The U.S. healthcare system operates within the public and private sectors. A large portion of the U.S. government budget is for healthcare services including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and Affordable Care Act (ACA) marketplace subsidies — together accounting for 20 percent of the budget in 2020, or $4.1 trillion (Center for Medicare and Medicaid Services 2021). Nearly two-thirds of this amount went to Medicare to provide health care services to 55 million elderly Americans. Therefore, the healthcare system is a component of the government, which is a social institution. The government creates new healthcare policies and regulates these programs. There is much debate on healthcare policy in the U.S. and how to provide coverage for as many Americans as possible. The U.S. is the only industrialized country that does not provide universal healthcare coverage for all of its citizens. Therefore, it is a philosophical and public policy issue that is being addressed in Congress and town halls across America. There is an attempt to replace the Affordable Care Act but policymakers on both sides of the aisle have not been able to create an alternate system that will decrease costs and insure more Americans. The private sector providers are comprised of health insurance companies, pharmaceutical companies, private hospitals, private clinics, and non-profit organizations. These entities operate independently and are less regulated by the government. There are problems within both the public and private sectors due to rising costs, perverse incentives in how the system pays for care, excessive fraud and waste, and uninsured Americans.