The United States is admired and emulated by the world as a leader in innovation and individual freedoms. But it falls behind in one of the most important aspects: healthcare as a basic human necessity. Americans live with the persistent fear of not being able to afford treatment for a serious illness or accident. The fear isn’t unfounded; a single day in a U.S. hospital can cost you $5,220 compared to $424 in Spain.

The country began its path forward as a nation with accessible healthcare for all through President Obama’s Affordable Care Act (ACA) of 2010. It required all Americans to have health coverage, and it set limits on what pharmaceutical companies and healthcare facilities could charge. The Act, however, was picked apart and nullified by the next president, leaving many wondering what to do now.

Almost a third of Americans have medical debt. For many, the amount owed is well over $10,000. The high medical bills are responsible for the fact that half of those with medical debt end up defaulting. Is there any hope that the U.S. healthcare system will change to provide more affordable healthcare to all Americans? Take a closer look at what obstacles the country faces.

The High Cost of Healthcare

One of the reasons universal American healthcare isn’t available is because of the high costs. Pharmaceutical companies regularly hike prices for medications with little resistance from the government. The most recent price increase occurred at the beginning of the year and included higher prices on 250 drugs. The increase in blood thinners, HIV treatments, and others went into effect with little press coverage. The federal government recently published a paper that showed that U.S. drug prices are four times higher than the same medication in similar countries.

Besides the high expense of medication, there’s also a shortage of qualified physicians and nurse practitioners nationwide. The lack of qualified medical providers causes current physicians to work longer hours, potentially facing burn out sooner. These physicians may cut back their hours or retire earlier.

In unevenly distributed communities with limited availability of doctors and medical practitioners, people may go without healthcare longer. The lack of easily accessible healthcare may lead to chronic diseases or complications which are more expensive to treat and could have been easily avoided with regular, preventative care.

The Limitations of Private Health Insurance

Even with health insurance, many Americans may not be able to afford their medical bills.

Private health coverage is supposed to protect the insured from high medical bills, but what does good health insurance encompass?

Good health insurance allows healthy people to receive affordable, preventative medical care for small, non-threatening ailments before they get worse. Unforeseen events such as car accidents or medical illnesses can still happen, however. A good health insurance plan covers the insured person’s bills so they don’t risk financial ruin over something they didn’t see coming. As for other people with pre-existing conditions or chronic illnesses, health coverage is meant to provide them with the care they need in an affordable way.

But unfortunately, too many insured individuals still end up with high medical debt. Private health insurance premiums are often expensive. For many who choose to buy private health insurance, they may opt for a higher-deductible plan. The higher deductible and other out-of-pocket costs can still leave an insured person with tens of thousands of dollars of medical debt.

Is There Hope for Americans?

It’s hard to see what direction public policy is going at this time. There are a couple of health-related bills that may have enough bipartisan support to pass — one bill calls for negotiated drug prices to stop price hikes, while another bill goes after surprise medical bills for items consumers believed were covered by their health insurance.

It’s also an election year — so depending on what changes may occur in the fall, the next administration may place a greater focus on helping Americans access affordable healthcare and manage their current medical debt without facing financial ruin.