First of all, it's worth pointing out again that we operate under the Medicare program. Medicare, in the US, is primarily a single-payer socialized system suppo

First of all, it's worth pointing out again that we operate under the Medicare program. Medicare, in the US, is primarily a single-payer socialized system supported by taxes (but only people over the age of 65, or with certain disabilities/conditions, are eligible to enroll in it), but private insurers are able to operate under contract to Medicare. In that case, Medicare pays a premium to the insurer. The insurer can charge an additional premium to the member as well, and generally these plans come in tiers which make tradeoffs like premium versus deductible. Second, it's worth pointing out that this is also the case in countries with fully nationalized single-payer systems: supplementary/third-party plans tend to still be available in such countries. For example, in Canada private supplemental insurance is a multi-billion-dollar industry.