A working reference on how U.S. health care programs actually operate.
How the major programs are structured and financed — statutory basis, payment mechanics, and current administration.
Medicare Advantage
How MA plans are paid, risk-adjusted, and rated — and where the overpayment debate stands.
Reference
Traditional Medicare & Medigap
Parts A and B mechanics, and the private supplemental coverage that fills their gaps.
Reference
Medicaid
Federal-state financing, managed care, and state flexibility waivers.
ACA & the Marketplace
Exchange structure, subsidies, risk pools, and the individual mandate's afterlife.
FDA Drug Approval Process
Clinical trial phases, accelerated approval, and the statutory approval pathways.
Drug Pricing & Payment
Part B buy-and-bill, Part D negotiation, rebates, and PBM mechanics.
Health Savings Accounts
HDHP pairing rules, contribution limits, and the tax treatment that drives their use.
Cross-cutting issues that run through multiple systems at once — where a single-program lens misses the fight.
Site-Neutral Payment
Why Medicare pays differently for the same service across settings — and the push to stop.
Surprise Billing & the No Surprises Act
IDR arbitration mechanics and the 2026 Operations final rule.
340B Drug Pricing Program
Covered entities, contract pharmacies, and the manufacturer pushback.
Data sources, code, and other links used across this overview.