Healthcare
The United States spends more on healthcare per person than any country in the world β nearly twice the average of comparable wealthy nations β yet achieves worse outcomes on many measures including life expectancy, infant mortality, and management of chronic disease. This paradox drives a persistent debate about how to improve value from the system. Federal healthcare policy centers on three major programs: Medicare (covering approximately 65 million seniors and disabled Americans), Medicaid (covering approximately 80 million low-income people), and the Affordable Care Act marketplace. The ACA, enacted in 2010, dramatically reduced the uninsured rate but remains politically contested. Drug pricing is a central concern: Americans pay 2β4 times more for the same medications than people in Canada, Germany, or the UK, reflecting a system in which manufacturers set prices without the government negotiation that occurs in most countries. The 2022 Inflation Reduction Act allowed Medicare to negotiate prices for the first time, starting with a small number of drugs. Rural hospital closures, a shortage of primary care physicians, and the aftermath of the COVID-19 pandemic further strain an already stressed system. Mental health and addiction treatment remain chronically underfunded relative to need.
Why it matters
Healthcare affects every American directly through insurance costs, access to care, and the quality of that care. Congressional decisions about what Medicare and Medicaid cover, how drugs are priced, and who is eligible for coverage determine whether people can afford to get and stay healthy β shaping individual lives and the nation's productivity and budget.