We really need a universal health care “insurance” system

In case you were wondering, here’s how Americans pay for health care.

142,792,423 Americans are covered for their health care (43% of the US population) by one of three government programs – Medicare, Medicaid and CHIPS. The programs are funded by dedicated taxes, income taxes, premiums and out-of-pocket cost sharing. The programs are operated by both the federal and state governments.

Each plan reimburses providers at different levels, but always considerably below what private insurance pays. In other words, in addition to taxes, employers and individuals not eligible for such programs are further subsidizing them by paying more for their health care.

Why is it so difficult to make the leap to one universal insurance system using uniform coverage and reimbursements covering all U. S. residents? Employers, workers, and health care providers would all be better off.

And no, we are not talking about national health care or socialized medicine.

Today, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for more millions of Americans.


As of July 2022, 64,831,706 people are enrolled in Medicare. This is an increase of 149,601 since the last report. 

34,919,687 are enrolled in Original Medicare.

29,912,019 are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage. 

50,343,344 are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage. 

Over 12 million individuals are dually eligible for Medicare and Medicaid, so are counted in the enrollment figures for both programs. 

Detailed enrollment data can be viewed here: https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment

Medicaid and Children’s Health Insurance Program (CHIP)

As of July 2022, 89,960,717 of people are enrolled in Medicaid and CHIP. This is an increase of 516,557 since the last report. 

82,845,954 are enrolled in Medicaid

7,114,763 are enrolled in CHIP 

For more information on Medicaid/CHIP enrollment, including enrollment trends, visit https://www.medicaid.gov/medicaid/program-information/medicaid-chip-enrollment-data/medicaid-and-chip-enrollment-trend-snapshot/index.html


  1. The problem isn’t that we don’t have a universal insurance system using uniform coverage and reimbursements. The problem is that politicians want to promise more than they are willing to tax – so they hide the true cost of coverage under Medicare and Medicaid and the Public Exchanges by limiting covered charges, providing taxpayer subsidies, etc.

    if we were all in one system, well then, they would likely be limited to one system of financing coverage. I would have been happy to pay for my coverage throughout my lifetime. However, I spent all of my working years (50+ to date) subsidizing coverage for other folks – both via FICA-Med and FITW (Medicare Part B, recently Part D, Medicaid, and now the Public Exchanges).

    And, of course, it would be that much harder to buy votes – because the cost of health care is not a function of compensation (think of all the PPACA limits and subsidies based on income), nor would it be a “right” or “entitlement” – but a tax, or like auto insurance, a mandate (where 15+% of Americans on the road this day are not insured). The cost would be a function of risk, actual spend, etc. – meaning the costs increase with age, and, will be highly concentrated among individuals with physical and medical conditions, co-morbidities, etc.

    The solution will likely require various levels of stop loss, pooling, reinsurance, etc. – again, funded by taxpayers. And, do you propose to have Medicare or Medicaid pricing/reimbursements? Watch how physicians respond, look to Canada, England, etc.

    You mention all the time about people making poor decisions regarding purchases – such as Halloween stuff. Just think about the cross currents of criticism about paying for treatment of lung cancer for those who smoke, diabetes for those who are obese, accidents due to reckless or risk taking activities.


  2. We might as well have a single payer healthcare system. Since the pandemic it is obvious to me that doctors have lost their independence as far as treatment and seem to have a singular opinion influenced by government and CDC money. The only opinions permitted are what the government, corporate hospitals, or university overlords allow. Doctors are no longer allowed to practice medicine.

    But I want one condition. Every procedure, pill, and treatment is charged exactly the same across the board. Why should I be charge one price for a pill or a procedure and another person a different price?


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