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Quick facts about Medicare Parts A, B, C, and D

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Medicare is the federal health insurance program for:

People who are 65 or older

Certain younger people with disabilities

People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to:

Original Medicare

Some Medicare Cost Plans

Some Medicare Private-Fee-for-Service Plans

Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Medicare Advantage (also known as Part C) is an "all in one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D.

Not sure what kind of coverage you have?

1. Check your red, white, and blue Medicare card.

2. Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.

3. Check your Medicare health or drug plan enrollment.

4. Call us at 1-800-MEDICARE (1-800-633-4227).

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Medicare is the federal health insurance program for: People who are 65 or older Certain younger people with disabilities People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) The different parts of Medicare help cover specific services: Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

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Medicare is the government health care program for people 65 and over, and its coverage plays an important role in containing medical costs as you age. But Medicare benefits don't pay for everything.

As you approach age 65, you'll need to decide how to deal with some of those coverage gaps. For now, knowing the basics of how Medicare works can help you understand some of the expenses you'll face.

IN THIS ARTICLE

What is Medicare?
Who qualifies for Medicare?
How do I enroll in Medicare?
Is Medicare free?
What does Medicare Part A cover?
What does Medicare Part B cover?
What is the Medicare Part B penalty?
What is Original Medicare?
What is Medicare Advantage?
What is Medicare Part D?
What isn't covered by Medicare?
What is Medigap?
Where can I find out more about Medicare?

What is Medicare?

Medicare is a federal health insurance program for people in the U.S. who are 65 and older as well as some younger people with disabilities. Medicare is a different program than Medicaid, which offers health and other services to eligible low-income people of all ages.

Who qualifies for Medicare?

You're entitled to Medicare if you're at least 65 and a U.S. citizen, or a permanent legal resident for the past five years. Medicare also covers some disabled people under age 65. People who receive Social Security disability insurance usually become eligible for Medicare after a two-year waiting period, although those with end-stage renal disease (permanent kidney failure) and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) can be eligible immediately.

How do I enroll in Medicare?

If you're receiving Social Security benefits when you turn 65, you will be enrolled automatically in Medicare Part A, which covers hospital costs, and Part B, which covers doctor visits. If you want Medicare Part D, which covers prescription drug costs, you'll need to enroll yourself - that's not automatic. If you're not receiving Social Security benefits, you'll sign up through the Social Security Administration website. You typically should do so in the seven-month window around your 65th birthday (which includes the three months before the month you turn 65, your birthday month, and the three months after your birthday month) to avoid permanent penalties. If you want supplemental coverage (Medigap or Medicare Advantage), you would sign up during the same seven month enrollment period. The private insurers to provide Medigap and Medicare advantage plans are required to take you, if you sign up during that period. Otherwise, they can turn you down.

Is Medicare free?

You don't have to pay premiums for Medicare Part A if you or your spouse paid Medicare taxes for at least 10 years. (Medicare taxes are part of the payroll taxes deducted from most working people's paychecks. You can see if you qualify by checking your Social Security statement, which is available through the Social Security website.) Otherwise, eligible people pay monthly premiums for Part A of up to $437 each month. The other parts of Medicare, which cover things like doctor visits and prescription drugs, require monthly premiums.

What does Medicare Part A cover?

Medicare Part A covers inpatient care in a hospital or skilled nursing facility, although not custodial or long-term care. Part A also helps pay for hospice care and some home health care. Medicare Part A has a deductible ($1,364 in 2019) and coinsurance, which means patients pay a portion of the bill. There is no coinsurance for the first 60 days of inpatient hospital care, for example, but patients typically pay $341 per day for the 61st through 90th day of the hospitalization, and more after that.

What does Medicare Part B cover?

Medicare Part B covers doctor visits and other medically necessary services and supplies. That includes preventive services or health care to prevent illness, as well as ambulance services, durable medical equipment, mental health coverage and a few types of outpatient prescription drugs. Medicare Part B requires a monthly premium that starts at $135.50 per month. Single people with adjusted gross incomes over $85,000 and married couples with AGIs over $170,000 pay higher premiums. Medicare Part B has a $185 deductible. After that, you typically pay 20% of the Medicare-approved amount for the services and supplies.

What is the Medicare Part B penalty?

If you don't sign up for Medicare Part B at 65 and later decide you need it, you'll likely pay a penalty of 10% of the premium for each 12-month period that you delayed. You will pay this penalty for life, basically, since few people drop Medicare Part B once they have it. Claiming ignorance won't get you excused from this penalty, but you can avoid it if you had health insurance through your job or your spouse's job when you first became eligible. You must sign up within eight months of when that coverage ends.

What is Original Medicare?

Original Medicare refers to Medicare Part A and Medicare Part B, which are managed by the federal government. People can see any doctor that accepts Medicare and the government pays a portion of the cost.

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is a type of health plan offered by private insurance companies that provides the benefits of Parts A and Part B and often Part D (prescription drug coverage) as well. These bundled plans may have additional coverage, such as vision, hearing and dental care. Unlike Original Medicare, Medicare Advantage plans have an annual limit on out-of-pocket costs. Medicare Advantage plans are typically HMOs or PPOs and are available only in certain areas.

What is Medicare Part D?

Medicare Part D helps cover the cost of prescription drugs. Plans are offered by private insurers and require monthly premium that average about $33 a month. Higher income beneficiaries pay more. As with Part B, there typically is a late penalty premium if you don't sign up when you are first eligible.

What isn't covered by Medicare?

The biggest potential expense that's not covered is long-term care, also known as custodial care. Medicaid, the federal health program for the poor, pays custodial costs but typically only for low-income people with little savings.

Other common expenses that Medicare doesn't cover include:

Hearing aids and exams for fitting them.

Eye exams and eyeglasses.

Dentures.

Most dental care.

Medical care overseas.

Cosmetic surgery.

Acupuncture.

Massage therapy.

What is Medigap?

Medigap, or Medicare supplement insurance, is an additional health insurance policy you can buy from a private insurer to help pay some of the costs not covered by Medicare Part A and Part B, including deductibles, coinsurance and health care if you travel outside the US. Medigap plans don't cover long-term care, prescription drugs, dental, vision, hearing aids or private nursing care. There are 10 types of Medigap plans available in most states. Plan F is the most comprehensive and the most popular. Premiums depend on gender, ZIP code and tobacco use and for Plan F can range from around $120 per month to over $400. You must have Medicare Part A and Part B to purchase a Medigap policy. Medigap is not compatible with Medicare Advantage - you would purchase one or the other.

Where can I find out more?

Medicare.gov is the official site for Medicare, and you can find additional information at AARP's Medicare Made Easy.

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What Is Medicare, and What Does It Cover? - NerdWallet

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Medicare is the government health care program for people 65 and over, and its coverage plays an important role in containing medical costs as you age. But Medicare benefits don't pay for everything. As you approach age 65, you'll need to decide how to deal with some of those coverage gaps.

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Learn About the Senior Population in U.S.

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Learn About the Senior Population in U.S.

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What is the need of healthcare among older adults in the United States when compared to other countries?

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The American public really likes Medicare: in a Harvard School of Public Health survey, 72 percent had a favorable opinion of the federal health program for people 65+ and 54 percent in a Kaiser Family Foundation poll said Medicare is "working well for most seniors." But a new, bubble-bursting 11-country survey finds that, in reality, Medicare pales against many other nations that also have universal health coverage for their older populations.

More precisely, according to the Commonwealth Fund's 20 th International Health Policy Survey, the health and well-being of many of those in Medicare is generally worse than for people over 65 in the 10 other countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom). The headline for the survey, just published in Health Affairs: Adults 65 and older in the U.S. are sicker than those of a similar age in other countries with universal health coverage and are more likely to go without needed care because of costs.

Dissatisfaction Among High-Need People Around the World

Lest you think health care is stellar in the other nations surveyed, however, there's this: across all 11, many "high-need" people 65+ (those with multiple chronic conditions and/or trouble with the basic activities of daily living) expressed dissatisfaction with the quality of health care they'd received.

The U.S. has a significantly higher rate of high-need older adults (43 percent) than most of those other countries, however. And, the researchers said, high-need elderly are more likely to suffer economic hardship, experience depression and anxiety, live alone and feel socially isolated and be at greater risk for falls than those who aren't high need. America also has the highest proportion of people 65+ with multiple chronic conditions.

More Financial Barriers for Older Americans

"U.S. seniors face more financial barriers to care than those in other countries and are, in effect, hit with a triple whammy - higher health care costs, higher out-of-pocket costs and because the U.S. doesn't invest heavily in social services, they are more likely to struggle to have their basic needs met," said Robin Osborn, lead author of the study and vice president and director of the International Program in Health Policy and Practice Innovations at The Commonwealth Fund, a private foundation studying America's health care system.

Said Commonwealth Funds President Dr. David Blumenthal: "Clearly there are struggles everywhere, but here in the U.S., we are hearing loud and clear that many of our seniors, especially those who are sickest, need more support if they are going to get the health care they need and live healthy lives." The United States, the researchers noted, has disproportionately low spending on social care services, compared to health services. While some countries spend $2 on social services for every dollar on health care, the U.S. spends less than 60 cents.

One caveat about the survey: older adults living in nursing homes and other facilities weren't sampled.

The Survey's Key Findings on Medicare vs. Other Countries

Now to some of the key findings in the survey, the Commonwealth Fund's first one looking at the experiences of high-need older adults. "The real test of a health care system is how well it performs for patients with the greatest need," said Osborn. And, she added, "our focus on the high-need elderly brought into sharp relief the extent to which they were exposed to financial barriers when it came to care."

Here's how America's Medicare system performs against the other 10 nations:

41 percent of Americans 65+ said it was somewhat difficult to get after-hours care. While that was better than the 64 percent of Swedes who had this complaint, it was much worse than in the Netherlands and Norway, where under 30 percent had problems getting after-hours care.

31 percent of Americans age 65+ who are high-need skipped medical care because of their costs. That's more than 15 times the rate in Sweden. Older Americans have comparatively high out-of-pocket expenses in Medicare, with co-payments, deductibles and premiums and bills for prescription drugs. Also, Medicare doesn't cover certain expensive health costs such as hearing aids. In Canada, the Netherlands and the United Kingdom, there are no deductibles or cost sharing for primary care. France exempts people from cost sharing for primary care and prescription drugs if they have any of 32 chronic conditions.

25 percent of Americans 65+ said they were often worried about having enough money to buy nutritious meals and pay for housing, utilities or medical needs. In France, the Netherlands, New Zealand, Norway, Switzerland, Sweden and the U.K., only 10 percent or less had similar concerns.

24 percent of Americans 65+ who needed help with activities of daily living (like eating and dressing) said they didn't get the help they needed because of costs. That was the highest of all countries surveyed. Just 6 percent or less in Sweden, France, the Netherlands and the U.K. said they didn't get this kind of help due to costs.

Citing costs, in the past year, 23 percent of Americans 65+ either didn't go to the doctor when they were sick, didn't fill a prescription or skipped a dose or didn't get a recommended test or medical treatment. America ranked worst on this measure. By contrast, no more than 5 percent of people 65+ in France, Norway, Sweden and the U.K. skipped needed care because of costs. (This statistic is shown in the graphic in the article, where figures are percentages.)

22 percent of Americans 65+ spent $2000 or more out-of-pocket for health care in the past year. In every other country surveyed other than Switzerland (31 percent), fewer than 10 percent of residents 65+ spent $2,000 or more.

15 percent of Americans 65+ reported going to the emergency room for a condition that could have been treated by a regular doctor or place of care had one been available - the highest of all nations in the survey. Rates of avoidable ER visits were 8 percent or below in all the other countries surveyed except Canada (11 percent). "Going to the emergency room, particularly for the elderly, will increase the fragmentation of care," said Osborn. "These patients probably won't have their health records, so they'll be repeating tests. And they may not remember what happened in the ER when they do go to their doctor."

Older adults in the U.S. - as well as in Canada and the U.K. - were the most likely to say they didn't always or often hear from their regular doctor on the same day when they contacted the physician with a medical concern. But truly long waiting times to see a doctor when sick were most prevalent in Germany, Canada, Sweden and Norway; there, 26 to 34 percent said they had to wait six or more days for an appointment in the past year (18 percent of Americans said this).

All told, Blumenthal said, as a nation, "we are a little complacent about the value and benefits of Medicare."

The Silver Lining for Medicare Beneficiaries

Where America's health system for its older Americans shined in the survey, however, was on prevention and staying healthy.

More than half (53 percent) of Americans 65+ with a regular doctor or place of care said their physician talked to them about exercise and healthy eating - the highest of all nations. Similarly, 63 percent of Americans 65+ who felt they are at risk for falls said their doctor discussed falls with them, a higher rate than all the other countries except France (65 percent) and Australia (tied with the U.S. at 63 percent).

But "across all countries, most survey respondents said their physicians were not engaged with them in conversations about mental health," said Osborn. "That's a missed opportunity. Depression when coupled with other chronic conditions can increase costs 50 percent or more."

When asked about pending legislation that could help Medicare beneficiaries in a significant way, Blumenthal pointed to the bipartisan-sponsored CHRONIC Act (Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care). "It would support chronic care to a greater extent than current Medicare," he noted. For example, the bill would extend the federal Independence at Home program for the chronically ill who are homebound and offer more flexibility for nontraditional, nonmedical services for Medicare Advantage plans.

A final thought: No one country performed the best on all measures in the Commonwealth Fund survey. "So every country can learn from the others," said Osborn.

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How Medicare Pales Against Health Care Abroad

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The American public really likes Medicare: in a Harvard School of Public Health survey, 72 percent had a favorable opinion of the federal health program for people 65+ and 54 percent in a Kaiser Family Foundation poll said Medicare is "working well for most seniors."

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Fast facts about what Medicare-for-All entails

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Ask someone what they think about the idea of "Medicare for All" - that is, one national health insurance plan for all Americans - and you'll likely hear one of two opinions: One, that it sounds great and could potentially fix the country's broken healthcare system. Or two, that it would be the downfall of our country's (broken) healthcare system.

What you likely won't hear? A succinct, fact-based explanation of what Medicare for All would actually entail and how it could affect you.

We asked healthcare experts to answer your most pressing questions.

What is the overall plan?

One of the biggest misconceptions about Medicare for All is that there's just one proposal on the table.

"In fact, there are a number of different proposals out there," explained Katie Keith, JD, MPH, a research faculty member for Georgetown University's Center on Health Insurance Reforms.

"Most people tend to think of the most far-reaching Medicare for All proposals, which are outlined in bills sponsored by Sen. Bernie Sanders and Rep. Pramila Jayapal. But there are a number of proposals out there that would expand the role of public programs in healthcare," she said.

Although all of these plans tend to get grouped together, "there are key differences among the various options," Keith added, "and, as we know in healthcare, the differences and details really matter."

According to the Kaiser Family Foundation, Sanders' and Jayapals' bills (S. 1129 and H.R. 1384, respectively) share many similarities, such as:

comprehensive benefits

tax financed

a replacement for all private health insurance, as well as the current Medicare program

lifetime enrollment

no premiums

all state-licensed, certified providers who meet eligible standards can apply

Other bills put a slightly different spin on single-payer health insurance. For instance, they may give you the right to opt out of the plan, offer this healthcare only to people who don't qualify for Medicaid, or make it eligible to people who are only between the ages of 50 and 64.

How, exactly, would Medicare for All work?

As far as the Sanders and Jayapal bills go, "the simplest explanation is that these bills would move the United States from our current multi-payer healthcare system to what is known as a single-payer system," explained Keith.

Right now, multiple groups pay for healthcare. That includes private health insurance companies, employers, and the government, through programs like Medicare and Medicaid.

"Under Medicare for All, we would have only a single entity - in this case, the federal government - paying for healthcare," said Keith. "This would largely eliminate the role of private health insurance companies and employers in providing health insurance and paying for healthcare."

The current Medicare program wouldn't exactly vanish.

"It would be also expanded to cover everyone and would include much more robust benefits (such as long-term care) that is not currently covered by Medicare right now," said Keith.

What might out-of-pocket costs look like for different income brackets?

Despite what some online conspiracy theories warn, "under the Sanders and Jayapal bills, there would be virtually no out-of-pocket costs for healthcare-related expenses," Keith said. "The bills would prohibit deductibles, coinsurance, co-pays, and surprise medical bills for healthcare services and items covered under Medicare for All."

You may have to pay some out-of-pocket costs for services that aren't covered by the program, "but the benefits are expansive, so it's not clear that this would happen often," said Keith.

The Jayapal bill fully prohibits all cost-sharing. The Sanders bill allows for very limited out-of-pocket costs of up to $200 per year for prescription drugs, but that doesn't apply to individuals or families with an income under 200 percent of the federal poverty level.

Other proposals, such as the Medicare for America Act from Reps. Rosa DeLauro (D-Conn.) and Jan Schakowsky (D-Ill.), would nix out-of-pocket costs for lower-income individuals, but people in higher-income brackets would pay more: up to $3,500 in annual out-of-pocket costs for individuals or $5,000 for a family.

Will you be able to keep your doctor?

This is a sticking point for many people - and why not? It can take time to find a doctor you trust, and once you do, you don't want to walk away from that relationship.

The good news is that "the Medicare for All bills generally build on the current provider system, so doctors and hospitals that already accept Medicare could likely continue to do so," Keith said.

What isn't clear yet is whether all providers would choose to participate in the program since they currently won't be required to do so.

"The bills include a 'private pay' option where providers and individuals could come up with their own arrangement to pay for healthcare, but this would be outside of the Medicare for All program, and they would have to follow certain requirements before doing so," explained Keith.

Will private insurance still be available?

Neither the Sanders nor Jayapal bills would allow private health insurance to operate the way it does now.

In fact, "both bills would prohibit employers and insurance companies from offering insurance that covers the same benefits that would be provided under the Medicare for All program," Keith said. "In other words, insurers couldn't offer coverage that would duplicate the benefits and services of Medicare for All."

Considering that in 2018, the average cost for employer-based family healthcare was up 5 percent to nearly $20,000 per year, maybe that's not a bad thing.

The number of Americans without health insurance also increased in 2018 to 27.5 million people, according to a report issued in September by the Census Bureau. This is the first increaser in uninsured people since the Affordable Care Act (ACA) took effect in 2013.

A Medicare for all option could provide coverage for a significant number of those who are currently unable to afford healthcare under the current system.

Will preexisting conditions be covered?

Yes. Under the Affordable Care Act, a health insurer can't refuse to give you coverage because of a health issue you already have. That includes cancer, diabetes, asthma, and even high blood pressure.

Before the ACA, private insurers were allowed to turn down prospective members, charge higher premiums, or limit benefits based on your health history.

Medicare for All plans will operate in the same way as the ACA.

Will Medicare for All solve all the problems of our healthcare system?

"The honest, although somewhat dissatisfying answer at this stage is 'It depends,'" said Keith.

"This would be a brand new, very ambitious program that would require a lot of changes in the way healthcare is paid for in the United States. There are likely to be at least some unintended consequences and other costs in the form of higher taxes, at least for some people," she said.

But if the bills work as well in real life as they look on paper? "People would be insulated from out-of-pocket costs like high prescription costs and surprise hospital bills," Keith said.

Let's say Medicare for All happens. How would the transition occur?

That depends on how disruptive of a model is adopted, said Alan Weil, JD, MPP, editor-in-chief of Health Affairs, a journal of healthy policy thought and research.

"If we literally eliminate all private insurance and give everyone a Medicare card, it would probably be implemented by age groups," Weil said.

People would have a few years to transition, and once it's your turn, "you'd move from private coverage and into this plan," Weil said. "Because the vast majority of providers take Medicare now, conceptually, it's not that complicated."

Although the current Medicare program truly is. While it covers basic costs, many people still pay extra for Medicare Advantage, which is similar to a private health insurance plan.

If legislators decide to keep that around, open enrollment will be necessary.

"You're not just being mailed a card, but you could also have a choice of five plans," said Weil. "Preserve that option and that offers a layer of complexity."

Architects of a single-payer health system will also have to tweak Medicare to make it suitable for people who aren't only 65 or over.

"You'd have to come up with billing codes and payment rates and enroll a bunch of pediatricians and providers who aren't currently involved with Medicare," Weil noted. "There's a lot that would need to happen behind the scenes."

How will Medicare for All be financed?

The specifics vary a bit plan to plan. In Jayapal's bill, for instance, Medicare for All would be funded by the federal government, using money which otherwise would go to Medicare, Medicaid, and other federal programs that pay for health services.

But when you get right down to it, the funding for all the plans comes down to taxes.

That still might not be as awful as it sounds.

After all, "you won't be paying [health insurance] premiums," Weil pointed out.

Although you may be able to say right now that your employer pays part of your health benefits, "economists would say it comes out of your pocket," Weil said. "You're also paying office co-pays and deductibles."

With Medicare for All proposals, some portion of the money you're now paying toward health insurance would be shifted to taxes.

Will quality of care go down?

"The rhetorical response to single-payer health insurance is that it's government-controlled healthcare. It's then used to argue that the government would be making important decisions about the care you get and don't get, and who you see," Weil said.

But Medicare for All could actually give you more choice than private insurance.

"With Medicare, you can go to any doctor," Weil said. "I have private insurance and have a lot more restrictions as to who I see."

How likely is it that Medicare for All will happen?

Likely, but not any time soon, guesses Weil.

"I think we're divided politically in lots of ways as a country," he explained. "I don't see our political process able to metabolize change on this scale."

Plus, healthcare providers, legislators, policy makers, and insurance providers are still trying to wrap their heads around what this change would mean.

When people are polled on the subject, they agree that the concept of Medicare for All sounds good, said Weil. "But when you start to talk about disruption in coverage and the potential of taxes to go up, people's support starts to weaken," he said.

Although there's a growing sense that our current healthcare system isn't sustainable, "you learn to navigate what you have," said Weil.

In other words, you may despise your health insurance, but at least you understand just how awful it is.

Weil thinks it's likely that "elements of pressure" will start making the debate about Medicare for All less relevant. Healthcare systems will continue merging and buying up acute-care centers, for instance. Prices will keep rising.

Public outrage may force the government to step in and regulate the healthcare system over time.

"And once you have a consolidated, regulated industry, it's not that different than single-payer," he pointed out.

And it might not be as different as you feared - and much better for your health (and your wallet) - than you hoped.

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Medicare for All: What Is It and How Will It Work?

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Ask someone what they think about the idea of "Medicare for All" - that is, one national health insurance plan for all Americans - and you'll likely hear one of two opinions: One, that it sounds great and could potentially fix the country's broken healthcare system.

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How a socialist-seeming health-care policy became a rallying cry in the Democratic mainstream

Joseph Ax / Reuters

If you want to understand why Rebecca Wood supports Medicare for All, you have to understand the story of her mouth. In 2015, Wood cracked a tooth. Around the same time, her daughter, Charlie, began to speak. Charlie was already 3 years old, but her premature birth had left her with delayed speech and in need of extensive therapies. When a payment for Charlie's speech therapy came due, Wood, who had stopped working so she could take care of her daughter, had to make a choice. Should she pay for a root canal and crown for herself, or pay for Charlie's therapy?

Wood could only afford one, she told me recently. Deciding not to risk losing momentum on Charlie's language skills, she opted to postpone the root canal. But before she could get the procedure done, she developed an infection that spread throughout her entire mouth and jaw. A dentist had to drain her infection and scrape away part of her jaw under local anesthesia; Wood could not afford to be put completely under. The dentist also pulled every one of her teeth. "I told myself, This is the price of a miracle, " Wood said of her daughter.

The choice she was forced to make still stings-sometimes literally. Wood now has dentures, and they fit poorly. Her dental insurance only covers a new pair every five years. Throughout this saga, Wood was frustrated that her health insurance didn't protect her from staggering bills and difficult choices. It felt like politicians didn't care. She decided that "the only way we're going to ever have health-care justice is if the guys writing the policies have to live by it." That would mean everyone would have the same health-insurance plan. Which would mean Medicare for All.

In 2017, Wood spoke at a Bernie Sanders press conference on universal health care. This past June, she testified at a congressional hearing on universal health coverage. She now works full-time for Mass-Care, a Massachusetts-based nonprofit advocating for Medicare for All.

Not every single-payer advocate's story is as heartbreaking as Wood's. But Medicare for All-otherwise known as single-payer health care-has taken on an astonishing popularity among Democrats and independents in recent years, rising from a fringe, socialist hobbyhorse to a policy seriously and frequently considered during the Democratic primary debates. In 2016, it was the special quirk of Sanders's candidacy; now 11 candidates support some version of it. Single-payer health care, the kind that exists in Canada and some European countries, would make medical care free or nearly free for all Americans. Under some versions of these plans, private insurance would be eliminated, and all Americans would be covered under one, government-run plan, similar to Medicare.

Wood and a half-dozen other supporters of Medicare for All told me about the deep physical and emotional wounds that brought them into the fold. Most either have or recently had health insurance, but they say it wasn't enough to protect them or their family members from death, illness, or debt. Medicare for All strikes many as the easiest way to stop the health-care madness, even if the political path to it isn't yet clear. They've grown disgusted with the American health-care system and reached the conclusion that blowing up the system is the only way forward.

In a way, the rallying cry of single-payer harkens back to President Barack Obama's use of, in the dark days of the 2008 recession, uplifting slogans like "Hope," "Change," and "Yes, we can." Most people didn't know exactly how "hope" would lead us out of economic gloom. But just as with health care today, they were pretty sure it couldn't get any worse.

Though the exact number depends on the poll and the way the question is asked, a slim majority of Americans- 51 percent-now support Medicare for All, according to a Kaiser Family Foundation poll. Many moderate Democrats and most conservatives remain staunchly opposed to any kind of single-payer plan. Former Vice President Joe Biden, who supports more incremental health reforms, has said Medicare for All would raise taxes on the middle class. Many Democrats are uneasy about dismantling the private health-insurance market, and they worry about how such a sweeping program would be funded. Instead of premiums and deductibles, under Medicare for All Americans would pay for their health care through taxes-although who would pay and how much are matters of great dispute.
Read: Warren won't soak the middle class after all
Marie Fishpaw, the director of domestic-policy studies at the Heritage Foundation, a conservative think tank, disputes that Medicare for All is even all that popular. (Support for Medicare for All has declined somewhat since 2017.) "While polls show initial support for Medicare for All, there is a remarkable drop in support when people learn more about the details," she told me via email. "Any program that is going to create more taxes, take away health-care choices, or outlaw private health coverage entirely becomes a nonstarter."

The main proponents of single-payer in the Democratic race, Senators Bernie Sanders and Elizabeth Warren, have defended their plans against these attacks and more. And the fact is, many supporters of this plan don't need all the details. The horrors of American health care have become so clear that Medicare for All feels, to many, like a refreshing breeze of simplicity.

Medicare for All is easy to understand and promote on social media. The idea is hashtag-friendly-#Medicare4All or #singlepayernow-in a way that "create a Medicaid buy-in" or "add ACA subsidies for people making more than 400 percent of the federal poverty level" are not. Medicare for All is "short and catchy," says Adam Hodges, a linguist at the University of Colorado at Boulder who specializes in political slogans. And employing Medicare, a system that most Americans are familiar with, makes the concept seem less complex and unknown.

Still, it's a bit surprising that single-payer is gaining speed now, because Physicians for a National Health Program, the main American organization dedicated to the single-payer issue, was formed in the late '80s. Before that, Americans could have looked abroad for inspiration: England's National Health Service came into being in the '40s. Adam Gaffney, the president of PNHP, told me he attributes the popularity of single-payer to advocacy by his and other groups, to the continuing high cost of medical care, and to the rise of politicians who are willing to be out and proud about government-run health care.

Most of the people I interviewed either had heard about Medicare for All through Sanders's 2016 candidacy for president, or said his campaign was when they became truly fired up about the issue. Jessica Neeley, of Veneta, Oregon, was a bookkeeper for the United Brotherhood of Carpenters and Joiners of America for four years before a pulmonary embolism and Addison's disease left her unable to work last year. She said when she first heard about Medicare for All, during the 2016 campaign, her ears "perked up." Even with excellent union insurance, she was still paying more than $1,000 a month in prescriptions and treatments. She said she's now uninsured and in debt. " Why should I suffer more than the millionaire?" she asked. "We have the same condition, but I just can't afford to take my medication."

Some support for single-payer is based not on personal experience, but that of others. Ashley Hudson's family was so poor when she was growing up that her parents could rarely afford to see a doctor. When she was 14, her father was diagnosed with cirrhosis and died three weeks later. Today, the 32-year-old Hudson, who has worked for local Democratic political campaigns, thinks that if the disease had been caught earlier, her father might have lived. Hudson's mother, who recently had to quit her job at McDonald's because of poor health, now relies on a GoFundMe campaign to pay for her medical care. "My heart is constantly pounding, just kind of waiting for the other shoe to drop," Hudson said-meaning, she's dreading the day her mother gets sicker and dies.

The single-payer fans I spoke with are skeptical that making small fixes to the Affordable Care Act-such as adding a p ublic optio n or increasing its subsidies-would suffice. A decade of brawling over Obamacare has left some Democrats with private-health-insurance PTSD. A guaranteed, free system, some say, is the only way to ensure that everyone would be taken care of, forever. Hudson worries that even a small out-of-pocket cost could lead to more deaths like her father's. Even if the ACA were more robust, Neeley argued, there would still be a chance that infighting among politicians would lead to "taking stuff off of it, putting stuff on it."

Others' trust in private insurance companies has completely evaporated. Liz Deere, a clinical social worker and co-chair of the Central Arkansas DSA, worried that if private insurers still existed, they could kick sick patients off their plans. (They can't currently do this.) Ben Fong, who is on the executive committee of the Phoenix DSA as well as the steering committee of the Democratic Socialists of America's national Medicare for All campaign, thinks insurers' profits are to blame. "What the ACA has failed to deal with is the profit motive," Fong told me. "The fact that a lot of people are becoming enormously rich off of our lives."

The animosity toward corporations-insurance corporations-fits with the growing acceptability of various permutations of socialism in the U.S. (One interviewee even told me he was "a socialist.") After years of being told that socialism is evil, and that socialized medicine is therefore evil, too, some Democrats are reclaiming the word. Medicare for All is an easy-to-understand, decisive departure from what Sanders calls a " cruel and dysfunctional " health-care system. So what if it's socialist?

True believers of Medicare for All don't want to hear that single-payer health care will be very difficult to achieve in the U.S. Entrenched medical interests will lobby against it; Congress may never have the votes. If it ever does come to pass, hospitals may close. But the committed are not daunted by these obstacles. To them, there's only one response to the question, "Can we really do single-payer here?" Yes, we can.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Olga Khazan is a staff writer at The Atlantic.

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steering committee of the democratic socialists of america

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growing acceptability of various permutations of socialism

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The Stunning Rise of Single-Payer Health Care

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How a socialist-seeming health-care policy became a rallying cry in the Democratic mainstream If you want to understand why Rebecca Wood supports Medicare for All, you have to understand the story of her mouth. In 2015, Wood cracked a tooth. Around the same time, her daughter, Charlie, began to speak.

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Key Points of Medicare-for-All from Bernie Sanders

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Issues

Health Care as a Human Right - Medicare For All

We say to the private health insurance companies: whether you like it or not, the United States will join every other major country on earth and guarantee healthcare to all people as a right. All Americans are entitled to go to the doctor when they're sick and not go bankrupt after staying in the hospital.

Create a Medicare for All, single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage, free at the point of service.

No networks, no premiums, no deductibles, no copays, no surprise bills.

Medicare coverage will be expanded and improved to include: include dental, hearing, vision, and home- and community-based long-term care, in-patient and out-patient services, mental health and substance abuse treatment, reproductive and maternity care, prescription drugs, and more.

Stop the pharmaceutical industry from ripping off the American people by making sure that no one in America pays over $200 a year for the medicine they need by capping what Americans pay for prescription drugs under Medicare for All.

Today, more than 30 million Americans still don't have health insurance and even more are underinsured. Even for those with insurance, costs are so high that medical bills are the number one cause of bankruptcy in the United States. Incredibly, we spend significantly more of our national GDP on this inadequate health care system-far more per person than any other major country. And despite doing so, Americans have worse health outcomes and a higher infant mortality rate than countries that spend much less on health care. Our people deserve better.

We should be spending money on doctors, nurses, mental health specialists, dentists, and other professionals who provide services to people and improve their lives. We must invest in the development of new drugs and technologies that cure disease and alleviate pain-not wasting hundreds of billions of dollars a year on profiteering, huge executive compensation packages, and outrageous administrative costs.

The giant pharmaceutical and health insurance lobbies have spent billions of dollars over the past decades to ensure that their profits come before the health of the American people. We must defeat them, together. That means:

Joining every other major country on Earth and guaranteeing health care to all people as a right, not a privilege, through a Medicare-for-all, single-payer program.

And to lower the prices of prescription drugs now, we need to:

Allow Medicare to negotiate with the big drug companies to lower prescription drug prices with the Medicare Drug Price Negotiation Act.

Allow patients, pharmacists, and wholesalers to buy low-cost prescription drugs from Canada and other industrialized countries with the Affordable and Safe Prescription Drug Importation Act.

Cut prescription drug prices in half, with the Prescription Drug Price Relief Act, by pegging prices to the median drug price in five major countries: Canada, the United Kingdom, France, Germany, and Japan.

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Medicare for All | Bernie Sanders Official Website

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We say to the private health insurance companies: whether you like it or not, the United States will join every other major country on earth and guarantee healthcare to all people as a right. All Americans are entitled to go to the doctor when they're sick and not go bankrupt after staying in the hospital.

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2020 Candidates Views

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Sen. Bernie Sanders, who popularized Medicare for All during his 2016 campaign, has taken an "all or nothing" stance - arguing incremental proposals that would preserve a large role for private insurance are unacceptable. Sanders and other Medicare for All hardliners say it's the only way to address deeper problems in the health care system, from medical bankruptcies to high maternal mortality rates, especially among poor and minority women.

While other candidates have proposed plans requiring patients to shoulder some of the cost of their care, plans from Sanders and Elizabeth Warren would fully cover every service and procedure, including dental, vision, long-term care and abortion, at no charge to patients.

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A voter's guide to Medicare For All: Compare where all the 2020 candidates stand

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Sen. Bernie Sanders, who popularized Medicare for All during his 2016 campaign, has taken an "all or nothing" stance - arguing incremental proposals that would preserve a large role for private insurance are unacceptable.

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Where 2020 Democratic Candidates stand on Healthcare

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Where Democrats stand Health care Immigration Voting Climate Education Foreign policy Economy Guns Criminal justice
Warning: This graphic requires JavaScript. Please enable JavaScript for the best experience.

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Where 2020 Democrats stand on Medicare-for-all and other health-care issues

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The major Democratic presidential contenders have been vocal about the need to expand health-care coverage for more Americans. But they have split on how to do so.

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9 things Americans need to learn from the rest of the world’s health care systems

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9 things Americans need to learn from the rest of the world’s health care systems

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Another quick look into the universal coverage in nine countries, including some intersting comprison and visualization

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Everywhere I went last fall, I would often hear the same twang of pitywhen I told someone I'd come to their country from America to learn how their health care works.

There were three moments I will always remember, one from each of my trips to Taiwan, Australia, and the Netherlands. In Taiwan, I met a man named Wong Shin-Fa, of the Taroko people, an indigenous tribe living in the mountains on the island's east coast.

I was walking along a township road, clearly out of place, and he was planting orchids with his mother. He stopped me and asked what I was doing there. I said I was a journalist from the US, reporting on health care. He smiled a bit and then went straight into a story, about his friend who was living in Los Angeles and broke his arm but came back to Taiwan to get it fixed because it'd be cheaper than getting it fixed in the US.

In Australia, my colleague Byrd Pinkerton and I got caught in a rainstorm while walking through a park to one of our appointments. We took shelter in a small building with a cafe and tourist information desk, and one of the employees, Mike, introduced himself. I ended up telling him why we were there; he considered it a moment and then said: Well, we've got some problems, but nothing as bad as yours. (Check out Everybody Covered on The Impact podcast series on Wednesday and Friday, with episodes covering Taiwan and Australia. Our project was made possible by a grant from The Commonwealth Fund.)

In the Netherlands, the researchers I met with at Radboud University had asked me to give a presentation on American health care, a quid pro quo for their presentation on the country's after-hours care program. So I obliged. There were two moments when the audience audibly gasped: one when I explained how many people in the US are uninsured and another when I mentioned how much Americans have to spend out of pocket to meet their deductible.

Throughout my travels, I was ever mindful of my own country's shortcomings in health care - and was constantly evaluating how what I was learning might inform our next steps in reforming it. People have often asked which system was my favorite and which one would work best in the US. Alas, that is not so simple a question to answer. But there were certainly plenty of lessons we can take to heart as our country engages in its own discussion of the future of health care.

1) Every developed country in the world is committed to universal health care - except the United States

The first necessary condition for universal health care is a collective commitment to achieving it. Every one of the countries we covered - Taiwan, Australia, the Netherlands, and the United Kingdom - has made such a commitment. In fact, every other country in the developed world has decided that health care is something everybody should have access to and that the government should play a significant role in guaranteeing it.

Except for the United States. Our two political parties are still deeply polarized on this question: 85 percent of Democratic voters think it's the government's responsibility to ensure everybody has health coverage, but only 27 percent of Republicans agree. (Overall, including independents, 57 percent of Americans say the government has this obligation.)

In other countries, there might be disagreement about how to achieve universal health care, but both ends of the political spectrum start from the same premise: Everybody should be covered. Even in the Netherlands, which overhauled its health insurance in 2006 under a center-right government, there was no question about universal coverage.

I came across this quote from Princeton economist Uwe Reinhardt while I was starting to report this project, and it stuck with me throughout. From his most recent book Priced Out, which was published after he died in 2017:

Canada and virtually all European and Asian developed nations have reached, decades ago, a political consensus to treat health care as a social good.

By contrast, we in the United States have never reached a politically dominant consensus on the issue.

When I told people in Taiwan or the Netherlands that millions of Americans were uninsured and people could be charged thousands of dollars for medical care, it was unfathomable to them. Their countries had agreed that such things should never be allowed to happen.

The only question for them is how to prevent it.

2) Every system for universal health care comes with trade-offs that should be taken seriously

I saw all kinds of health systems in action: true single-payer in Taiwan, a mix of public and private insurance in Australia, private coverage for everybody in the Netherlands. Each of them surpassed the United States in two critical ways: Everybody had insurance, and costs to patients were much lower.

But each system also had its downsides.

In Taiwan, there still isn't enough health care supply. The country does a good job of keeping wait times for surgeries down, but doctors say they're overwhelmed. Taiwan's doctor-to-patient and nurse-to-patient ratios are terrible compared to Europe. Specialty care in the rural parts of the country is lacking. On the whole, the medical field seems to be ambivalent about the national health insurance. And while it's been difficult to measure whether there's been a "brain drain" resulting from this dissatisfaction or how bad it's been, it's a real concern.

It could be that Taiwan is underfunding its health care system; it's spending a smaller share of GDP than even the socialized systems in Europe. But raising taxes to more adequately fund the system or bumping up cost sharing to encourage more discretion in health care use is almost as big of a political challenge there as it would be here. Nobody wants to pay more for health care next year than they did the year before.

Australia has layered a private health care system on top of its universal public insurance program, and that gives both doctors and patients more choice about medical care. But once you have different tiers in your health care system, disparities are going to emerge. Wait times in Australia's public hospitals are twice as long as those in private hospitals.

And because the Australian government is spending billions of dollars supporting a struggling private insurance industry for middle-class and wealthier patients, it has fewer resources to devote to disadvantaged populations, like indigenous Australians or patients living in rural areas who have less access to medical care. Public patients in public facilities face longer wait times.

The Netherlands, meanwhile, has handed over the responsibility for providing coverage to private health insurers, and that has come with costs too. The Dutch have had to impose strict regulations on health insurance, including harsh penalties for people who fail to sign up for insurance on their own.

Patients have to pay out a 385-euro deductible every year - that's serious money for lower-income families. Doctors in the Netherlands are more likely than those in more socialized systems to say their patients struggle to afford medical care. They are also more likely to say the administrative work they have to do is a drain on their time. Health care spending in the Netherlands has also been rising at a faster clip since the move to the mandatory private insurance system.

So the question becomes what kind of trade-off is more palatable. That's a decision for each country to make: Taiwan wanted equity; Australia is trying to balance access and choice; the Netherlands bet on managed competition.

3) Universal health coverage requires a lot of government spending and regulations

There is no way to avoid it: If you want universal coverage, the government is going to play a huge role. In Taiwan and Australia, that means the government runs a universal insurance program that covers everybody for most medical services.

But even in the Netherlands, which relies on private health insurers, the government oversees everything. It sets rules about what benefits have to be covered, what prices can be charged, and what cost sharing is required. It collects contributions from employers to pay the cost of covering everybody and spreads it among the insurers based on the health status of their customers.

All told, about 75 percent of the funding for health insurance in the Netherlands is still running through the national government, even if the actual insurance benefits are being administered by private companies.

The US stands alone in how much of its health spending comes from private sources - and still doesn't have universal coverage.

4) Other countries put much stricter controls on health care costs than the US

Under all of these insurance schemes, the governments use much more force to keep health care prices down compared to the US.

In Taiwan, that means global budgets - an annual amount set aside every year for various sectors of the health industry (hospitals, drugs, traditional Chinese medicine, etc.).

In Australia, most doctors do what's called bulk billing for their Medicare program: The government sets a price, and doctors generally accept it. They can choose to charge more, but it's relatively rare. They've also set up a respected system for evaluating the value of drugs and what their national health insurance plan will pay for them, incorporating input from medical experts, patients, and the drug industry.

In the Netherlands, even with private insurers, the government sets limits on how much health spending can accrue in a given year and has the authority to impose budget cuts if spending exceeds that limit. Prices are also set for particular services, like after-hours primary care. Insurers do have some limited flexibility in which providers they contract with, but the government sets their health care budget for them.

We have experimented with that kind of system in the US, as Tara Golshan covered in this series in her story on Maryland. She documented how the state has tried to use a model like this, global budgets, to improve care for patients by encouraging hospitals to focus on the health of their patients instead of whether they have enough people in their beds.

But Maryland remains an exception. And as the research shows, the US spends dramatically more for many common medical services compared to other developed countries:

5) Other countries are still figuring out how to deliver long-term care

Something we didn't cover as much in our stories but that came up again and again in my reporting is the challenge for long-term care for older people and those with disabilities. For most developed economies, their aging populations will present a serious challenge of both cost and care delivery. The chart below shows what countries were already paying (notice the US lags significantly both overall and in public investment) and then projects what they will be paying in 2050:

What was most interesting is that the countries' different approaches to long-term care didn't necessarily track with how they handle the rest of medical care. Taiwan, for example, even with its single-payer program, doesn't include long-term care as a benefit. Yi Li Jie, a spinal atrophy patient I met, has to pay out of pocket for her caregivers; she also has to pay a substantial share of her transportation costs to get to medical appointments. Taiwan is beginning to debate how to add long-term care to its national health insurance plan, but it's going to be expensive.

On the other end of the spectrum, the Netherlands has a universal public program to cover long-term care, even though it has private medical insurance. The country's primary care is geared toward accommodating the needs of patients who are older or have disabilities; doctors make more home visits, and even the after-hours primary care program is set up to be able to reach older people and those with disabilities in their homes.

Of course, the needs for these populations extend beyond the basic provision of medical care. Australia recently transitioned to a new disability insurance program, which covers nonmedical supports for those folks, and beneficiaries have described it as "too complex and difficult to navigate," as the Guardian reported.

No matter the health system, the most complex patients are going to have the most challenging needs to meet. Nobody has figured out a silver bullet for fixing that yet.

6) Private insurance can play a role in universal health care, but it comes with downsides

I think it's telling that Uwe Reinhardt, invited to participate in Taiwan's debate in the late 1980s about how to achieve universal health coverage, had a pretty simple answer to the question of which system was best for that country: single-payer. It would be the most equitable and the most efficient. But he didn't believe it would work in the US, because of the influence wielded by private industry.

But other countries, like Australia and the Netherlands, have found a significant role for private insurance even as they strive toward the same goal. Frankly, however, private insurance seems to be more of a political compromise (and, by extension, to reflect some differences in societal values) than a preferred policy solution.

Australia had had private insurance for decades before its universal public insurance plan was introduced in the 1980s; both of its major political parties have come to accept the existence of that program. The conservatives scrapped the first public program in the '70s, but they've given up trying to roll back the current one. Private insurance in Australia has given the better-off more options in their health care; that comes at the expense of some equity, but it is a compromise the country has been willing to make as it tries to balance access and choice.

It's a different story with similar themes in the Netherlands: Its old two-tiered system was facing an existential crisis in the mid-2000s. Because a center-right government was in charge, they wanted to pursue a market-driven, managed-competition model to try to fix it. Universal coverage was still a shared goal for all the political parties, but they pursued private insurance to do it because it aligned more with the ideology of the ruling government.

Now critics say that was a mistake, that it has made health care more expensive in the Netherlands. But it was the pragmatic path available to the country at that moment.

7) Health care providers are probably never going to be happy with a big government role

I'll never forget a chart Po-Chang Lee, director-general of Taiwan's National Health Insurance Administration, showed me during our interview. He had approval ratings for the single-payer plan on big whiteboards, and he had just been showing us the enormous spike in approval among the public for the national insurance plan and its steadiness over the years.

But then he pulled out a chart showing how doctors felt about the program.

As recently as 2016, 39 percent of physicians said they were either dissatisfied or very dissatisfied with national health insurance. Another 31 percent said they were neutral. Just 30 percent said they were satisfied or very satisfied (a paltry 2.9 percent said the latter).

I encountered that ambivalence from the two doctors I met in a coffee shop in downtown Taipei. One of them said he was by nature a lefty politically, but he felt the country's very low cost sharing - what patients have to pay out of pocket when they go to the doctor or hospital - had spoiled patients. His friend cried out at one point, "We're not the Avengers!"

But such complaints are not unique to Taiwan or its single-payer system. The data suggests physicians the world over are often frustrated by their health systems. Even incountries like the Netherlands and Australia, which have more of a role for private insurance and therefore for doctors to have more choice in their practice and the opportunity to make more money, opinions are split.

But at the same time, providers everywhere are generally happy about the actual practice of medicine.

It's a pipe dream to think you can build a health system with only happy doctors. But luckily, doctors seem to get into medicine not because they like their country's health care policies but because of the experience they have treating patients.

8) Health care delivery reforms are necessary to attain "health care as a human right"

Coverage isn't enough. You actually have to get health care to people.

All of these systems, even with their varying approaches to insuring people, have had to add other reforms to improve medical care itself. In Taiwan, that meant setting up a rural health program that employed doctors to work in clinics at mountain outposts and make visits to indigenous communities part of their daily routine.

"That's the essence of universal health coverage," Hong-Jen Chang, the former NHIA director who set up the program, told me. "The principle of health [as a] human right is that everybody, regardless of geography, religion, gender, age, should have the right to access."

In the Netherlands, it was the doctors who saw a delivery problem and came up with a way to fix it. Years ago, every individual doctor was responsible for providing after-hours care to their patients if needed. Elise Nillesen, who followed in her father's footsteps to become a general practitioner, remembers her family had to stay home most nights when she was a child and couldn't really take vacations.

So the doctors proposed a new model: What if they formed cooperatives so they could share the load? They would pool their patients together and each doctor would take a few shifts a month, either providing care in an after-hours clinic or doing home visits. They get paid a flat hourly rate by the private insurance plans.

The result? Today, people in the Netherlands say they have very little trouble getting after-hours care. Just one in four Dutch patients say it's hard to get treated outside of business hours; in other developed countries, it's closer to 50 percent or even higher.

9) It's hard to translate health care policy successes elsewhere to the US

Maybe the most sobering interview I had was before I ever left the United States, with Ellen Nolte at the London School of Hygiene and Tropical Medicine. She has evaluated health care systems on how well they prevent deaths that should be avoidable with accessible medical care.

I had asked her what I thought was a pretty basic question: How would you describe the US health system in relation to other countries? Her answer surprised me.

"One thing that always strikes me about the American system," she said, "is effectively there are, like, 51 American systems."

Health care in the US varies by geography, of course, depending on which state you live in. It also varies by age: The US does quite well with the over-65 population (which is covered by one public program, Medicare) but struggles with the under-65 patients (covered by a hodgepodge of private and public insurers) compared to other countries. Racial disparities run deep too: There is effectively one health system for white people and another for minorities, given the disparities in income.

"If you want to have access, if you have money, then the US probably is a good system," Nolte said. "If you want a fairly equitable system, it's probably not the best. It's probably better to look at other places."

Taiwan and Australia have about the same population as Texas, but Taiwan's is contained to a tiny island off the coast of China and Australia is a continent. The Netherlands is one of the most densely populated countries in the world; the United States is one of the least.

Then you've got political differences; Uwe Reinhardt famously didn't believe single-payer could work in the US, not because it's not a good idea but because the government was too beholden to corporate interests. The recent failure of surprise billing legislation in the face of industry opposition is certainly a warning sign to any aspiring reformers.

So the dissatisfying answer to "so what can the US learn from these other countries' successes?" is: It's complicated. But my hope for this series is it would speak to the kinds of values and strategies, if less the specific policies, that are necessary to achieve universal health care.

Every health system is different. But all of them, except ours, have figured out a way to make being uninsured or going bankrupt over medical bills a thing of the past. The US can do better.

Ask Dylan anything

Want to learn more about universal health coverage around the world? Read Dylan Scott's answers to your questions in his Reddit AMA.
This series was made possible by a grant from The Commonwealth Fund. All content is editorially independent and produced by our journalists.

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9 things Americans need to learn from the rest of the world's health care systems

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Everywhere I went last fall, I would often hear the same twang of pitywhen I told someone I'd come to their country from America to learn how their health care works. There were three moments I will always remember, one from each of my trips to Taiwan, Australia, and the Netherlands.

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Explore the Pros and Cons of Universal Healthcare

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Explore the Pros and Cons of Universal Healthcare

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A look of Universal Health care systems in seven developed countries

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Key Takeaways

How Universal Health Care Works

Universal health care (UHC) comes in several different forms, but the basic idea is the same across the board: The government steps in with taxpayer money to ensure that every citizen has access to the medical care they need. With universal health care, no citizen is denied coverage based on their ability to pay.

The sheer cost of providing quality health care makes universal health care a large expense for governments. Medical coverage must be paid for by taxpayer-funded programs.

A substantial portion of countries around the world have UHC, including Canada, much of Europe, Asian countries such as Japan and South Korea, along with Australia and New Zealand. The U.S. has the distinction of being the only wealthy, industrialized nation without universal health care.

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Types of Universal Health Care Models

Universal health care can work in several different ways, depending on the exact system. There are three main universal health care models: single payer, mandatory insurance, and national health insurance.

Single-Payer Model

In a single-payer system, the government provides free health care paid for with revenue from income taxes. Services are government-owned and service providers are government employees. Every citizen has the same access to care. This is called the Beveridge Model.

When governments provide health care, they work to ensure doctors and hospitals provide quality care at a reasonable cost. To do this, government agencies must collect and analyze data and use their purchasing power to influence health care providers.

The United Kingdom helped advance the single-payer health care system with its National Health Service, in which the government not only pays for health services, but runs hospitals and employs doctors. Other single-payer-based countries include Spain, New Zealand, and Cuba. The United States offers it to veterans and military personnel with the Department of Veterans Affairs and the armed forces.

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Social Health Insurance Model

Countries that use a social health insurance model require everyone to buy insurance, usually through their employers. Employers deduct taxes from employee payrolls to cover the costs, and the taxes go into a government-run health insurance fund that covers everyone. Private doctors and hospitals provide services. The government controls health insurance prices. It also has a lot of clout to control the private providers' prices.

Germany developed this system, which is also known as the Bismarck model. France, Belgium, the Netherlands, Japan, and Switzerland also use it. In the U.S., meanwhile, the Affordable Care Act, also known as " Obamacare," also requires insurance, but there are many exemptions, and this rule is no longer enforced by penalties. It is also similar in that it provides subsidies to health insurance companies for low-income enrollees.

National Health Insurance

The national health insurance model uses public insurance to pay for private-practice care. Every citizen pays into the national insurance plan. Administrative costs are lower because there is one insurance company. The government also has a lot of leverage to force medical costs down.

Canada, Taiwan, and South Korea, for instance, all use this model. The U.S. Medicare, Medicaid, and TRICARE systems are based on a national health insurance approach.

Pros and Cons of Universal Health Care

Pros Explained

Lowers overall health care costs: The government controls prices through negotiation and regulation. Certain costs can also be lowered because of universal access to preventive care, which can head off problems before they become serious and much more expensive to treat. It reduces the need for expensive emergency room usage, which some patients are forced into when they have no access to preventive care. This health care inequality is a big reason for the rising cost of medical care.

May lower administrative costs: If doctors only deal with one government agency, their costs can be a lot lower. For example, a 2011 study found that U.S. doctors spent four times as much as Canadians dealing with insurance companies.

Standardizes service: In a competitive environment like the U.S., health care providers must also focus on profit. They do this by offering the newest technology. They also offer expensive services and pay doctors more, which drives up costs and can limit health care for the less wealthy. A universal system takes away the profit motive and focuses on providing equal care for all.

Prevents future social and health costs: Preventive care can prevent future health issues and improve outcomes in the most vulnerable communities.

Guides the population toward healthier choices: Better investment in health care, health infrastructure, and public education can help push the population toward healthier choices and lifestyles.

Cons Explained

Healthy people pay for the care of the sickest: Chronic diseases and mental illness make up 90% of health care costs. According to Brookings research, the half of the population that uses the least health care accounts for only 3% of total (including out-of-pocket) expenditures (excluding long-term care and some other components of spending), while the top 1% accounts for 22%. However, this is true to some extent even outside of universal health care systems, as spending on chronic diseases will raise the cost of private health insurance plans as well.

Possibly less financial incentive to stay healthy:In systems where this is no copay, people might overuse emergency rooms and doctors.

Long wait times: The government focuses on providing basic and emergency health care, so wait times for elective procedures can be much longer. Some care might have to be foregone.

Doctors incentivized to cut care to lower costs: Government cost-cutting can lead to reduced availability of care. For example, doctors reported Medicare payment cuts in 2018 would force them to close many in-house blood testing labs.

Costs may overwhelm government budgets: Health care costs make up a significant portion of government budgets. For example, on average, Canadian provinces spend almost 40% of their budgets on health care.

Government may limit services with a low probability of success. This includes drugs for rare conditions and expensive end-of-life care. In the United States, care for patients in the last year of life makes up between 13% and 25% of the Medicare budget.

Examples of 6 Developed Countries With UHC

Here is a look at the UHC systems in some of the world's developed nations, and their costs.

Australia has a mixed health plan. The government provides public health insurance, called Medicare, and runs public hospitals. Everyone receives coverage, and people must pay deductibles before government payments kick in. If you earn above a certain level of income, you must also purchase private hospital coverage or pay a tax surcharge.

Many residents are willing to pay for additional private health insurance to receive a higher quality of care. Government regulations protect seniors, people considered economically disadvantaged, children, and rural residents.

As of 2020, health care cost 10.6% of Australia's gross domestic product (GDP). The per capita cost was US$5,627, slightly above average for developed countries. Wait times for elective surgeries ranged from 17 days for a coronary bypass to 209 for knee replacement. Australia's infant mortality rate is 3.2% in 2020.

Canada has a national health insurance system. The government pays for services provided by a private delivery system. Private supplemental insurance pays for vision, dental care, and prescription drugs. Hospitals are publicly funded. They provide free care to all residents regardless of their ability to pay. The government keeps hospitals on a fixed budget to control costs, but it reimburses doctors at a fee-for-service rate.

In 2021, health care cost 11.7% of Canada's GDP. The cost per person was US$5,905. Wait times for elective surgeries ranged from six days for a coronary bypass to 122 for knee replacement. The infant mortality rate was 4.5% in 2020.

France has a social health insurance system that provides care to all legal residents. That includes hospitals, doctors, drugs, and some dental and vision care. It also pays for homeopathy, spa treatments, and nursing home care. As of 2016, payroll taxes funded 64% of the costs, income taxes paid for 16%, and 12% came from taxes on tobacco, alcohol, the pharmaceutical industry, and private voluntary health insurance.

As of 2020, health care cost 12.2% of GDP. That was US$5,468 per person. The infant mortality rate was 3.6%. These statistics are all in the middle of the pack for developed nations.

Germany has a social health insurance program. Everyone who earns less than a certain amount must have public health insurance, but people earning more can choose private insurance instead. The state-sponsored insurance covers hospitalization, except for meals and accommodation. It also covers rehab for hospital stays, mental health, addiction, and long-term care. Funding comes from premiums paid by employees and their employers.

As of 2021, health care cost 12.8% of GDP. It averaged US$7,383 per person. Both figures are the highest among industrial countries outside of the U.S. In addition, most Germans can get next-day or same-day appointments with general practitioners. The infant mortality rate was 3.1%.

Switzerland

Switzerland has a social health insurance system for all residents. Coverage is provided by competing private insurance companies. Residents pay premiums, and the government provides income-based subsidies to some. People can buy supplemental insurance to access better hospitals, doctors, and services not covered by mandatory insurance.

As of 2020, health care spending was 11.8% of GDP. It was USD $7,179 per person. In 2021, the infant mortality rate was 3.2%.

United Kingdom

The United Kingdom has single-payer health care that covers all residents. The National Health Service (NHS) runs hospitals and pays doctors as employees. As of 2016, the government paid nearly 80% of costs through income and payroll taxes. The rest was paid from copayments and people paying out-of-pocket for NHS services. The NHS pays for most medical care, including some dental and eye care, hospice care, and some long-term care. Copays are required for outpatient medications.

As of 2021, health care costs accounted for 11.9% of GDP. The cost was US$5,387 per person. Wait times ranged from 55 days for a coronary bypass to 98 days for knee replacement. The infant mortality rate was 3.6% in 2020.

Comparing Universal Health Care to the U.S. System

The United States has a mixture of government-run and private insurance.

As a result, in 2021, 66% of Americans had private health insurance, mostly from their employers. The government subsidizes private health insurance through Obamacare. Another 35.7% of Americans had public government coverage. This includes Medicaid, Medicare, Children's Health Insurance Program, and military coverage including the Veterans Administration (VA). Only 8.3% had no coverage at all.

All health care service providers, except for the VA, are private. Some democratic candidates have promoted universal health care under the title "Medicare for All."

In 2021, health care cost a staggering $12,318 per capita in the U.S., or 17.8%. These costs are the highest of those reported in 53 countries by the Organisation for Economic Cooperation and Development.

The U.S. infant mortality rate was 5.4% in 2020, significantly higher than that of countries such as Australia, Germany, and all other developed countries reported on by the OECD.

Frequently Asked Questions (FAQs)

Why are Americans against universal health care?

Is universal health care free?

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Universal health care is a system in which the government provides health care to all citizens regardless of their ability to pay. Learn the pros and cons, and how it works.

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Facts about universal coverage in eight countries

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Variations on a Theme: A Look at Universal Health Coverage in Eight Countries | Commonwealth Fund

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Let's take a closer look at how eight of our peer countries get to universal coverage, how much they pay for their health care, and what role private insurance plays in each.

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Europe’s Alternative to Medicare for All

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Europe’s Alternative to Medicare for All

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Experience from Swiss and Dutch

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Sen. Bernie Sanders described his Medicare for All legislation in a Fox News town hall the other night: "What we are talking about is simply a single-payer insurance program, which means that you will have a card which says Medicare on it, you go to any doctor that you want, you will go to any hospital that you want." He added that "you're not paying any more premiums, you're not paying any more copayments, you're not paying any more deductibles." In another context, he said the plan "would allow all Americans, regardless of their income, to get the health care they need when they need it."

Not...

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Opinion | Europe's Alternative to Medicare for All

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Sen. Bernie Sanders described his Medicare for All legislation in a Fox News town hall the other night: "What we are talking about is simply a single-payer insurance program, which means that you will have a card which says Medicare on it, you go to any doctor that you want, you will go to any hospital that you want."

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The Eye-Popping Cost of Medicare for All

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According to new figures: more than the federal government will spend over the coming decade on Social Security, Medicare, and Medicaid combined.