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Health coverage

Who is insured, who pays, and whether government should cover everyone or run health care itself.

Last reviewed October 11, 2026

Know

Facts that are not in dispute. Guess first, then see the figure and where it comes from.

This page is about who is covered and who pays. Why care costs so much is on the Healthcare costs page, and drug prices are on the Prescription drugs page. Coverage figures are for 2025, from the Census Bureau, and count everyone living in the United States regardless of citizenship or immigration status. Spending figures are for 2024.

  1. Of every 100 people living in the United States, about how many had no health insurance at any point in 2025?

    Slide to make your guess

    About 8 of every 100 people living in the United States had no health insurance in 2025.

    That is 26.7 million people who were uninsured for the whole year. About 53.5% of residents had coverage through an employer. The count covers everyone living in the country, whatever their citizenship or immigration status.

    Source: US Census Bureau, Health Insurance Coverage in the United States: 2025 (P60-291)

  2. Of every 100 people living in the United States, about how many are covered by a government program?

    Slide to make your guess

    About 36 of every 100 people living in the United States are covered by a government program.

    Medicare, mainly for people 65 and older, covers 20.1% of the population. Medicaid, for people with low incomes, covers 17.1%. The military's TRICARE covers 2.8% and veterans' programs 1.2%. Some people have more than one kind of coverage.

    Source: US Census Bureau, Health Insurance Coverage in the United States: 2025 (P60-291)

  3. Of every 100 dollars spent on health care in the United States, about how many are paid by governments?

    Slide to make your guess

    Governments pay about 47 of every 100 dollars spent on health care in the United States.

    The federal government paid 31% of the total in 2024 and state and local governments 16%. Households paid 28% and private businesses 18%.

    Source: Centers for Medicare & Medicaid Services, National Health Expenditures 2024 Highlights

  4. Medicare and Medicaid together pay for about what share of all US health spending?

    Slide to make your guess

    Medicare and Medicaid together pay for about 39% of all US health spending.

    Medicare spent $1.1 trillion in 2024, or 21% of the national total, and Medicaid $932 billion, or 18%. Private insurance paid 31% and patients paid 11% out of pocket.

    Source: Centers for Medicare & Medicaid Services, National Health Expenditures 2024 Highlights

  5. Of every 100 people eligible for Medicare, about how many are in a private Medicare Advantage plan instead of the traditional government-run plan?

    Slide to make your guess

    About 55 of every 100 people eligible for Medicare are in a private Medicare Advantage plan.

    That was the share in 2025, up from 37 in 2018. In these plans a private insurer is paid by Medicare to provide the coverage. Medicare's advisory commission estimates the program will pay these plans about 14% more in 2026, or $76 billion, than it would spend covering the same people directly, and notes that the plans reduce what enrollees pay out of pocket.

    Source: Medicare Payment Advisory Commission, March 2026 Report to the Congress, executive summary

  6. About how many thousand dollars a year does the military health system spend for each person it covers?

    Slide to make your guess

    The military health system spends about $6,400 a year for each person it covers.

    It spent $59.95 billion in 2024, about 7% of defense spending, on 9.4 million service members, retirees and family members. The program is called TRICARE. It provides care in 601 military hospitals and clinics and buys more than 65% of care from private providers. National health spending that year was $15,474 per person, but the two figures are not like for like. Many military beneficiaries are young, and older retirees also have Medicare, which pays most of their bills.

    Source: Defense Health Agency, Annual Evaluation of the TRICARE Program, fiscal year 2024; Congressional Research Service, Defense Primer: Military Health System (IF10530); Centers for Medicare & Medicaid Services, National Health Expenditures 2024 infographic

  7. Which US program works most like Britain's National Health Service, owning the hospitals and employing the doctors?

    The Veterans Health Administration owns its hospitals and employs its staff. Medicare and Medicaid pay private doctors and hospitals.

    The veterans' system runs 170 medical centers and 1,380 sites of care, has more than 371,000 employees and 9.1 million enrolled veterans. It describes itself as the largest integrated health care system in the country.

    Source: Department of Veterans Affairs, About the Veterans Health Administration

How US residents were covered, 2025

Share of the population. People with more than one kind of coverage are counted in each.

  • Employer 53.5%
  • Medicare 20.1%
  • Medicaid 17.1%
  • Bought directly 10.5%
  • Military (TRICARE) 2.8%
  • Veterans' programs 1.2%
  • No insurance 7.9%

Source: US Census Bureau, Health Insurance Coverage in the United States: 2025 (P60-291)

Share of health spending paid by government, 2023

World Health Organization definitions, so the US figure differs from the 47 above. Compulsory private insurance, as in Switzerland, is not counted as government spending. The OECD is a group of 38 mostly wealthy countries that includes the United States.

  • Japan 84.8%
  • Britain 81.8%
  • Germany 79.1%
  • Canada 70.3%
  • France 67.7%
  • All OECD countries combined 62.6%
  • United States 54%
  • Switzerland 33.1%

Source: World Bank, Domestic general government health expenditure (% of current health expenditure), from World Health Organization data

Charts appear here once you have answered or skipped the questions above.

Debate

Questions the facts cannot settle, with the strongest case for each side.

Should the federal government insure everyone through a single public plan?

Yes, one public plan for everyone

About 26.7 million US residents had no health insurance in 2025. Governments already pay 47 of every 100 dollars spent on health care, yet coverage is not universal. Canada, Britain, Germany, France and Japan cover everyone, and each spends between about 11% and 12% of its economy on health, against about 17% in the United States (World Bank figures). The Congressional Budget Office studied five single-payer designs and found that coverage would be nearly universal under all of them, and that total national health spending would fall under some (the cost is disputed). A single plan would also end coverage that depends on a job, which is how 53.5% of residents are insured.

No, keep a mix of public and private

The same Congressional Budget Office study found that a single-payer system would raise federal spending by $1.5 trillion to $3.0 trillion a year, and that the savings would come mainly from paying doctors and hospitals less and from lower administrative costs. It concluded that demand for care would grow faster than supply, leaving more delays and more care forgone than today (waits are disputed). In Canada, 66% of hip replacements and 59% of knee replacements were done within the 26-week target in 2023. A single plan would replace the employer coverage that 53.5% of residents have, and 92% already have insurance of some kind.

Underneath is a disagreement about whether health care is something government should guarantee to everyone or a service best left mostly to private arrangement, and about how much choice and speed are worth trading for universal coverage.

Should public programs be run by government directly or through private plans and providers?

Directly by government

Medicare's own advisory commission estimates that in 2026 the program will pay private Medicare Advantage plans 14% more, about $76 billion, than it would spend covering the same people directly. It attributes most of that gap to the plans enrolling healthier people. The government already runs care on a large scale. The Veterans Health Administration operates 170 medical centers for 9.1 million enrolled veterans and describes itself as the largest integrated health system in the country. The Congressional Budget Office also counts lower administrative spending among the main savings from a single public plan (the cost is disputed).

Through private plans and providers

Given the choice, most Medicare beneficiaries pick a private plan. In 2025, 55% of those eligible were enrolled in Medicare Advantage, up from 37% in 2018. Medicare's advisory commission notes that these plans reduce what enrollees pay out of pocket and offer benefits that traditional Medicare generally does not cover. The military, which has 601 hospitals and clinics of its own, still buys more than 65% of its beneficiaries' care from private providers. Medicare and Medicaid pay private doctors and hospitals and do not employ them. The government's largest programs already depend on private delivery and on people's freedom to choose.

Underneath is a disagreement about whether competition and choice, or a single accountable public system, does more to control costs and protect patients.

Wording

Terms that frame the argument before it starts. Who uses each one, and what can be checked.

Uncertain

Questions that have a factual answer in principle, where the evidence is still contested.
Would a single public plan cost the country more or less in total?
The Congressional Budget Office analyzed five single-payer designs in 2020. Its estimates of the change in total national health spending in 2030 ran from $0.7 trillion less to $0.3 trillion more, depending on how much doctors and hospitals were paid and how much patients paid at the point of care. Federal spending rose under every design, by $1.5 trillion to $3.0 trillion a year, because government would pay bills that employers and households pay now. Supporters cite the lower total. Opponents cite the federal cost and the designs in which the total rises. Sources: Congressional Budget Office, How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems That Are Based on Medicare's Fee-for-Service Program
Would a national plan mean longer waits for care?
The Congressional Budget Office expected demand to grow faster than supply under single-payer designs, with more delays and more care forgone than now. Canada's health data agency reports that 66% of hip replacements and 59% of knee replacements met the 26-week target in 2023, down from 75% and 70% in 2019. Opponents of a national plan cite both. Supporters answer that waits differ widely among countries with universal coverage, and that people without insurance in the United States also wait or go without. There is no comparable national measure of waiting times for the United States. Sources: Congressional Budget Office, How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems That Are Based on Medicare's Fee-for-Service Program; Canadian Institute for Health Information, Canadians waiting longer for priority surgeries and diagnostic imaging compared with pre-pandemic period

Sources