Compared to other similarly developed countries, the US has the greatest amount of healthcare expenditures and the worst healthcare outcomes. This is in part due to its convoluted insurance/payment systems and the degree of variation present in the country—not only is it geographically expansive, but it is also diverse in virtually every other aspect.

More and more research shows that health is impacted by more than just biological factors. In fact, social factors like race, socioeconomic status, gender, and access, among others, can often impact it more than the quality or quantity of medical care. The vast variation in the US furthers the inequality gaps certain demographics face in their access to healthcare, including the complex infrastructure of the country’s insurance system.

Another factor that complicates healthcare is the different schools of thought behind the politics and regulation of healthcare: market justice and social justice. There is this constant tension between market efficiency and fairness.

• Market justice implies that healthcare is an economic good and that each person is responsible for their own healthcare.
• Social justice implies that healthcare is a right and that everyone is entitled to the same basic benefits.

America’s trademark “American Dream” also promotes the idea of ‘rugged individualism’ and earning respect and luxury, explaining the innate preference for market justice solutions over social justice ones. However, most countries recognize the importance of both, so they tend to use a mixture of the two, and combining these two ideologies well is where the challenge lies.