The United States health system consists of over 400 insurance companies and thousands of different plans.  Indeed, in the early 1990s, after Taiwan concluded a worldwide investigation of health plans in preparation to designing its own, its Minister of Health reportedly was said to have been asked what aspect of the U.S. health system he had examined.  He responded, “The US does not have a health system.”

In the U.S. over 400 lightly regulated health insurance companies offer thousands of different plans.  We have the Veterans Administration, where doctors are employees and the system is entirely funded by taxpayer dollars.  We have Medicare which is funded by taxing people’s paychecks and which covers catastrophic health insurance but requires participants to buy private health insurance plans to cover other medical expenses.  There is Medicaid, which is means tested and which is financed out of the general budget, with states paying a significant share of the expenses.

The 2009 Patient Protection and Affordable Health Care Act reforms this complex system, but doesn’t fundamentally change it.  In June 2012 the US Supreme Court ruled that the Act was Constitutional but voided the section that would have imposed severe penalties on states that did not expand Medicaid as required under the new law.  Meanwhile state and even municipal health care programs have been launched.

The U.S. health system is 50-100 percent more expensive than that of countries that provide universal health care and have equal or superior health outcomes.

Canadian Healthcare System

Since 1971 all Canadian citizens, regardless of income, employment or health, have enjoyed access to basic health care, whether it's provided in a hospital, home or clinic. Canada provides this coverage at a fraction of what the United States pays in health care costs. Americans spend 14 percent of their GDP on health care expenditures; Canadians only 9 percent. Yet despite its high cost, the U.S. system fails to insure more than 44 million of its citizens. Some analysts predict that figure will grow to 60 million by 2008.… Read More

Health Care Security Act – New York City

Enacted in August 2005, the New York City Health Care Security Act requires any grocery store with 35 or more employees or any retailer larger than 10,000 square feet to contribute $2.50 to $3.00 towards health care for each hour an employee works.

CityCouncilors said the measure was necessary to prevent employees from having to rely on public health programs paid for by the city and state. The law will expand health care for up to 6,000 employees in the grocery industry and protect coverage for 21,000 employees now receiving health care through their employers.

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Universal Health Care Initiative – San Francisco

In 1998, San Franciscans passed Measure J with a 65 percent majority vote and made it city policy to provide affordable, preventive healthcare to the uninsured. In 2006, the city passed the San Francisco Universal Healthcare Initiative, with aims at giving an estimated 82,000 uninsured San Franciscans access to healthcare regardless of income, immigration status, or medical condition. Launched in July of 2007, Healthy San Francisco enrolled 3,100 people and has 14 city health clinics and 8 community affiliated clinics as of October of 2007. … Read More


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David Morris

David Morris is co-founder of the Institute for Local Self-Reliance and currently ILSR's distinguished fellow. His five non-fiction books range from an analysis of Chilean development to the future of electric power to the transformation of cities and neighborhoods.  For 14 years he was a regular columnist for the Saint Paul Pioneer Press. His essays on public policy have appeared in the New York TimesWall Street Journal, Washington PostSalonAlternetCommon Dreams, and the Huffington Post.