Healthcare in The United States

As the nephrologist I shadowed reviewed the lab results and the PA translated them into Spanish, the patient’s already anxious expression grew tense with fear. The labs indicated a severe quantity of protein in the patient’s urine, and the doctor recommended a kidney biopsy to determine the cause of the condition. To this suggestion, the man shook his head. As an uninsured immigrant, he couldn’t afford the out-of-pocket cost. The doctor presented another option: “Why don’t you travel to Mexico and get the biopsy performed, then come back with the results?” The man expressed his fear that he would miss a significant amount of work, along with the possibility of not being allowed back into the United States. His dilemma reflects a harsh reality many immigrants and uninsured patients face: in the world’s richest country, life-saving healthcare is still out of reach. 

The United States is a global leader for the advancement of medicine and research. About 0.5% of air travelers entering the United States annually list health treatment as a reason for flying. This equates to between 100,000 and 200,000 people per year. It’s no secret that several cities in the United States such as Boston and Houston are hotspots for advancing research and providing world-class treatments for patients. However, these treatments come at a great cost. For those who pay insurance premiums, the annual price amounts to about $9,000 for a single person and $25,000 for family coverage. On top of paying for insurance costs, the Milliman Medical Index of 2025 provides a fuller picture, factoring in out-of-pocket costs. This brings the total amount of money an insured family spends on healthcare to an estimated $35,000 annually. These prices are only expected to rise rapidly, as seen by comparing current prices to the average total cost of healthcare being $12,000 in 2005. 

These staggering costs only tell half the story. The reality is that about 23% of the U.S. population was underinsured, meaning they were covered by insurance but still faced high out-of-pocket costs relative to their income. Among those individuals, 9% were uninsured entirely. For American citizens without adequate insurance coverage, the financial situation is significantly worse than their insured counterparts. While it is true that they pay less in absolute dollars, the costs consume a far larger portion of their income, pushing many into debt. This financial burden forces many to delay treatments, skip medications, and overall put off care that they direly need. Additionally, affordable healthcare is especially difficult for immigrants in the United States. Immigrants often face exclusion from Medicaid, language obstacles, and fear of the deportation process. For example, in California, 55% of undocumented immigrants avoided or delayed vital emergency care by 2-3 days. Immigrants end up using significantly less care, and not because it is unnecessary, but because they find it to be unsafe. If insured families are straining under the weight of the healthcare system, the uninsured are being crushed by it. 

While medical debt is the leading cause of bankruptcy in the United States, financial burden is not the only way tens of millions of uninsured individuals are affected by the American healthcare system. The consequences affect health outcomes by a significant amount. In a poll by the KFF, 70% of uninsured people reported that they skipped important medical care due to high costs. Skipping medical care contributes to chronic illnesses such as diabetes, hypertension, and asthma to go unchecked and worsen. Uninsured adults are also three times more likely to be hospitalized and die from preventable conditions than insured individuals. This disparity likely occurs because they are less likely to receive mammograms, colonoscopies, or annual vaccinations, contributing to illnesses that are more difficult and costly to treat. Constant preoccupation about medical bills also contributes to chronic stress and anxiety among uninsured patients, directly causing worse mental health. Additionally, due to poor health, uninsured patients can face negative career and educational impacts. Adults who depend on weekly paychecks heavily rely on the hours they work, and if they are unable to work due to an illness, a cycle of lost wages and medical debt is created. Children who are forced to stay home sick lose their valuable time in the classroom. Beyond just affecting families, entire communities can be impacted by the avoidance of medical care, as preventable diseases can be spread due to missing routine vaccinations. Uninsured individuals overall face several unavoidable issues such as financial struggles, poorer health, and life and social consequences. 

While legislation like the Affordable Care Act (ACA) has made progress by expanding coverage, gaps still remain for the most vulnerable individuals in our society. Federal legislation is slow to acknowledge financial disparities and allow affordable healthcare for all. Access to affordable healthcare is still a reality for millions of Americans, and costs rise quicker than wages can account for. As a part of the next generation that can vote, it is important to understand that we have a voice in shaping healthcare. It is imperative that we know our rights, understand social and economic gaps, and discuss the issue with friends and family. While some actions like volunteering at the food bank or at local clinics may feel like it has no impact, these programs succeed significantly in providing help for uninsured immigrants and families. Remember to vote if possible and consider going the extra mile by writing to lawmakers to advocate for equal healthcare rights for all. If this topic inspires you to invoke change in the American healthcare system, consider a future career in medicine, public health, or advocacy. The future of the United States relies solely on the choices that we make, what we learn, and our advocacy to create a world in which healthcare is a right and not a privilege.

Sources

Moynihan, Ray, et al. “Preventing Overdiagnosis: How to Stop Harming the Healthy.” The BMJ, vol. 344, British Medical Journal Publishing Group, 29 May 2012, www.bmj.com/content/344/bmj.e3502.

Majeed, H., and V. Gupta. "Adverse Effects of Radiation Therapy." StatPearls, edited by Amirhossein Mohebati, StatPearls Publishing, 2025, https://www.ncbi.nlm.nih.gov/books/NBK563259/.

Viste, A et al. “Postoperative complications and mortality after surgery for gastric cancer.” Annals of surgery vol. 207,1 (1988): 7-13. doi:10.1097/00000658-198801000-00003

Colloca, Luana, and Franklin G Miller. “The nocebo effect and its relevance for clinical practice.” Psychosomatic medicine vol. 73,7 (2011): 598-603. doi:10.1097/PSY.0b013e3182294a50

Todd E. Elder, et al. “The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates.” Journal of Health Economics, North-Holland, 17 June 2010, www.sciencedirect.com/science/article/abs/pii/S0167629610000755?via%3Dihub.