The US may be the only rich western country without universal health care, but it is by no means the only one without single-payer. Germany, for example, has pr

The US may be the only rich western country without universal health care, but it is by no means the only one without single-payer. Germany, for example, has private health insurance[0] but everyone has to have insurance, public insurers have to accept everyone, and employers have to pay part of the cost. [0] There's a distinction between "public" (gesetzlich) and "private" (privat) health insurance, but neither is run by the government. Public insurers are private organizations. The difference is in what is covered (all public insurers provide essentially the same cover), and how they are funded (the cost of public insurance depends on income, while private insurers can set their own prices). There is an income threshold below which one is required to take public insurance; private insurance is seen by many as kind of a scam. Private insurance is generally cheaper for young people, but one can't easily switch from private to public, so you'd better be sure your income will continue to be high as you get old and premiums go up.