The pharmaceutical industry’s core defense of American drug prices is that research and development is expensive, risky, and requires the returns that high prices generate. The documented reality is more complicated. The foundational research underlying most major drugs was funded by the National Institutes of Health — meaning American taxpayers — before private manufacturers acquired … Read more
The American health insurance industry is not a system built to deliver care. It is a financial intermediary — a layer of profit-taking inserted between patients and the providers who treat them. That distinction matters because it shapes every argument in this hub. Understanding the insurance industry requires understanding what it actually does. Insurers collect … Read more
The American hospital market has been reorganized. What was once a landscape of independent community hospitals — locally governed, operating within defined geographic areas, competing for patients on the basis of quality and access — has been consolidated into large regional and national systems whose market position is measured not by the care they deliver … Read more
Medicare was created in 1965 as a public insurance program for Americans over 65 and people with qualifying disabilities. Since the 1980s a growing share of Medicare has been administered by private insurers under contracts with the federal government — first as Medicare+Choice, now as Medicare Advantage. Today nearly half of all Medicare enrollees are … Read more
Behavioral health — mental illness and addiction — remains structurally separate from physical healthcare in the United States. That separation is not accidental and it is not clinical. It is the product of decades of insurance design, reimbursement decisions, and regulatory choices that treated the mind as categorically different from the body. The consequences are … Read more
The United States has no coherent system for financing long-term care. Medicare does not cover it in any meaningful way. Private long-term care insurance collapsed as a viable market because the actuarial math made it unprofitable. What remains is a patchwork: Medicaid for those who have spent down their assets to near poverty, unpaid family … Read more
The United States spends more on healthcare per person than any other wealthy country and produces worse population health outcomes than most of its peers. Every other high-income nation has achieved universal coverage. Every one of them spends less. The gap between what Americans pay and what they get is one of the most thoroughly … Read more
Student activism has shaped American civic life for generations. The energy, the urgency, and the moral clarity that students bring to civic work are genuine assets — not just for the movements they join, but for the broader civic system those movements are part of. And yet the pattern repeats. A wave of organizing builds … Read more
The United States spends more on healthcare than any other wealthy country and does not get the best results. It is the only wealthy nation without universal coverage. Its administrative overhead is without parallel among peer countries. Its prices are set through a process largely hidden from the people paying them. And every major attempt … Read more
Housing costs and affordability affect nearly every dimension of American life — from household finances and wealth accumulation to public health, educational outcomes, labor markets, and the structure of communities. The articles collected here examine how the housing system works, how it came to operate as it does, who bears its costs and who benefits … Read more