The medical care system in the United States is a mix of different approaches. Private insurance is provided to many workers through their employment. A “single payer” system operates for people over the age of sixty-five through Medicare. The government provides and manages medical care for low-income people through Medicaid. Just about all hospitals operate as private businesses, with the exception of those run by the Veterans Administration, which provide free care to military veterans.

Macionis, Sociology, 17e

So there is no single “system” for medical care in the United States. But there is fairly widespread agreement that the U.S. health care system doesn’t do a very good job. The two major complaints: It is too expensive and millions of people do not have health insurance coverage.
To gain a sense of the alternatives, here is a brief summary of the ways in which some other high-income nations handle health care.
Canada and Great Britain: Single Payer

Both Canada and Britain use this system. In Canada’s case, government directs tax revenue to pay for health insurance. In Britain, government operates the National Health Service (NHS), while allowing a fee system to operate as well. The U.S. draws inspiration from both countries: Our Medicare is similar to the Canadian system, and our Veterans Administration is more like the British NHS. The cost for both the Canadian and the British system is about 10 percent of each country’s GDP (the cost in the United States is 17 percent of GDP).

Singapore
The government operates hospital facilities that provide basic care for little or no cost. Higher-level care and upscale hospital accommodations can be purchased for additional cost. The government has a requirement—probably unique in all the world—that every worker contribute 37 percent of their pay to a savings account that can provide funds for medical care, as well as housing and education. Government has a broad role in guiding the health care industry, including regulating costs, regulating the use of high-technology equipment, and setting the salaries of physicians and other medical personnel. The health care system in Singapore costs just 5 percent of GDP.
France
The French government requires everyone to purchase health insurance from nonprofit insurance companies, and this protection covers about three-fourths of all medical costs. Almost all people in France also purchase private insurance to cover the rest. The government has a large hand in the operation of the health care system, regulating costs and the availability of services. The cost of operating the French system is about 12 percent of GDP.

Australia
The government in Australia operates public hospitals and covers most of the cost of inpatient care, as well as most of the costs of outpatient services and drug prescriptions. About half of Australia’s hospitals are public, and the other half operate privately. People may also buy private health insurance. Most physicians operate in group practices. The price tag for Australia’s health care system is 9 percent of GD

Based on Carroll, Aaron E., and Austin Frankt. “The Best Health Care System in the World: Which One Would You Pick?” The New York Times (September 18, 2017).

Discussion Questions
1. What do you like about the health care system in the United States? What do you not like?
2. What are the features of the health care systems in other countries that most appeal to you?
3. Overall, do you prefer a specific country’s system over all the others? If so, which one? Why?