Medicaid and CHIP: 85,614,581 people enrolled [1]
Military: 9.5 million people covered [2]
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 any European country's 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...
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.
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.
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.
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.)
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.
