CDC to establish real-time dashboards tracking (1) hospital admissions related to COVID-19, especially for ICUs and emergency departments, in concert with the American Hospital Association and large hospital chains, for which the HHS must ensure data is able to be shared, as needed; and (2) supply chain information – including availability, allocation, and shipping – for essential equipment and personal protective equipment, including in the various places where there may be federal reserves. The strategic national stockpile must be used to supplement any shortages that exist, especially for essential medical supplies, like oxygen, ventilators, and personal protective equipment.

Ensuring that training, materials, and resources reach federally qualified health centers, rural health clinics, and safety-net hospitals, which are typically resource-poor and care disproportionately for vulnerable populations that will bear the brunt of COVID-19. This effort will lay the foundation for a deeper and more lasting public health infrastructure for accessible national health care for all.

Surge tele-emergency room, tele-ICU care, and telemedicine through a concerted, coordinated effort by health care providers to enable staff to manage additional patients and save beds for the very sick. Leverage existing efforts like Project ECHO to ensure health professionals have tele-mentoring and other training resources they need to make informed decisions.

Support older adults, vulnerable individuals, and people with disabilities. Ensure essential home- and community-based services continue and Centers for Medicare and Medicaid works to provide the waivers necessary for those who rely on medication to have a sufficient supply.

Protect health care workers, first responders, assisted living staff, and other frontline workers.

Give all frontline workers high-quality and appropriate personal protective equipment – and enough of it and appropriate training to use it – so they don’t become infected. If our health care workers, first responders, and essential workers like transportation and food workers cannot function, we cannot protect and care for the public. The Biden Plan calls for issuing guidance to states and localities to ensure first responders and public health officials are prioritized to receive protective personal equipment and launching an education campaign to inform the general public about equipment that should be reserved for professionals.

Direct the Occupational Safety and Health Administration (OSHA) to keep frontline workers safe by issuing an Emergency Temporary Standard that requires health care facilities to implement comprehensive infectious disease exposure control plans; increasing the number of OSHA investigators to improve oversight; and working closely with state occupational safety and health agencies and state and local governments, and the unions that represent their employees, to ensure comprehensive protections for frontline workers.

Ensure first responders, including local fire departments and Emergency Medical Services, can meet the staffing requirements needed to respond and are trained to recognize the symptoms of COVID-19.

Accelerate the Development of Treatment and Vaccines

Ensure the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority are swiftly accelerating the development of rapid diagnostic tests, therapeutics and medicines, and vaccines. NIH must be responsible for the clinical trial networks and work closely with the U.S. Food and Drug Administration (FDA) on trial approvals.

Ensure the FDA is working with the NIH to prioritize review and authorization for use of COVID-19 countermeasures and strengthen regulatory science at the FDA to make certain it has the needed resources to evaluate the safety and efficacy of new tools.

Provide Timely Information and Medical Advice and Guidance

Work with the CDC and HHS to ensure that health departments and health providers across the country give every person access to an advice line or interactive online advice so they can make an informed decision about whether to seek care or to stay at home. This will preserve the health care system for those who are sick and prevent people who may not need to see a provider from becoming needlessly exposed. Ensure all information provided to the public is accessible to people with disabilities, including through plain language materials and American sign language interpreters.

Instruct the CDC to provide clear, stepwise guidance and resources about both containment and mitigation for local school districts, health care facilities, higher education and school administrators, and the general public. Right now, there is little clarity for these groups about when to move toward social distancing measures, like cancelling school, mass gatherings, and travel and when to move to tele-work and distance learning models.

Ensure firefighters and other emergency responders are notified if they have been exposed to individuals infected with COVID-19.

Launching Urgent Public Health System Improvements for Now and the Future

Work with businesses to expand production of personal protective equipment, including masks and gloves, and additional products such as bleach and alcohol-based hand sanitizer. Incentivize greater supplier production of these critically important medically supplies, including committing, if necessary, to large scale volume purchasing and removing all relevant trade barriers to their acquisition.

Task the U.S. Department of Justice with combating price gouging for critical supplies.

Take steps in the aftermath of the crisis to produce American-sourced and manufactured pharmaceutical and medical supply products in order to reduce our dependence on foreign sources that are unreliable in times of crisis. The U.S. government should immediately work with the private sector to map critical health care supplies; identify their points of origin; examine the supply chain process; and create a strategic plan to build redundancies and domestic capacity. The goal is to develop the next generation of biomedical research and manufacturing excellence, bring back U.S. manufacturing of medical products we depend on, and ensure we are not vulnerable to supply chain disruptions, whether from another pandemic, or because of political or trade disputes.

Establish and fund a U.S. Public Health Service Reserve Corps to activate former Public Health Service Commissioned Corps officers to expand medical and public health capacity. By creating the Reserve Corps, we will have a larger team of health professionals to deploy across the nation to help train health care systems in detection and response, educate the public, provide direct patient care as needed, and support the public health infrastructure in communities that are often under-resourced and struggling.

Expand the Staffing for the Adequate Fire and Emergency Response (SAFER) Grant program so that fire departments – critical first responders in health emergencies—can increase staffing. As Vice President, Biden secured an expansion of the SAFER Act to keep more firefighters on the job during the Great Recession. He will expand the grants to build well-staffed, well-trained fire departments across the country.

Providing the Resources Necessary to Achieve These Outcomes

To implement this national emergency response, the Biden Plan calls for an immediate increase of federal resources to cover all necessary federal costs, as well as the creation of a State and Local Emergency Fund that gives state and local leaders the power to meet critical health and economic needs to combat this crisis. This Fund will be designed as follows:

Resources will be allocated according to a formula: 45% to state governments; 45% to local governments; and 10% reserved for special assistance for “hot-spots” of community spread.

Menus of Permissible Usages: Governors and mayors will be given significant flexibility to ensure that they can target their health and economic spending where it is most needed in their respective states and cities. Such usages include:

Paying for medical supplies and expanding critical health infrastructure, including building new or renovating existing facilities, if necessary;

Expanding hiring where needed including health care and emergency services workers, caregivers in nursing homes, drivers, childcare workers, substitute teachers, and others;

Providing overtime reimbursements for health workers, first responders, and other essential workers.

The Fund will also be deployed to cushion the wider economic impact of the crisis, helping hard-hit families and communities, as described later in the fact sheet.