Anyone who believes the American healthcare system is the best in the world is in for a surprise.事实上，美国在人均医疗保健上花费最多，但医疗保健效果最差。
An analysis by The Commonwealth Fund specifically looked at 11 developed nations.收集了五类数据：1）护理过程（预防性护理，safe care,协调护理，和耐心的参与，2) administrative efficiency,3）访问（可承受性和及时性）；4）低收入和高收入人群的公平性；以及5）医疗保健结果（人口健康，mortality amenable to healthcare,and disease-specific health outcomes).Sad to say,美国ranked 10th for administrative efficiency and 11th for access,equity,以及医疗保健结果。
Medicare as a Single-Payer System
A single-payer system is one where one entity,通常是政府，管理和支付您的医疗保健费用。"Single payer"经常与短语“互换universal health care""躺着,though they are not exactly one and the same.
更棘手的可能是，虽然医疗保险最初是作为一个真正的单一支付系统，it has evolved into something more capitalistic.The federal government sets the standards for what must be covered but people may choose to sign up for a医疗保险优势计划,run by private insurance companies,as opposed to traditional Medicare,run by the government.
医疗保险可以扩大并向所有美国人提供。In that way,Medicare could become universal health care.Such a plan was endorsed by Senator Bernie Sanders of Vermont and came to be known as Medicare for All.
During her bid for the 2016 presidency,前国务卿希拉里克林顿建议更多医疗保险”作为扩大医疗保险的一种方式。Instead of Medicare for All,she proposed decreasing the医疗保险资格age from 65 to 50 years old.
How would this help??
这个年龄段的人往往有许多医疗条件，更多的医疗条件意味着更多的医疗支出。At least 87 percent of Americans aged 65 to 74 years old have at least one chronic medical problem.对于75岁及以上的人，这个数字增加到了92%。The numbers decrease to 72 percent when we look at the younger 50 to 64-year-old population,not currently covered by Medicare.
Once someone meets eligibility criteria for Medicare,他们开始每月支付医疗保险费。这笔钱被存入一个资金池，用于支付所有受益人的服务费用。如果年轻，relatively healthier Americans were added to that pool,那么一件有趣的事情就会发生在我们今天所知道的医疗保险上。会有更多的钱可以分享。虽然游泳池里会有更多的人，there would be a smaller average number of medical conditions to address.This could potentially add years of医疗保险信托基金的储蓄.
Pros of Universal Health Care
The truth is that healthcare costs have increased sharply over the years,不是因为通货膨胀或昂贵的医疗技术，而是因为大企业和资本主义。
不管年龄大小，每个人都有平等的机会得到照顾，收入，或能力。也，你不再需要了find a doctor in your"network""因为all医生会在你的网络中。Copays and deductibles would go away.
A national survey from the Pew Research Center in 2017 noted that 66 percent of Americans believe the government should ensure access to health care and that 33 percent feel that a single-payer system is the best way to go.
Cons of Universal Health Care
Dollars and cents are not the only cost of universal health care.美国人不仅需要考虑他们可能支付的税收增加，而且还需要考虑全民医保如何影响他们得到的医疗服务。Wait times for non-emergent services会变长。系统中有更多人，他们选择的医生可能会受到更长的等待时间的影响。有些人可能需要更换医生才能及时获得非紧急护理。
在享有普遍医疗保健的国家，等待时间可能很长。In Denmark,the mean time to get cataract surgery after the decision is made to treat is 112 days.You may not be able to get a hip replacement in England for 78 days.爱尔兰或挪威的选择性手术会让你等上75天。这就是说，紧急情况紧急处理。There is no delay in care when you truly need it.
从长远来看，the United States could save in overall costs and improve healthcare outcomes under a universal system,but do Americans have the patience to wait their turn??
美国医疗保健系统有一个选择。It can improve upon its single-payer model of Medicare,扩大对更多美国人的影响。或者，它可以遵循许多发达国家已证明具有更高的成本效益和效率、更好的卫生成果的全民保健的道路。在全球医疗保健领域排名第十一还不够好。美国应该得到更好的待遇。