Medicare: 65,748,297 people enrolled

Medicaid and CHIP[1]: 85,614,581 people enrolled

Military [2]: 9.5 million enrolled

The US has not one but two of the largest single payer health insurance programs in the world.

Medicare alone has more people enrolled than all European single payer programs other than Germany (pop 83,294,633) and the UK (pop 67,736,802).

[0] https://medicareadvocacy.org/medicare-enrollment-numbers/ [1] https://www.medicaid.gov/medicaid/program-information/medica... [2] https://www.health.mil/Military-Health-Topics/MHS-Toolkits/M...

I don't think having discrete programs for subsets of the population is single-payer. Single-payer to my understanding means that the health system itself has a single payer. Having the government pay for some patients and a myriad of insurance plans covering the bulk of other patients is not single payer.

As they said, it is bizarre the lengths the US will go to to maintain its layered system. It seems purpose built to screw people over.

I think it would likely be called a non-universal multiple single-payer system if you want to get pedantic about things, but either way given that Americans spend more on healthcare in relative terms while lagging in most health measures makes it all seem very foolish.

We do not have universal single-payer but we have a few very large government-run single-payer systems.

If you have an example of a country with a single program that has more effective outcomes for a population of similar makeup and size, that would be a useful comparison.

A significant administrative vost benefit to single payer is not having to identify the correct payer, do coordination of benefits, etc.

With multiple “single-payer” systems in the same population (often serving overlapping populations with each other and private health insurance) you've negated that benefit.

You’ve also negated the market power advantage of monopsony purchasing by having multiple of them, and again having them coexist with private health insurance.

(And that's even before considering that while Medicare and some state Medicaid plans have single payer components, Medicare is not a single-payer plan covering the listed number of beneficiaries, but instead just under half are in the single-payer traditional Medicare, and that Medicaid isn't a single payer plan, or even a plan, at all, its a funding mechanism for state-operated plans, each of which may or may not operate entirely as a state-level single-payer plan.)

> With multiple “single-payer” systems in the same population (often serving overlapping populations with each other and private health insurance) you've negated that benefit.

Turkey's system used to have that exact flaw (three single-payers, to be precise) until 2008. All merged thereafter.

> The US has not one but two of the largest single payer health insurance programs in the world.

Neither Medicare as a whole nor Medicaid is single-payer. (Individual state Medicaid plans may be single payer plans, but very often they aren't, either.)

Traditional Medicare is single-payer, but the majority (as of this year) of Medicare beneficiaries use partially-subsidized private insurance (Medicare Advantage) plans, not traditional Medicare.

When you start to list all the groups that already get free healthcare, it looks like only middle class workers actually pay:

- seniors

- native americans

- low income women

- single moms

- military

- illegal immigrants

- homeless

- government employees

The debate about government healthcare is so far gone, we can't even imagine what a "free market" for healthcare looks like. It's time to throw away all these special programs and just get one system for everyone.

I don't think military medical coverage really counts as single payer; it's an in-house employer plan, it's just that the employer is the federal government. Just because the federal government is paying for it, doesn't make it single payer.

Re: medicare, I think a reasonable way towards universal single payer (or whatever you call medicare advantage plans, as a sibling notes) would be to drop the eligibility age over many years, and eventually get full coverage; and at the same time, add all kids to medicaid. Ex: years 1-10, reduce medicare eligibity age by 1, have medicaid cover kids less than year number; after ten years, medicare covers you at 55, medicaid covers kids less than 10. Years 11-20, reduce medicare eligibity age by 2, still increase kids by one year per year; after twenty years, medicare covers you at 35, and medicaid covers until 18. Years 21-28?, add medicare one year from both ends, and I think at year 28, everyone is covered. Congress should adjust the rollout schedule regularly, as scaling problems emerge, or don't; if after a couple years it becomes obvious that it's too slow or too fast, it can be adjusted; it'd also work, but be more complicated, to do it on a % basis --- once a year, determine what age (years + months even?) would result in a 1% enrollment increase, and do that, you'll finish before 100 years, but I'm not doing the math to figure out how much sooner.