This is Part 4 in a series exploring how American systems are rigged against regular people. Part 1: The Rankings | Part 2: Language Manipulation | Part 3: Follow the Money
Let’s Talk About Congressional Healthcare
Remember in Part 3 when we documented that Americans pay $12,555 per person for healthcare (#1 in the world) but rank 36th in life expectancy?
Here’s a fun detail we left out: The people making decisions about your healthcare have completely different healthcare than you do.
Not “slightly better.” Not “a bit more coverage.” Completely. Different. Healthcare.
And if you forced them to use what they’re giving you, the system would be fixed within a year.
Let me show you exactly what I mean.
What Congress Actually Gets
Since 2014, members of Congress technically have to buy insurance through the DC Health Link (the ACA exchange), same as regular folks using Obamacare.
But that’s where the similarity ends.
The Premium Subsidy
Congress members get:
- Government pays 72% of their premiums (capped at 75% of total premium)
- They pay about 28% through pre-tax payroll deductions
- Zero risk of losing coverage if they lose their job (they ARE the job)
Regular Americans on ACA exchanges get:
- Subsidies only if income is low enough (138-400% of federal poverty level)
- If you make $60,000/year single? You’re paying full price, bucko
- Subsidies phase out based on income
- Lose your job? Better hope you can afford COBRA at 102% of the full premium
The Office of the Attending Physician
Here’s where it gets interesting.
For an annual fee of about $$650, members of Congress get access to the Office of the Attending Physician – a Navy-staffed medical clinic right in the Capitol.
What that $650 buys:
- Walk right in, no appointment needed – straight to a physician
- “Not rushed. Examined thoroughly.” (Quote from former OAP physician)
- On-site X-rays, lab work, physical therapy
- Routine exams, consultations, diagnostic tests
- Free referrals to Washington-area military hospitals
- Prescriptions written (but not dispensed – they have to fill those themselves, how tragic)
What it doesn’t include:
- Surgery, dental, vision (they have separate insurance for that, poor things)
Compare that to Medicare:
For Medicare Part B (doctor visits, outpatient care), seniors pay:
- $185.00/month premium (2025 rate) = $2,220/year
- $257 annual deductible
- 20% coinsurance on most services (NO annual cap on out-of-pocket costs)
- To GET a wheelchair through Medicare: Face-to-face exam, written prescription, Medicare Part B application, approved supplier, sometimes home evaluation, 20% copay
When Mitch McConnell needed a wheelchair after a fall? One just appeared. No paperwork. No copay. Funny how that works.
Military Hospital Access
Members of Congress can receive:
- Free outpatient care at military facilities in the DC area
- “The best care in the country free to members, also on the taxpayer’s dime” (direct quote from reporting)
- For inpatient care: billed at full rates (but insurance covers it)
Regular veterans using VA healthcare:
- Wait times averaging 20-30 days for appointments
- Facilities often underfunded and understaffed
- Have to prove service-connected disability for priority access
Members of Congress get military hospital access because they work in DC. Veterans get waitlists because… well, you know.
What Regular Americans Get
Let’s compare what Congress gets ($650/year for nearly unlimited care) to what’s available to regular people:
Medicare (for seniors 65+)
Coverage:
- Part A (hospital): Usually premium-free if you worked 10 years
- But: $1,676 deductible per benefit period
- Days 1-60: $0 copay after deductible
- Days 61-90: $419/day copay
- After 90 days: $838/day copay
- Part B (doctor visits): $185/month = $2,220/year
- Plus: $257 annual deductible
- Plus: 20% coinsurance on all covered services with NO annual out-of-pocket maximum
- If your doctor charges more than Medicare-approved amounts, you pay the difference
What Medicare doesn’t cover:
- Long-term nursing care
- Dental care
- Vision care (except post-surgery)
- Hearing aids
- Most prescription drugs (need Part D)
To get prescription coverage:
- Add Medicare Part D: Average $40-50/month = $480-600/year
- Plus deductibles
- Plus copays
- Plus “donut hole” coverage gap where you pay more
Total annual cost for basic Medicare:
- Part B premium: $2,220
- Part D premium: ~$550
- Deductibles: ~$700 minimum
- Copays/coinsurance: Variable, but easily $1,000-3,000+
- Total: $4,500-6,500+ per year minimum
And that’s if you’re healthy and don’t need anything serious.
Medicaid (for low-income Americans)
Coverage:
- Varies by state (because fuck consistency, apparently)
- Usually covers: doctor visits, hospital stays, long-term care, dental/vision for kids
- Minimal or no premiums
- Low copays ($1-4 typically)
Sounds good, right?
The catch:
- Income limits so low you have to be near poverty to qualify
- Many doctors don’t accept Medicaid (reimbursement rates too low)
- 10 states still haven’t expanded Medicaid, leaving millions uninsured
- Social stigma (you’re on “welfare”)
- Can lose coverage if income increases even slightly (“Medicaid cliff”)
Example of how absurd this is:
- Texas: Qualify for Medicaid only if income is below 18% of federal poverty level for parents
- That’s $4,824/year for a family of three
- Work a minimum wage job 20 hours/week? You make too much.
- Literally too poor to get insurance, too “rich” to qualify for help
The Contrast in One Chart
| Feature | Congress ($650/year) | Medicare ($4,500+/year) | Medicaid (Free-ish) |
|---|---|---|---|
| Walk-in care | Yes, immediate | No | Depends on provider availability |
| On-site diagnostics | Yes | No | No |
| Physical therapy | Yes, on-site | Covered with 20% copay | Covered, if provider accepts Medicaid |
| No appointments needed | Correct | LOL no | Double LOL no |
| Annual out-of-pocket max | $650 total | None (unlimited exposure) | Minimal |
| Quality of care | “Best in the country” | Depends on doctor acceptance | Many doctors won’t see you |
| Dental/vision | Separate coverage available | NOT covered in basic Medicare | Covered for kids only (usually) |
| Prescription drugs | Separate insurance | Separate Part D needed | Covered (if state includes it) |
| Military hospital access | Yes, free outpatient | No | No |
| Lose coverage if income changes | Never | No (age-based) | Yes, immediately |
What Would Happen If Congress Had to Use Medicare/Medicaid?
Let’s play a thought experiment:
New law: Starting tomorrow, members of Congress must use either Medicare or Medicaid (based on age/income), with one additional rule: No supplemental insurance allowed.
If you’re under 65: Medicaid only. If you’re 65+: Medicare Parts A, B, and D only. No Medigap. No Medicare Advantage. Just basic Medicare.
What gets fixed within 6 months:
- Out-of-pocket maximums for Medicare
- Current: Unlimited exposure to 20% coinsurance
- After Congress experiences it: Annual cap of $3,000 implemented immediately
- Why: Because unlimited financial risk is terrifying when it’s YOUR unlimited financial risk
- Medicare Part D “donut hole” eliminated entirely
- Current: Coverage gap where you pay more for prescriptions mid-year
- After: Full coverage at all income levels
- Why: Explaining to donors why you can’t afford your medications is embarrassing
- Medicaid acceptance requirements
- Current: Doctors can refuse Medicaid patients (and many do)
- After: Any provider accepting Medicare must accept Medicaid
- Why: Can’t get an appointment? Suddenly that’s a crisis worth solving
- Medicaid expansion in all 50 states
- Current: 10 states still refuse expansion, leaving millions uninsured
- After: Universal expansion with federal funding
- Why: Members from non-expansion states suddenly care about their constituents having coverage
- Dental and vision added to Medicare
- Current: Not covered, seniors go without dental care or pay $$$
- After: Full dental and vision coverage included in Part B
- Why: Hard to smile for campaign photos with missing teeth
- Prescription drug price negotiations
- Current: Limited negotiation, prices often 10x higher than other countries
- After: Full price negotiation with pharma companies, prices drop 60-80%
- Why: Paying $300 for insulin when you make $174,000 is annoying. Imagine being on a fixed income.
- End of prior authorization requirements
- Current: Insurance can require approval before covering treatments
- After: If a doctor prescribes it, insurance covers it
- Why: Dying while waiting for an insurance company to approve your treatment focuses the mind wonderfully
Timeline: This all gets fixed in one legislative session.
Why? Because it stops being theoretical when it’s happening to YOU.
But Wait, There’s More: Even Their “Regular” Insurance Is Better
Okay, so Congress gets the Office of the Attending Physician for $650/year. But what about their actual insurance plan – the one they’re “forced” to use through the ACA exchanges?
Let’s compare what they get to what you get.
Congress’s Insurance: DC Health Link Gold Plan
What Congress buys:
- Gold-tier ACA plan (covers 80% of costs on average)
- Government pays 72% of the premium
- They pay ~28% via pre-tax payroll deduction
- Total out-of-pocket maximum: $9,200 individual / $18,400 family (2025 ACA limits)
Typical gold plan coverage:
- $0-20 copay for primary care visits
- $40-60 copay for specialists
- Prescription coverage with tiered copays
- Emergency room: $350 copay, then covered
- Hospital stays: Covered after deductible (usually $1,000-2,000)
What this costs a Congress member (family coverage):
- Premium: ~$1,900/month total
- Government pays: ~$1,370/month (72%)
- Member pays: ~$530/month = $6,360/year
- Plus deductibles/copays up to out-of-pocket max
Total maximum annual cost: ~$15,560 (if they hit the family OOP max, which is unlikely given OAP access)
Median Employer-Sponsored Insurance
What the median American worker gets:
- Plan covers ~82% of costs on average (similar to gold)
- Employee premium contribution: $1,401/year single, $6,296/year family (2023 average)
- Deductible: $1,735 single / $3,722 family (average)
- Out-of-pocket maximum: $4,611 single / $8,764 family (average)
But here’s the catch:
Networks are restricted:
- Congress’s DC Health Link plans have nationwide coverage (they travel constantly)
- Your employer plan? “In-network” only, or pay 50% out of network
- Go to the wrong ER during an emergency? Out of network, you pay more
Prior authorization required:
- Congress’s plan: Minimal (they can push back, they literally write the laws)
- Your plan: Insurance company can deny your doctor’s recommendation, delay treatment, require “step therapy” (try cheaper drug first, even if doctor says you need the expensive one)
Surprise billing:
- Congress: Protected by federal law they passed
- You: Also protected now (thanks to their 2020 bill), but only after decades of people going bankrupt from out-of-network anesthesiologists
Job loss risk:
- Congress: Can keep their plan as long as they’re in office (elections are every 2-6 years)
- You: Lose your job, lose your insurance. COBRA costs 102% of the full premium, which you can’t afford because YOU JUST LOST YOUR JOB
Individual Marketplace Insurance (No Employer)
What you pay if you have to buy insurance yourself:
If you make $60,000/year (just above subsidy cutoff in many states):
- Premium: $450-600/month = $5,400-7,200/year (and rising annually)
- Deductible: $5,000-8,000 (to keep premiums lower)
- Out-of-pocket maximum: $9,200
- Networks: Even more restricted than employer plans
- Coverage: Usually silver tier (covers 70% of costs vs. gold’s 80%)
Total maximum annual cost: $14,200-16,200 and you’re NOT getting access to the Office of the Attending Physician or military hospitals.
If you make $65,000/year:
- Zero subsidies in most states
- Pay full freight: $600-750/month = $7,200-9,000/year
- Still have the deductible and OOP max
The Comparison Chart: Three Americas
| Feature | Congress Member | Median Worker | Individual Market |
|---|---|---|---|
| Annual premium cost | $6,360 (28% of premium) | $6,296 family avg | $7,200-9,000 (100% of premium) |
| Premium subsidy | Government pays 72% | Employer pays ~70% | $0 if income too high |
| Deductible | $1,000-2,000 | $3,722 family | $5,000-8,000 |
| Out-of-pocket max | $18,400 family | $8,764 family | $9,200 individual |
| Network | Nationwide | Restricted, regional | Very restricted |
| Prior authorization | Minimal | Required, delays common | Required, denials common |
| Walk-in clinic access | OAP: $650/year | $0 (but no walk-in) | $0 (but no walk-in) |
| Military hospital access | Free outpatient | $0 | $0 |
| Lose coverage if leave job | Only if leave Congress | YES, immediately | N/A (but can’t afford it) |
| Can negotiate prices | They write the laws | LOL no | Double LOL no |
The real kicker:
Even ignoring the Office of the Attending Physician, Congress members have:
- Government subsidy that doesn’t phase out with income (yours does)
- Nationwide coverage (you’re stuck with regional networks)
- Zero job loss risk for 2-6 years guaranteed (you can be fired tomorrow)
- Actual ability to fix problems by writing new laws (you can write your senator, good luck)
And this is the “regular” insurance they’re “forced” to use after the ACA.
Imagine what they had before 2014 when they got full Federal Employee Health Benefits with zero restrictions.
The Real Question: Why Does Congress Get Better Healthcare?
The official answer: “They’re federal employees, they get federal employee benefits.”
The real answer: Because they can.
They write the laws. They set their own benefits. They exempt themselves from the systems they create for you.
And they know – they KNOW – that if they had to use Medicare or Medicaid without supplemental coverage, those programs would be fixed immediately.
The existence of separate, superior healthcare for Congress is proof that they know the system is broken.
If Medicare was good enough, they’d use it. If Medicaid was adequate, they’d use it. If the ACA exchanges with no subsidies were functional, they’d use that.
Instead, they get:
- 72% premium subsidies (you don’t)
- $650/year concierge medicine (you can’t access)
- Free military hospital care (you’re on a waitlist)
- Zero risk of medical bankruptcy (you have 66.5% chance if you go bankrupt)
This Isn’t About Jealousy. It’s About Proof.
I don’t begrudge Congress having good healthcare.
I begrudge them having good healthcare while creating a completely different system for everyone else.
The existence of the Office of the Attending Physician is an admission:
- Waiting weeks for appointments is unacceptable
- Having to get insurance company approval for treatment is unacceptable
- Paying 20% coinsurance with no cap is unacceptable
- Being rushed through 15-minute appointments is unacceptable
They know these things are unacceptable, which is why they don’t subject themselves to them.
And if they had to experience what they’re forcing on you – just for one year – every single problem would be fixed.
The Healthcare They Could Give You (But Won’t)
Want to know what’s possible? Look at what Congress gave themselves:
$650/year for:
- Immediate walk-in access
- Thorough examinations, not rushed
- On-site diagnostics
- Preventive care
- Specialist referrals
- Access to top-tier military hospitals
Why can’t this scale?
It can. It does. In every other developed nation.
The UK’s NHS:
- Free at point of service (funded by taxes)
- No copays, no deductibles, no medical bankruptcies
- Covers dental, vision, prescriptions
- Life expectancy: 81.0 years (US: 76.4)
- Cost per person: $5,387/year (US: $12,555/year)
Canada’s Medicare:
- Single-payer, covers all medically necessary care
- Zero medical bankruptcies
- You can see any doctor, no networks
- Life expectancy: 82.2 years (US: 76.4)
- Cost per person: $5,738/year (US: $12,555/year)
France’s system:
- Universal coverage, mix of public/private
- Covers 70-100% of costs depending on service
- Maternal mortality rate: 7 per 100,000 (US: 22.3)
- Life expectancy: 82.5 years (US: 76.4)
- Cost per person: $5,700/year (US: $12,555/year)
We already spend more per person than any country in the world.
We just spend it on:
- Insurance company profits
- Pharmaceutical company profits
- Administrative bloat (33% of spending vs. 10-15% in other countries)
- Billing complexity
- Prior authorization bureaucracy
Congress has proven what good healthcare looks like. They gave it to themselves for $650/year.
They’re just refusing to give it to you.
The Fix Is Simple (Which Is Why It Won’t Happen)
Here’s the solution:
- Expand the Office of the Attending Physician model to all Americans
- Community health centers with walk-in access
- Preventive care, diagnostics, referrals
- Funded by tax dollars (like the OAP already is)
- OR: Mandate Congress use Medicare/Medicaid only
- No supplements, no private insurance, no OAP
- Watch how fast things improve
- OR: Just adopt what every other developed country does
- Single-payer or tightly-regulated universal coverage
- Negotiate drug prices (like Congress literally just started doing for 10 drugs – wow, so brave)
- Eliminate insurance company middlemen extracting profit
Why won’t this happen?
Because the healthcare industry donates to both parties. Because insurance companies employ 3,000+ lobbyists. Because pharmaceutical companies fund campaigns.
And because Congress has good healthcare, so why would they fix yours?
The Bottom Line
Congress gets concierge medicine for $650/year.
You pay $4,500-6,500/year for Medicare with unlimited out-of-pocket exposure.
Or you’re too poor to afford insurance but too “rich” to qualify for Medicaid.
Or you’re trapped in your job because your kid has diabetes and you can’t risk losing employer coverage.
And the people with the power to fix this have exempted themselves from experiencing it.
That’s not a bug. It’s the design.
Next Time
Now that you’ve seen how different your healthcare is from theirs, let’s examine the most brilliant trap of all:
Employer-based health insurance.
It’s not just about healthcare access. It’s about control. It’s a system that:
- Prevents you from quitting your job
- Eliminates your wage negotiation leverage
- Stops you from starting a business
- Keeps you terrified of getting fired
- Affects conservative and liberal workers identically
Part 5: Employer-Based Insurance – Modern Serfdom
Because nothing says “freedom” like being chained to your job because your kid needs insulin.
If this made you angry, ask yourself: Why do the people deciding your healthcare have completely different healthcare than you?
And if you think “well, they’re important” – congrats, you’ve internalized that your life matters less than theirs.
Share this if you think others should see what Congress won’t tell them: They know the system is broken because they won’t use it themselves.
Sources
- Congressional healthcare benefits: Congressional Research Service Report R43194, “Health Benefits for Members of Congress and Designated Congressional Staff”
- Office of Attending Physician: ABC News investigation (2009), American Prospect report (2025), GAO Report GGD-75-54
- OAP annual fee: Congressional Research Service, recent reporting estimates $650
- Medicare costs: Medicare.gov official 2025 rates, CMS data
- Medicaid coverage: HHS.gov, state Medicaid agency data
- International comparisons: OECD Health Statistics 2023
- Healthcare spending: CMS National Health Expenditure Data
- Life expectancy: OECD Health Data 2023
- Maternal mortality: WHO, CDC NCHS
- Medical bankruptcy: American Journal of Public Health, Harvard Medical School study
Even that's Odd 
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