America's Health Care System is Broken: What Went Wrong and How We Can Fix It. Part 2: Health Insurance

Unlike most Western democracies, health insurance in the United States is provided by a haphazard mix of employer-based plans, Medicare for those over age 65 years or on social security disability or with chronic renal failure, Medicaid under varying state-dependent rules for some low-income recipients, and no insurance for tens of millions. Administrative costs, which include both the direct costs of the insurers and the indirect costs imposed on physicians and hospitals, make up nearly 25% of our bloated national health care expenditures. This high cost adds no proven value to health care outcomes. Our current system of covering health care expenditures is both inefficient and unfair. Changes must be made. (C) 2019 Elsevier Inc. All rights reserved.