Well, Medicare (health insurance for people 65+) is not that different, and is essentially a federal single pay program. (Though they don't pay salaries, but o

Well, Medicare (health insurance for people 65+) is not that different, and is essentially a federal single pay program. (Though they don't pay salaries, but on care provided like regular insurance). The military health system (for veterans, the VA) mostly have their own facilities, but don't have the best reputation (and have had some scandals recently... https://en.wikipedia.org/wiki/Veterans_Health_Administration_scandal_of_2014 https://en.wikipedia.org/wiki/Veterans_Health_Administration... ) Medicaid (for poor people) is managed at the state level, and is 50% federal funded (and each state has different income limits for who is covered) All three of the above make up roughly half of all US health care spending. At the state level, some states have additional programs and subsidies, like https://en.wikipedia.org/wiki/Massachusetts_health_care_reform https://en.wikipedia.org/wiki/Massachusetts_health_care_refo... and Obamacare tried to create something similar for all states with uniform availability and coverages along with subsidies (and penalties for people who voluntarily decline to purchase health insurance). https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda... So yes, it's a complex kinda mess...but there are too many stakeholders in the current system for it to be easily changed.