The US Situation

The present US healthcare system is a mix of awesome and awful. In terms of treatments available and quality of facilities, the US performs very well; people from all over the world travel to the US to take advantage of its facilities.

Unfortunately, however, the US falls over when it comes to the accessibility and affordability of its health services. The most telling statistic^[PDF]: 62% of people who go bankrupt in the US do so because of medical costs. Even more damning: 78% of those are people who had health insurance.

Also interesting: People in the US spend on average $4500 each per year on healthcare - more than any other country - and yet get worse results in terms of life expectancy than most other countries (source).

George W. Bush famously said that America has no problem with access to healthcare:

"I mean, people have access to health care in America, after all, you just go to an emergency room."

Technically, this is absolutely correct - if you go to a hospital's emergency room, the hospital is legally obliged to treat you (eventually). Unfortunately, it is also absolutely wrong:

• Emergency rooms are for emergency treatment, such as car accidents, shootings, and so on. They should not be clogged up with people who have headaches.
  
• Emergency rooms are expensive: yes, you will get treated. But then the hospital will send you a bill, and will continue to hound you for payment, eventually taking your life savings, your house, and your ability to feed your children.
• Leaving illnesses until they're serious enough to warrant an emergency room visit can allow simple problems to fester and turn into huge, expensive, life-threatening infections.

The American government provides a range of health services to its citizens: veterans get excellent coverage through Veterans' Affairs; the elderly can take advantage of Medicare; Medicaid is available for a minority (about 60% of the poor are not covered by it, according to Wikipedia) of people who are unable to afford health insurance. All of these programmes are very popular; people who are on them resist any change to them.

Unfortunately, the vast majority of people in the US have no access to these programmes and have to resort to private health insurance. Policies can cost around US$12000 (about NZ$18000) a year for a family, and you have a very good chance of having your coverage dropped if you actually need it. From the linked article:

"Rescission is rare. It affects less than one-half of one percent of people we cover. Yet, it is one of many protections supporting the affordability and viability of individual health insurance in the United States under our current system."
(Assurant CEO, Don Hamm)

But:

"If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette."
(Taunter Media, July 28 2009)

Which means that, when they most need it, Americans are likely to lose their ability to pay for their own care. Horror stories abound about insurance companies refusing to pay for people's care, given the tiniest excuse.

Another issue with health insurance is the 'pre-existing condition'. That means that, if you want to get insurance but are already sick, you are not covered for that sickness. If you had a cancer scare, say, when you were young but were cleared, then get insurance, then actually do get cancer, your insurer could easily drop you because of this condition. It means, essentially, that once you're sick, you're on your own. You have no option but to pay, and pay, and pay, until you are bankrupt.

Essentially, then, the system is such that you need insurance, but have no guarantee that your insurance company will pay if you need it.