One of the biggest holes in Biden’s new plan is that it doesn’t force Medicare and Medicaid, which together cover a third of Americans, to pay for the tests. For now, only insurance plans that people get through work or the Affordable Care Act exchanges will be required to cover the swabs. To get reimbursed, privately insured Americans will have to go out and buy the tests, then file claims with their insurer. Meanwhile, the United Kingdom is sending people bags of tests for free. At a recent White House press conference, NPR’s Mara Liasson wondered why America can’t do the same.

Biden administration officials note that they have taken several steps they hope will increase testing capacity. The at-home test supply has quadrupled since late summer, in part because the administration used the Defense Production Act to rev up manufacturing. The administration plans to give community clinics 50 million tests for the poor and uninsured, and Americans can also get a free test at a federally supported testing site. And to be fair, many people thought the need for testing would abate after vaccines rolled out: “Once a vaccine for the coronavirus becomes widely available, the market for the tests will diminish, if not disappear entirely” is a sentence I wrote around this time last year.

Now, with the rise of the Omicron variant, the need for testing will clearly be with us for a while. But the Biden administration’s ability to make it rain rapid tests remains hampered by the peculiarities of American health care, which is more complicated and privatized than the systems in the U.K. and many other rich countries. “The sheer, cussed complexity of how we finance health care in this country creates unexpected challenges,” Nicholas Bagley, a health-care expert and law professor at the University of Michigan, told me.