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.