Why Is Healthcare a Political Issue?

Why Healthcare Isn't Just Medical — It's Political

If you’ve ever seen the inside of a hospital bill or tried to pick a health insurance plan, you’ve probably wondered: Why is this so confusing? And why does it cost so much? The answer isn't just about medicine — it's about politics.

Healthcare is a political issue because governments decide many of the rules that shape the health system. They choose what kinds of health services are covered by insurance, how much drugs can cost, and who gets access to care in the first place.

The U.S. Doesn’t Have One Health System — It Has Many

In countries like Canada or the UK, the government runs or heavily regulates a single healthcare system for all people. In the United States, it's different — more like a patchwork quilt:

• Some people get health insurance through their jobs
• Older adults use Medicare (a federal program)
• Low-income families may qualify for Medicaid (run by each state)
• Others buy private insurance or go without it

This mix creates confusion and uneven care. A newborn in Massachusetts might get completely different coverage than one born in Mississippi, simply because state rules differ. That's a political choice.

As journalist Elisabeth Rosenthal points out in her book An American Sickness, part of the problem is that U.S. healthcare has become less about care and more about business — and politics decides how that business works.

Health Insurance: Who Has It — and Who Pays for It

Health insurance helps you afford medical services you might not otherwise be able to pay for — like surgeries, check-ups, or even routine prescriptions. But not all insurance is created equal. What your plan covers, how much you pay per month, and how much you owe after visiting a doctor all depend on national and state policies.

For instance, the Affordable Care Act (ACA), also known as "Obamacare," was passed to expand access to health insurance. It made it illegal for insurance companies to deny coverage because of a “pre-existing condition” and gave subsidies to help people afford plans. When the Trump administration came into office, it worked to weaken the ACA. These aren't numbers in a spreadsheet. They’re political decisions affecting whether someone gets treated or not.

Access to Care: Not the Same for Everyone

Let’s say you live in a rural area with one overworked hospital. Or maybe you can't afford the gas to drive to the big city for a specialist. You’re technically “insured,” but you still can’t easily get treated. That’s a gap in access to care — and it's widespread.

T.R. Reid’s book, The Healing of America, compares the U.S. to other countries. He found that many nations guarantee access to essential care as a basic right. In the U.S., access often depends on where you live, your income, and your insurance — all shaped by political decisions.

Drug Prices: Why Are They So High?

Ever wondered why that inhaler or EpiPen costs hundreds of dollars in the U.S. yet just a few bucks in other countries? That's not a fluke. It's policy. In many developed countries, governments negotiate directly with drug makers to keep prices down. But in the U.S., federal law blocks Medicare — the nation’s biggest insurance buyer — from negotiating drug prices.

Jonathan Cohn, in Sick: The Untold Story of America's Health Care Crisis, shares examples of patients stuck with massive bills for life-saving drugs. These aren’t isolated stories — they’re the result of laws made (and blocked) by elected officials.

Public Health Is Political

The COVID-19 pandemic showed just how political public health could get. Decisions about masks, vaccines, testing sites, and funding sparked major national debates — often between state governors and the federal government. When a pandemic hits, public health isn’t just about individuals. It's about everyone working together to stop illness, and that requires political leadership.

The Bottom Line

Healthcare will always be a political issue because it touches every part of our lives — and because it moves massive amounts of money. Health outcomes (like life expectancy or cancer survival rates) are worse in the U.S. than in most wealthy nations because of how the system is built. Understanding those choices — and the systems they shape — is the first step to changing them. Because when it comes to healthcare, politics isn't just about red vs. blue. It's about who lives, who gets care, and who pays the price.