The U.S. Health System: An Overview

If you’ve ever felt like you're falling through the cracks of this poorly-knit system, that’s not just a feeling.

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Why It Feels So Disconnected

You (probably)- “Isn’t there just one healthcare system?”

Yes and no.

We don’t really have a singular healthcare system. We have a patchwork of systems—some public, some private, some charitable—that are loosely stitched together. So, if you’ve ever felt like you're falling through the cracks of this poorly-knit system, that’s not just a feeling. It’s, unfortunately, just how the system has come to exist.

This newsletter is a plain-language walk-through of how healthcare is set up in the U.S., how people move through it, and why it often feels chaotic or unfair.

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The U.S. System Isn’t Really One System

Unlike countries with national health systems (like the UK or Canada), the U.S. system is built on a mix of public and private programs. That means:

• There’s no universal healthcare

• Where and how you get care depends on your job, income, age, military status, location, and even luck

Think of it like a messy kitchen where every family member is cooking their own meal, but using the same fridge.

The main systems include:

• Employer-based insurance

• Government programs (Medicare, Medicaid, VA, etc.)

• Private insurance you buy yourself

• Safety net & charity care

• Public health services (like the health department)

AND, the icing on this cake is that none of them talk to each other very well.

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How Most People Get Care (And What It Means)

If you’re working and insured through your job,

You likely have private insurance. Your employer pays part of the premium, and you pay the rest. You choose from a network of doctors.

If you're 65+, disabled, or have end-stage kidney disease,

You qualify for Medicare. It's a federal program with different parts (hospital, outpatient, drug coverage) that can be confusing to navigate.

If you're low-income or on disability,

You may qualify for Medicaid, run by your state with federal help. Coverage and rules vary a lot by state.

If you serve(d) in the military,

You might be eligible for VA healthcare or Tricare, depending on your service history.

If you buy insurance yourself,

You use the Marketplace (Healthcare.gov or your state exchange). You may get subsidies based on income.

If you’re uninsured,

You rely on:

• Community health clinics

• Emergency rooms (required to stabilize, not treat everything)

• Public health departments

• Safety net hospitals and charity care programs

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The Public Health & Safety Net System

You might not think about public health unless there's an outbreak, but it's a critical piece of the U.S. healthcare puzzle.

Public health departments handle:

• Vaccinations

• STD testing and treatment

• Disease surveillance

• Environmental health (like lead or water safety)

• Emergency preparedness

These services are usually free or low-cost but often underfunded and overstretched.

The Safety Net includes:

• Federally Qualified Health Centers (FQHCs)

• County or public hospitals

• Free clinics

• Planned Parenthood

• Mobile units or community outreach programs

These places help people who:

• Are uninsured

• Are undocumented

• Can’t afford private care

• Face barriers due to language, transportation, or stigma

“The safety net isn’t extra — for millions, it’s the only net keeping them from hitting the ground.”

Here’s one of the many catches: the safety net is not universal or guaranteed. It’s a patchwork (like we discussed above), and it varies drastically by city and state.

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Why It All Feels Disconnected

In the U.S. system:

• Your primary care doctor might be part of one network

• Your specialist might be part of another

• Your insurance might only approve certain drugs

• Public health and primary care are funded by different budgets

• Mental health is often carved out and handled separately

There's no centralized coordination. That’s why:

• You fill out the same forms over and over

• You have to explain your medical history 10 times

• Nobody seems to “have your file”

• You’re the one keeping track of everything

Real Talk:
The U.S. healthcare system was built to prioritize access to services — not continuity of care— (which is funny…not really) because most of the time, it feels inaccessible. So, in many cases, they’re there, but they’re also not. Make sense?

That means you can usually find someone to treat you, but making it make sense is another story.

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The Challenges of a Disconnected System

When systems don’t talk to each other, patients pay the price, and not just financially—emotionally, physically, and logistically.

Here’s what that disconnection looks like in practice:

• Redundant tests and procedures
  You might get the same lab work done multiple times because one provider can’t see the results from another.

• Gaps in care
  When there’s no smooth hand-off between providers, things fall through the cracks—medications get missed, follow-ups don’t happen, and symptoms get overlooked.

• Confusing medical bills
  One visit could generate multiple bills: from the hospital, a specialist, a lab, and a separate billing company. And good luck figuring out who to call with a question.

• Delayed diagnoses and treatments
  Providers often don’t have access to your full medical history, which slows down decision-making or leads to poor decisions based on incomplete info.

• Mental health fragmentation
  Behavioral health is often handled separately, with different networks, providers, and rules. It makes coordination with your primary care provider extremely difficult.

• Lost time and trust
  Patients spend hours navigating phone trees, hunting down records, rescheduling due to “insurance issues,” or just trying to figure out where to go next.

All of this leads to a system that is hard to trust, harder to navigate, and deeply inequitable. The burden of making it work falls disproportionately on patients, especially those already dealing with chronic illness, language barriers, disabilities, or economic stress.

I don’t like the excuse that “this is just how things are.”

It’s the result of policy decisions, industry structures, and a lack of coordination that prioritize access to services over access to care.

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Why Understanding This Helps You

When you understand how the U.S. system is structured, you can:

• Navigate care more confidently

• Ask better questions (“Is this doctor in my plan’s network?”)

• Know where to go when something goes wrong

• Avoid scams, misinformation, or redundant care

• Advocate for better policies that actually fix the system

This knowledge doesn’t fix the flaws, but it gives you tools to move through them with more power, not just frustration.

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Call to Action

Have you ever fallen through the cracks of this “system”? Have you ever felt like nobody in healthcare is talking to each other?

Reply or comment: I’d love to highlight your story.

If this helped you understand how it all fits together (or doesn’t), please share it with a friend or family member who’s trying to figure it out too.

Until next time,

Caroline Waltzman

Your health Translator and Navigator, one newsletter at a time