ABSTRACT
The U.S. health care system starts with a foundation of employment-based health insurance with targeted programs added for those who do not have health insurance through their jobs. This results in many specific and fairly independent insurance programs providing access to health care services, several of which have been described in Chapters 18-20. This model has its rationale in the philosophical values of market justice underlying the U.S. economy and which are present, although in a more limited fashion, in the health care system. It has always been argued that this targeted program approach allows for more flexibility and innovation and is more likely to meet the special needs of the various target groups. There does not seem to be much evidence to support this. Each program has separate eligibility requirements, such as employment status, age, disability status, or income. Because of this, the targeted program system is administratively more expensive. No other country organizes their health care system in the way in which the United States does, with South Africa being the closest. All other countries with economies similar to the United States spend much less money, have fewer administrative costs, and obtain better health outcomes.
