Healthcare in the United States

Washington: The waiting room at East of the River Health Centre. Around 47 million Americans are currently without health coverage of any kind Photograph: Jocelyn Augustino/Guardian

Washington: The waiting room at East of the River health centre. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a recent report by the Commonwealth Fund Photograph: Jocelyn Augustino]/Guardian

Washington: Dr Jamal Gwathney examines Priscilla Johns, a patient at the East of the River health centre Photograph: Jocelyn Augustino/Guardian

Hackensack, New Jersey: Nurse Melanie Weigeshoff uses the 'computer on wheels' to input patient information during a routine check up. This device is used to transmit patient information wirelessly to a central data base at the Hackensack University medical centre Photograph: Ed Kashi/Corbis

New York: At the Laser and Skin Surgery Clinic in Manhattan, Stephanie gets a course of Sculptra injections to her cheeks, by Dr Karen Kim. To stay youthful, 52-year-old Stephanie Winters (whose name has been changed) takes more than 100 supplements a day, gives herself growth hormone injections almost daily, goes to an anti-aging clinic, exercises vigorously, practices gyrotonics, pilates and other forms of body work. She also gets botox injections for her face Photograph: Ed Kashi/Corbis

New York: The fridge in Stephanie's home is stocked with supplements, while many Americans have no access to any healthcare Photograph: Ed Kashi/Corbis

Homestead, Florida: Teresa Juanchi, a patient and volunteer at the Open Door health centre, sorts various medications with another woman while her grandchildren sit in the back. The centre is a free health clinic that helps the uninsured Photograph: Ed Kashi/Corbis

Coppel, Texas: Sheila Wessenberg shows the scars from her breast cancer surgery to her son. Due to the economic downturn and her battle with breast cancer, the Wessenberg family has been struggling. Sheila and Bob Wessenberg once lived in a luxury townhouse on a yearly income of $100,000. Since Bob lost his job, they face bankruptcy and breast cancer without healthcare Photograph: Ed Kashi/Corbis

Los Angeles: Paramedics attend to a 49-year-old woman suffering from chest pain. Though paramedics working with the Los Angeles fire department respond to 911 emergency calls in many instances they are forced to deliver primary care for people in the community they serve. With 47 million Americans without health insurance, the impact trickles down to the paramedics and hospitals Photograph: Ed Kashi/Corbis

Los Angeles: Paramedics attend to Esperanza Morales, 92, who had fallen and was in pain but has no medical insurance Photograph: Ed Kashi/Corbis

Los Angeles: Sabrina Smith, 51, had fainted due to her diabetes in a local pharmacy. When the paramedics arrived they gave her a dose of sugar then left her with instructions to eat Photograph: Ed Kashi/Corbis

Los Angeles: 53-year-old Juanita Landry, who is uninsured, suffers from high blood pressure and was feeling faint. Paramedics Pete Castro and Christian Gassler check her out and determine she does not have to go to the hospital Photograph: Ed Kashi/Corbis

Wise, Virginia: Patients wait outside in the early morning hours to be admitted to the Remote Area medical clinic at the Wise County fairground. Rural families, most with little or no insurance, lined up for hours to receive free health care from hundreds of professional doctors, nurses, dentists, and other health workers Photograph: Suzy Allman/Getty

Wise, Virginia: Patients undergo preliminary health screening inside animal pens at the Remote Area medical clinic. The annual medical clinic, in the heart of Appalachia, expects to see more than 7,000 patients in its three days this year Photograph: Suzy Allman/Getty

Wise, Virginia: An unidentified woman has her pupil dilated as other patients wait to be treated in a livestock barn at the Remote Area medical clinic Photograph: Suzy Allman/Getty

Wise, Virginia: Dentists and dental workers carry out tooth extractions under a tent at the Remote Area medical clinic Photograph: Suzy Allman/Getty