Health insurance, National, is government-provided insurance that pays the health care expenses of all or most of a nation’s citizens. Such programs are usually financed by income or payroll taxes on individuals. The government determines the medical services the program will cover and the prices it will pay for those services. There are two basic types of health care systems that incorporate national health insurance: public-only systems (also called single-payer systems) and two-tiered systems (also called multi-payer systems).
With public-only health care, the government is the sole payer of all covered medical costs. It may be illegal for individuals to pay for health services covered by the national insurance, and health care providers may only receive payment for covered services from the government. The government exercises a great deal of control over the price of health care under this system, which usually keeps prices lower. Some people criticize public-only systems by pointing out that patients have little choice over how their care is managed and may face a lengthy wait for services. Canada, with the exception of Quebec, has a public-only health care system.
A two-tiered health system, like the public-only system, provides basic health care to all citizens. However, a two-tiered system allows people to receive health care from government providers or to pay for private health services. A common criticism of this system is that the most skilled health care providers sometimes choose to practice in the private sector, where financial gains are greater. France and Germany have two-tiered health care systems. Other countries have variations on these systems. In some places, individuals buy private (nongovernment) health insurance to help with services that are not otherwise covered.
In the United States, a majority of the people have private health insurance, which many get through their employers. A portion of the population is covered by such government-run insurance programs as Medicaid and Medicare. In 2010, Congress passed the Patient Protection and Affordable Care Act (PPACA). This law provided for federal government subsidies (financial assistance) for states to expand Medicaid coverage to Americans at or near the poverty line—that is, an income level used as a standard for being poor. It also provided for government subsidies for small employers and lower-income individuals to help cover insurance costs.
