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It seems like this answer is being asked a LOT on Quora these days!I’ve answered this question several times over the past few weeks, so I’ve copied and pasted my answer below.Hope this helps…Although there are plenty of gurus out there who try to make financial freedom sound so complicated that it would require an advanced degree in differential calculus just to get started, it’s actually quite simple.In fact, there are only three ways that you can achieve financial freedom:Increase IncomeDecrease ExpensesLeverage High Return Opportunities by Creating a “War Chest”That’s it.Let’s dive in.(Note: This content originally appeared on my blog Knowledge for Men. If you’re interested in reading the article in its entirety just click here)Simple Strategies for Increasing Your IncomeBefore we can dive into the different strategies for increasing your income, let’s go ahead and get one thing straight…You cannot save your way to wealth.Sure, you can cut back on your expenses and invest the difference into a mutual fund or something similar.But at the current rate of inflation, it’s unlikely that you will be able to save enough to retire on, let alone to live your dream life.Unfortunately, this is how most people go about their financial journey.They trip over dollars to save pennies when they could just ignore the pennies and pick up the dollars.Just think about it…Even if you lived the most barebones quality of life (which for the record is not good for your health, longevity, or future earning potential) and you were able to cut your expenses back to only $1,500 a month on a $3,000 a month salary, you’re still sacrificing 80% of your quality of life for a fractional financial gain.If you spent the same amount of energy on doubling your income that you currently spend on scrounging for deals and clipping coupons, you would be able to enjoy a quality of life that is more than twice as high and still invest an additional $2,000 a month into your Roth or 401K (which I don’t recommend, but we will get to that).Do you get the point?Living below your means is necessary for financial freedom.But unless it is combined with a steady increase in your income, it will never be enough to break free from the system and live the life that you truly desire.With that out of the way, here are a few of my favorite ways to increase your income.1. Start a Freelancing/Service Based Side HustleThe fastest and easiest way to make up some extra cash is to use your existing skill set to find new clients that will pay you on a per-project basis.This could be anything from writing sales copy, designing marketing campaigns, remodeling homes, working as a personal trainer, or editing videos.It really matters what you do.If someone will pay you for it and you are able to charge a reasonable rate, you can turn just about any interest, skill, or hobby into a healthy side income.To get started, I recommend that you check out Chris Guillebeau’s Side Hustle School and start jumping into as many online communities and social media masterminds as you can.There’s money to be made with just about any skill set as long as you know the right place to look.2. Start a BusinessFor those of you with the patience to make it to profitability, starting a business is an excellent way to boost your income that will allow you to create automated systems to generate money without your direct input.Even though it took almost five years to work out the biggest kinks (and I can promise you that it is an ongoing process), I’ve built Knowledge for Men to the point where I could generate 6-figures+ per year while working fewer than 15 hours a week… If I wanted to.If you have the time, patience, and capital to dive into the world of part-time (or full time) entrepreneurship, these are a few of my favorite interviews to help you get started. (note: head over to my website to view these interviews, I’m not including the links due to Quora’s crackdown on external linking within answers)Pejman Ghadimi – Millionaire by 25 and the Founder of The Secret EntourageMJ Demarco – Author of The Millionaire FastlaneCameron Herold – Author of Double DoubleSean Ogle – Founder of Location RebelAlex Charfen – 7-Figure EntrepreuerJay Samit – World Renowned Consultant and author of Disrupt YouThese interviews will provide you with more than enough juice to get started down your journey to entrepreneurial freedom and if you take action on this content in conjunction with a few of the top business books, I promise you that you can achieve your entrepreneurial dreams faster than you ever thought possible.3. Negotiate a RaiseThe final way to increase your income is simply to negotiate a raise at your current position.Depending on your field, this could be as easy as talking with your boss for 15 minutes this Friday or it could require 3-6 months of working overtime and proving your worth.I don’t know your specific field and I have no idea what your manager’s temperaments are like, so instead of trying to give you a blow by blow checklist for negotiating a raise, I’ll provide you with a few tried and true principles that can help you increase your annual income by 10-40%.-Timing is Everything:If you ask for a raise during the wrong season or after an expensive reorganization then you will be shot down every single time. Try broaching the topic of a raise during your company’s highest grossing months or after some sort of positive event like a successful product launch.-Request a Raise on Merit, not Tenure or Market ConditionsYou can’t expect to receive a raise if your performance at work hasn’t earned it. When you go into negotiations, be sure to focus on the quality of work that you’ve been providing not the length of time you’ve been with a company or the salaries that the competition is paying.-Manage Your State During NegotiationsOne of the worst things you can do is to show up to your salary negotiations with weak and defeated body language. I know that these meetings can be tense and awkward, but maintaining an upbeat and positive attitude will make a “Yes” much more likely.-Figure Out the Number BeforehandIf you go into salary negotiations without a clear understanding of exactly how much of a salary increase you want and why you deserve it, you’re going to fail. If you bid too high, you’ll offend your employer and seem like a bit of a narcissist. If you go too low, the increase won’t be substantial enough to matter to you or your employer.-Handle Rejection GracefullyIf your manager or employer says “No” the first time around (and this is very likely), don’t get discouraged. Simply thank them for their time and ask them “What specific outcomes would be required for me to receive this raise within the next 3-6 months?” If they can’t answer this question, you should probably find another employer.How to Reduce Your Expenses without Sacrificing Your Quality of Life“Spend extravagantly on the things that you love and cut costs mercilessly on the things you don’t.” ~Ramit SethiAlthough increasing your income is the best way to move closer to financial freedom, in and of itself, it is rarely sufficient.Most people tend to spend whatever they earn and, without the proper systems in place, increasing your income will result in less financial freedom and more payments on pointless crap that you don’t need.Embracing Minimalism and an Experience-Driven LifeThe first and most important step that you can take to reduce your expenses without sacrificing your quality of life is to commit to the minimalist lifestyle.Ever since the 1950’s and the inception of the “American Dream”, our society has become hell-bent on owning and accumulating lots of “Stuff”.We spend $5,000 on our couch, $2,000 on a new TV, and $400 for a freaking nightstand.But when you stop and think about it, is this really the best way to spend your money and achieve happiness?I’m not saying that you shouldn’t want or buy nice things. But there comes a point where materialism can detract from the experience of living life.When you are mired in credit card debt and have more than $1,000/month in payments for things that you’ve financed, it makes it difficult to spend time and money on the things that really matter in life.So I want to encourage you to become a minimalist.Spend your money on things that will really matter in the long run.Would you rather have:A couch from restoration hardwareA brand new LexusA new wardrobe from GucciOr…A four-week backpacking trip across New ZealandA year abroad in Europe with your girlfriendA one-week seminar learning how to become your best selfSome of you may truly prefer things to experiences, but according to the research, people derive the greatest amount of happiness by spending their money on experiences and relationships, not things.I won’t tell you how to live your life or how to spend your money.That’s up to you and the next section will help you create a plan for your finances that is tailored to your personality and values.But I will tell you that becoming a minimalist was one of the greatest decisions that I ever made and I’d encourage you to give it a go for yourself.The Conscious Spending PlanMost people despise the idea of a budget because the method they’ve learned feels restrictive. In reality, however, a budget is simply a plan for spending your money.Since “Budget” has become a four-letter word to many people, I prefer using the term “Conscious Spending Plan” (coined by Ramit Sethi).Instead of having a specific destination for every single dollar you earn, you should have a written system that determines what portions of your income will be spent on what expenses and luxuries.But before you can do this, you need to know where you want to spend your money in the first place.How do you do this? By following your values.There’s an old saying that, “If you show me a man’s calendar you can show me his priorities.” I believe that this is true, but I believe that it’s even truer that “If you show me a man’s spending you can show me what he values”.Your conscious spending plan should reflect your internal values and goals, not meet some arbitrary standard set by society.If you are a single guy who doesn’t spend a lot of time at home, then why in the world should you spend 30% of your income on an expensive apartment?Conversely, if you are a married man with two children, it doesn’t make much sense to spend 10% of your income on car payments if you could simply buy a used car in cash and roll the 10% into a bigger and more comfortable home for you and your family.The only non-negotiable item in your conscious spending plan is your personal growth and development.If you aren’t setting aside at least 10% of your income to invest in coaching, masterminds, courses, books, and seminars, then you are doing it wrong.I’ve spent tens of thousands (maybe even more than 6-figures) on my personal growth and ever single investment I made paid back dividends.So right now, before you go any further in this article, I want you to take a minute and write down the answer to a few questions.What would I do if money was no objectIf I was given a blank check that could solve one problem in my life, what would that problem be?If I was given $10,000 and was forced to spend it on FUN how would I spend it?What is the one thing I would change about my current living situation (housing, cars, clothes, etc.)?Got it?Good. These questions will help you figure out your values and how you should allocate your money.By having a clearly defined set of values, you can decide exactly where you want to spend your money.For example, if you don’t spend a lot of time at home, you can spend less money on your apartment while spending more on dining out and partying with friends.If you are someone who doesn’t enjoy nightlife and prefers to be outdoors, you can create a conscious spending plan that allows you to spend $15,000 a year on adventure vacations and epic trips.Or maybe you are someone with a wide array of interests and you just want to have $500 a month to spend on whatever catches your fancy at the time.A conscious spending plan allows you to do just that!When you cut back on the things you don’t love, you will naturally have more money for the things that you do.Negotiating Lower Payments on Your Biggest ExpensesAlthough I’m not a fan of penny-pinching or scrounging for deals, there are a few key expenses where you can save yourself $1,000/year+ with just a few phone calls.Specifically:RentCar InsurancePhone BillLoans (Credit cards, student loans, etc.)Most people overpay for services and are completely oblivious to the massive number of discounts and specials that are offered by banks, insurance companies, and apartment complexes.For example, if you’ve been insured for more than a year and your premium hasn’t dropped, you should be able to get your insurance lowered with only one phone call.In twelve months, your car has lost a significant amount of value and this depreciation will only be reflected in your insurance premium if you are willing to call and request a rate change.The specific scripts and tactics that you should use to get a lower rate are beyond the scope of this guide, but Ramit Sethi has an excellent article on finding hidden income that will teach you the word by word responses you should use to lower your biggest expenses.The Ultimate Financial Hack: Becoming a Digital NomadFor those of you with a location independent income source, or the ability to find/create one in the next 12 months, becoming a digital nomad is the ultimate financial hack.Although more and more people are leaving the country in favor of cheaper locales, it amazes me how few people truly understand the power of geoarbitrage.In the United States, you can expect to spend:$1,000+/month for a single bedroom apartment$500+/month for groceries$200+/month for utilities$400+/month for transportation (Insurance, car payment, gas, Uber, etc.)Oh and 20%+ of your income in taxesIf you were willing to relocate to a developing country like Colombia, Thailand, Vietnam, Nicaragua, or Budapest you could simultaneously spend less money for a greater quality of life.Although prices vary, based on conversations with my digital nomad friends you should expect to spend:$750/month for a luxurious single bedroom apartment in the city center$200/month for groceries$100/month for utilities$200/month for transportation (or less)This is just a rough estimate and I’ve even known guys who have lived on less than $1,500 a month abroad.In and of itself, it’s pretty amazing that you can enjoy a higher quality of life, travel the world, and save money, but the real financial incentive comes from the tax advantages of living abroad.For individuals who spend 11 months or 330 days outside of the united states in a given calendar year, the first $102,000 that you earn are income tax exempt.Depending on the state that you live in, this could be a total savings of more than $25,000/year JUST for living outside of the country!Talk about a life hack.If you can adapt to life on the road, becoming a digital nomad is one of the best financial decisions that you can ever make.And you’ll have a helluva time while you’re saving money.Building Your War Chest: The Keys to the Financial KingdomI’m not a CPA.I don’t have special knowledge about different investing strategies and I couldn’t help you pick out the best index fund for your savings if I tried.However, over the past 10 years, I’ve consistently applied a single tactic that has allowed me to invest in opportunities that 2X, 5X, or even 10X’d my investment.I call this tactic the war chest.Better than a 401K: Why You Should Focus on Your War Chest and Not Your Retirement FundI know that plenty of gurus still preach the importance of investing in low-risk medium yield mutual funds and index funds.But I respectfully disagree.You’re never going to enter into the upper echelons of wealth by earning a 7%/year return on a few thousand dollars.You’re going to do it by amassing massive sums of money and then investing that money into highly profitable opportunities and endeavors.I realized early on that I would never be able to consistently save money if I was putting my hard earned cash into a boring fund or a 1% interest savings account for a “Rainy Day”.So I decided to make savings a game, to make it exciting!So, ever since I graduated college, I’ve been consistently socking away part of my income every single month into my “War Chest”, a savings account that I use exclusively for high yield investments.This war chest allowed me to:Quit my job and build Knowledge for Men for an entire year without needing to make a profitEarn $15,000+ in 14 days during the Crypto-Craze back in November 2017Generate more than $300k in revenue by spending $6,000 on a high-level sales coachInvest in high growth companies like Shopify, Salesforce, Facebook and Netflix before they peaked.Almost invested into a new vegan fast food concept thats got a line out the door everyday (I’m in California).And so much more.But you aren’t going to use your war chest for any investments like these… Not yet at least.For now, you are going to invest the funds from your war chest into one thing and one thing only.Yourself. Invest in books, coaching, seminars, and training programs that will help you improve your skills and become more valuable to the marketplace.From there, you will be able to dramatically increase your income and then intelligently invest your war chest funds into unique opportunities that arise.When you have developed a skillset that can earn you good sums of cash then you can continue to build your war chest.Your war chest is something you build for the rest of your life. Once you make an investment then you rebuild your war chest quickly from your cash flow from your job or business for another investment.This is how rich people get rich they buy assets they understand that either pay them healthy cash flows or yield a very high return.Without a war chest you would not have the opportunity to take advantage of opportunity when it arises.ConclusionThat’s it! I know this was a long response but I hope that it helped you get started on your journey to financial freedom.Let me know if you have any questions about the content or would like to know more in the comments :)Stay Grounded,AndrewLearn more about my work and mission by visiting my Quora profile here

The answer requires quite a bit of education, information and foresight as every other 1st world country has had a proven Universal health care system for decades that is lower cost with better outcomes than the USA health care system.US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse HealthPeople such as myself fight for the ACA because it is the only form of Universal health care available to USA citizens under age 65. All citizens including yourself are winners because of this as the Biggest Cause of Personal Bankruptcies? Medical Bills.You are a winner under this system in the long run because when the tax-exempt health sharing program kicks you out or when the tax-exempt health sharing program you are in becomes bankrupt you will have access to Universal health care.Your tax-exempt health sharing program is not large enough to be financially stable and is likely not available to all citizens especially those with pre existing conditions. we need to take care of all citizens.Universal health care is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship.[3]We need all healthcare model that covers all citizens not just the ones that happen to be fortunate and well off.The ACA (Patient Protection and Affordable Care Act - Wikipedia) is not the optimal solution as the best solution is likely a Single-payer healthcare which is a proven economic model practiced in many 1st world countries. It is probably the best proven method of providing economically efficient Universal health care.Here are the wikipages describing how Universal health care - Wikipedia works in all countries around the world. The ACA is a decent start although it is time to improve it not throw it out going back to the 3rd world stone ages.Even Trump may now realize this inescapable fact as Here’s why Trump is already waffling on Obamacare.Universal health care - WikipediaUniversal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system which provides health care and financial protection to all citizens of a particular country. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.[2]Universal health care is not one-size-fits-all and does not imply coverage for all people for everything. Universal health care can be determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered.[2]It is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship.[3]The health policy framework is of central importance. Thus, in the development of universal health systems, it is appropriate to recognize "healthy public policy" (Health in All Policies) as the overarching policy framework, with public health, primary health care, and community services as the cross-cutting framework for all health and health-related services operating across the spectrum from primary prevention to long term care and end-stage conditions. Although that perspective is both logical and well grounded in the social ecological model, the reality is different in most settings, and there is room for improvement everywhere.[4]History[edit]The first move towards a national health insurance system was launched in Germany in 1883, with the Sickness Insurance Law. Industrial employers were mandated to provide injury and illness insurance for their low-wage workers, and the system was funded and administered by employees and employers through "sick funds", which were drawn from deductions in workers' wages and from employers' contributions. Other countries soon began to follow suit. In the United Kingdom, the National Insurance Act 1911 provided coverage for primary care (but not specialist or hospital care) for wage earners, covering about one third of the population. The Russian Empire established a similar system in 1912, and other industrialized countries began following suit. By the 1930s, similar systems existed in virtually all of Western and Central Europe. Japan introduced an employee health insurance law in 1927, expanding further upon it in 1935 and 1940. Following the Russian Revolution of 1917, the Soviet Union came close to a universal health care system. It established a fully public and centralized health care system in 1920.[5][6]However, it was not a truly universal system at that point, as rural residents were not http://covered.In New Zealand, a universal health care system was created in a series of steps, from 1939 to 1941.[7][8]In Australia, the state of Queensland introduced a free public hospital system in the 1940s.Following World War II, universal health care systems began to be set up around the world. On July 5, 1948, the United Kingdom launched its universal National Health Service. Universal health care was next introduced in the Nordic countries of Sweden (1955),[9]Iceland (1956),[10] Norway (1956),[11] Denmark (1961),[12] and Finland (1964).[13]Universal health insurance was then introduced in Japan (1961), and in Canada through stages, starting with the province of Saskatchewan in 1962, followed by the rest of Canada from 1968 to 1972.[7][14]The Soviet Union extended universal health care to its rural residents in 1969.[7][15]Italy introduced its Servizio Sanitario Nazionale (National Health Service) in 1978. Universal health insurance was implemented in Australia beginning with the Medibank system in 1975, which led to universal coverage under the Medicare system, established in 1984.From the 1970s to the 2000s, Southern and Western European countries began introducing universal coverage, most of them building upon previous health insurance programs to cover the whole population. For example, France built upon its 1928 national health insurance system, with subsequent legislation covering a larger and larger percentage of the population, until the remaining 1% of the population that was uninsured received coverage in 2000.[16][17]In addition, universal health coverage was introduced in some Asian countries, including South Korea (1989), Taiwan (1995), Israel (1995), and Thailand (2001).Following the collapse of the Soviet Union, Russia retained and reformed its universal health care system,[18] as did other former Soviet nations and Eastern bloc countries.Beyond the 1990s, many countries in Latin America, the Caribbean, Africa, and the Asia-Pacific region, including developing countries, took steps to bring their populations under universal health coverage, including China which has the largest universal health care system in the world.[19]A 2012 study examined progress being made by these countries, focusing on nine in particular: Ghana, Rwanda, Nigeria, Mali, Kenya, India, Indonesia, the Philippines, and Vietnam.[20][21]Funding models[edit]Universal health care in most countries has been achieved by a mixed model of funding. General taxation revenue is the primary source of funding, but in many countries it is supplemented by specific levies (which may be charged to the individual and/or an employer) or with the option of private payments (by direct or optional insurance) for services beyond those covered by the public system.Almost all European systems are financed through a mix of public and private contributions.[22]Most universal health care systems are funded primarily by tax revenue (like in Portugal[22] Spain, Denmark, and Sweden). Some nations, such as Germany and France[23] and Japan[24] employ a multipayer system in which health care is funded by private and public contributions. However, much of the non-government funding is by contributions by employers and employees to regulated non-profit sickness funds. Contributions are compulsory and defined according to law.A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency.Universal health care systems are modestly redistributive. The progressivity of health care financing has limited implications for overall income inequality.[25]Compulsory insurance[edit]This is usually enforced via legislation requiring residents to purchase insurance, but sometimes the government provides the insurance. Sometimes, there may be a choice of multiple public and private funds providing a standard service (as in Germany) or sometimes just a single public fund (as in Canada). Healthcare in Switzerland and the US Patient Protection and Affordable Care Act are based on compulsory insurance.[26][27]In some European countries in which private insurance and universal health care coexist, such as Germany, Belgium, and the Netherlands, the problem of adverse selection is overcome by using a risk compensation pool to equalize, as far as possible, the risks between funds. Thus, a fund with a predominantly healthy, younger population has to pay into a compensation pool and a fund with an older and predominantly less healthy population would receive funds from the pool. In this way, sickness funds compete on price, and there is no advantage to eliminate people with higher risks because they are compensated for by means of risk-adjusted capitation payments. Funds are not allowed to pick and choose their policyholders or deny coverage, but they compete mainly on price and service. In some countries, the basic coverage level is set by the government and cannot be modified.[28]The Republic of Ireland at one time had a "community rating" system by VHI, effectively a single-payer or common risk pool. The government later opened VHI to competition but without a compensation pool. That resulted in foreign insurance companies entering the Irish market and offering cheap health insurance to relatively healthy segments of the market, which then made higher profits at VHI's expense. The government later reintroduced community rating by a pooling arrangement and at least one main major insurance company, BUPA, then withdrew from the Irish market.Among the potential solutions posited by economists are single-payer systems as well as other methods of ensuring that health insurance is universal, such as by requiring all citizens to purchase insurance or limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals.[29][30]Single payer[edit]Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs.[31]Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or own and employ healthcare resources and personnel (as was the case in England before of the Health and Social Care Act). "Single-payer" thus describes only the funding mechanism and refers to health care financed by a single public body from a single fund and does not specify the type of delivery or for whom doctors work. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.Tax-based financing[edit]In tax-based financing, individuals contribute to the provision of health services through various taxes. These are typically pooled across the whole population, unless local governments raise and retain tax revenues. Some countries (notably the United Kingdom, Canada, Ireland, Australia, New Zealand, Italy, Spain, Portugal, Greece and the Nordic countries) choose to fund health care directly from taxation alone. Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation, either by directly paying their medical bills or by paying for insurance premiums for those affected.Social health insurance[edit]In social health insurance, contributions from workers, the self-employed, enterprises and government are pooled into a single or multiple funds on a compulsory basis. The funds typically contract with a mix of public and private providers for the provision of a specified benefit package. Preventive and public health care may be provided by these funds or responsibility kept solely by the Ministry of Health. Within social health insurance, a number of functions may be executed by parastatal or non-governmental sickness funds or in a few cases by private health insurance companies.Private insurance[edit]In private health insurance, premiums are paid directly from employers, associations, individuals and families to insurance companies, which pool risks across their membership base. Private insurance includes policies sold by commercial for profit firms, non-profit companies, and community health insurers. Generally, private insurance is voluntary in contrast to social insurance programs, which tend to be compulsory.[32]In some countries with universal coverage, private insurance often excludes many health conditions that are expensive and the state health care system can provide. For example, in the United Kingdom, one of the largest private health care providers is BUPA, which has a long list of general exclusions even in its highest coverage policy,[33] most of which are routinely provided by the National Health Service. In the United States, dialysis treatment for end stage renal failure is generally paid for by government, not by the insurance industry. Those with privatized Medicare (Medicare Advantage) are the exception and must get their dialysis paid through their insurance company, but those with end stage renal failure generally cannot buy Medicare Advantage plans.[34]The Planning Commission of India has also suggested that the country should embrace insurance to achieve universal health coverage.[35] General tax revenue is currently used to meet the essential health requirements of all people.Community-based health insurance[edit]A particular form of private health insurance that has often emerged if financial risk protection mechanisms have only a limited impact is community-based health insurance. Individual members of a specific community pay to a collective health fund, which they can draw from when they need of medical care. Contributions are not risk-related, and there is generally a high level of community involvement in the running of these plans.Implementation and comparisons[edit]Main article: Universal health coverage by countrySee also: Health care system and Health systems by countryHealth spending per capita, in US$ purchasing power parity-adjusted, among various OECD countriesUniversal health care systems vary according to the degree of government involvement in providing care and/or health insurance. In some countries, such as the UK, Spain, Italy, Australia and the Nordic countries, the government has a high degree of involvement in the commissioning or delivery of health care services and access is based on residence rights, not on the purchase of insurance. Others have a much more pluralistic delivery system, based on obligatory health with contributory insurance rates related to salaries or income and usually funded by employers and beneficiaries jointly.Sometimes, the health funds are derived from a mixture of insurance premiums, salary related mandatory contributions by employees and/or employers to regulated sickness funds, and by government taxes. These insurance based systems tend to reimburse private or public medical providers, often at heavily regulated rates, through mutual or publicly owned medical insurers. A few countries, such as the Netherlands and Switzerland, operate via privately owned but heavily regulated private insurers, which are not allowed to make a profit from the mandatory element of insurance but can profit by selling supplemental insurance.Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually, some costs are borne by the patient at the time of consumption, but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others, tax revenues are used either to fund insurance for the very poor or for those needing long-term chronic care.The United Kingdom National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the United States), and their relative costs and key health outcomes.[36]A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004.[37]In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.Single-payer healthcareSingle-payer healthcare is a system in which the state, rather than private insurers, pays for all healthcare costs.[1]Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom).The term "single-payer" thus describes the funding mechanism, referring to healthcare financed by a single public body from a single fund, not the type of delivery or for whom physicians work. The British system is technically not single payer, as it consists of a number of financially and legally autonomous trusts.The actual funding of a "single payer" system comes from all or a portion of the covered population. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.Description[edit]Single-payer health insurance collects all medical fees and then pays for all services, by a single government (or government-related) source.[2]In wealthy nations, that kind of publicly managed insurance is typically extended to all citizens and legal residents. Examples include the United Kingdom's National Health Service, Australia's Medicare, Canada's Medicare, and Taiwan's National Health Insurance.The standard usage of the term "single-payer healthcare" refers to health insurance, as opposed to healthcare delivery, operating as a public service and offered to citizens and legal residents towards providing nearly universal or universal healthcare. The fund can be managed by the government directly or as a publicly owned and regulated agency.[2]Some writers describe publicly administered systems as "single-payer plans". Some writers have described any system of healthcare which intends to cover the entire population, such as voucher plans, as "single-payer plans",[3] but that is uncommon.Countries and regions[edit]Many nations worldwide have single-payer health insurance programs. These programs generally provide some form of universal healthcare, which are implemented in a variety of ways. In some cases doctors are employed, and hospitals run by, the government such as in the United Kingdom[4] or Spain.[5]Alternatively the government may purchase healthcare services from outside organizations, such as the approach taken in Canada.Australia[edit]Healthcare in Australia is provided by both private and government institutions. Medicare is the publicly funded universal health care venture in Australia. It was instituted in 1984 and coexists with a private health system. Medicare is funded partly by a 2% income taxlevy[6](with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that considerably subsidises a range of prescription medications. The Minister for Health, currently Sussan Ley, administers national health policy, elements of which (such as the operation of hospitals) are overseen by individual states.Canada[edit]See also: Canadian and American health care systems compared and Medicare (Canada)Healthcare in Canada is delivered through a publicly funded healthcare system, which is mostly free at the point of use and has most services provided by private entities.[7]It is guided by the provisions of the Canada Health Act of 1984.[8]The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician. Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. Private insurance represents a minimal part of the overall system.Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes, except in British Columbia, the only province to impose a fixed monthly premium which is waived or reduced for those on low incomes.[9]There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income). A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care.[10]There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, as long as premiums are up to date, and there are no lifetime limits or exclusions for pre-existing conditions.Pharmaceutical medications are covered by public funds for the elderly or indigent,[11]or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. Canadians do wait for some treatments and diagnostic services. Survey data shows that the median wait time to see a special physician is a little over four weeks with 89.5% waiting less than three months. The median wait time for diagnostic services such as MRI and CAT scans[12] is two weeks, with 86.4% waiting less than three months.[13]The median wait time for surgery is four weeks, with 82.2% waiting less than three months.[14]Spain[edit]Building upon less structured foundations, in 1963 the existence of a single-payer healthcare system in Spain was established by the Spanish government.[15]The system was sustained by contributions from workers, and covered them and their dependents.[16]The universality of the system was established later in 1986. At the same time, management of public healthcare was delegated to the different autonomous communities in the country.[17]While previously this was not the case, in 1997 it was established that public authorities can delegate management of publicly funded healthcare to private companies.[18]Additionally, in parallel to the single-payer healthcare system there are private insurers, which provide coverage for some private doctors and hospitals. Employers will sometimes offer private health insurance as a benefit,[19] with 14.8% of the Spanish population being covered under private health insurance in 2013.[20]In 2000, the Spanish healthcare system was rated by the World Health Organization as the 7th best in the world.Taiwan[edit]Healthcare in Taiwan is administrated by the Department of Health of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease.[21]In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population.[21]In 2002, there were a total of 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000.[21]Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 (or $951 US in 2009[22]); 64.9 percent of the expenditures were from public funds.[21]Overall life expectancy in 2009 was 78 years.[23]The current healthcare system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health-care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004.[24]NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment, NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.United Kingdom[edit]Healthcare in the United Kingdom is a devolved matter, meaning England, Northern Ireland, Scotland and Wales each have their own systems of private and publicly funded healthcare, generally referred to as the National Health Service (NHS). Each country having different policies and priorities has resulted in a variety of differences existing between the systems.[25][26]That said, each country provides public healthcare to all UK permanent residents that is free at the point of use, being paid for from general taxation. In addition, each also has a private sector which is considerably smaller than its public equivalent, with provision of private healthcare acquired by means of private health insurance, funded as part of an employer funded healthcare scheme or paid directly by the customer, though provision can be restricted for those with conditions such as AIDS/HIV.[27]The individual systems are:England: National Health ServiceNorthern Ireland: Health and Social Care in Northern Ireland (HSCNI)Scotland: NHS ScotlandWales: NHS WalesIn England, funding from general taxation is channeled through NHS England, which is responsible for commissioning mainly specialist services and primary care, and Clinical Commissioning Groups (CCGs), which hold 60% of the budget and are responsible for commissioning health services for their local populations.[28]These commissioning bodies do not provide services themselves directly, but procure these from NHS Trusts and Foundation Trusts, as well as private, voluntary and social enterprise sector providers.[29]United States[edit]A number of proposals have been made for a universal single-payer healthcare system in the United States, most recently the United States National Health Care Act, (popularly known as H.R. 676 or "Medicare for All") but none has achieved more than 20% congressional co-sponsorship.Advocates argue that preventive healthcare expenditures can save several hundreds of billions of dollars per year because publicly funded universal healthcare would benefit employers and consumers, that employers would benefit from a bigger pool of potential customers and that employers would likely pay less, would be spared administrative costs, and inequities between employers would be reduced. Advocates also argue that single payer could benefit from a more fluid economy with increasing economic growth, aggregate demand, corporate profit, and quality of life.[30][31][32]Also, for example, cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.[33][34]Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventive health care,[35] although estimates from the Congressional Budget Office and The New England Journal of Medicine have found that preventive care is more expensive due to increased utilization.[36]Any national system would be paid for in part through taxes replacing insurance premiums, but advocates also believe savings would be realized through preventive care and the elimination of insurance company overhead and hospital billing costs.[37]An analysis of a single-payer bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[38]The Commonwealth Fund believes that, if the United States adopted a universal health care system, the mortality rate would improve and the country would save approximately $570 billion a year.[39]Recent enactments of single-payer systems within individual states, such as in Vermont in 2011, are seen as possible routes to enacting single-payer on the federal level.[40][41]In December 2014, Vermont cancelled its plan for single payer healthcare.[42]National policies and proposals[edit]Medicare in the United States is a single-payer healthcare system, but is restricted to only senior citizens over the age of 65, people under 65 who have specific disabilities, and anyone with End-Stage Renal Disease.[43]Government is increasingly involved in U.S. health care spending, paying about 45% of the $2.2 trillion the nation spent on individuals' medical care in 2004.[44]However, studies have shown that the publicly administered share of health spending in the U.S. may be closer to 60% as of 2002.[45]According to Princeton University health economist Uwe Reinhardt, U.S. Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) represent "forms of 'social insurance' coupled with a largely private health-care delivery system" rather than forms of "socialized medicine." In contrast, he describes the Veterans Administration healthcare system as a pure form of socialized medicine because it is "owned, operated and financed by government."[46]In a peer-reviewed paper published in the Annals of Internal Medicine, researchers of the RAND Corporation reported that the quality of care received by Veterans Administration patients scored significantly higher overall than did comparable metrics for patients currently using United States Medicare.[47]The United States National Health Care Act, is a perennial piece of legislation introduced in the United States House of Representatives by Representative John Conyers (D-MI) every year since 2002.[48]The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare, the United Kingdom's National Health Service, and Taiwan's Bureau of National Health Insurance, among other examples. Under a single payer system, all medical care would be paid for by the Government of the United States, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought. The bill was first introduced in 2002,[48] and has been reintroduced in each Congress since. During the 2009 health care debates over the bill that became the Patient Protection and Affordable Care Act, H.R. 676 was expected to be debated and voted upon by the House in September 2009,[49] but was never debated.[50]The Congressional Budget Office and related government agencies scored the cost of a single payer health care system several times since 1991. The General Accounting Office published a report in 1991 noting that "[I]f the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage.”[51]The CBO scored the cost in 1991, noting that "the population that is currently uninsured could be covered without dramatically increasing national spending on health" and that "all US residents might be covered by health insurance for roughly the current level of spending or even somewhat less, because of savings in administrative costs and lower payment rates for services used by the privately insured.[52]A CBO report in 1993 stated that "[t]he net cost of achieving universal insurance coverage under this single payer system would be negative" in part because "consumer payments for health would fall by $1,118 per capita, but taxes would have to increase by $1,261 per capita" in order to pay for the plan.[53]A July 1993 scoring also resulted in positive outcomes, with the CBO stating that, "[a]s the program was phased in, the administrative savings from switching to a single-payer system would offset much of the increased demand for health care services. Later, the cap on the growth of the national health budget would hold the rate of growth of spending below the baseline."[54]The CBO also scored Sen. Paul Wellstone's American Health and Security Act of 1993 in December 1993, finding that "by year five (and in subsequent years) the new system would cost less than baseline."[55]A 2014 study published in the journal BMC Medical Services Research by James Kahn, etal, found that the actual administrative burden of health care in the United States was 27.4% of all national health expenditures. The study examined both direct costs charged by insurers for profit, administration and marketing but also the indirect burden placed on health care providers like hospitals, nursing homes and doctors for costs they incurred in working with private health insurers including contract negotiations, financial and clinical record-keeping (variable and idiosyncratic for each payer). Kahn, et al. estimate that the added cost for the private insurer health system in the US was about $471 billion in 2012 compared to a single payer system like Canada's. This represents just over 20% of the total national healthcare expenditure in 2012. Kahn asserts that this excess administrative cost will increase under the Affordable Care Act with its reliance on the provision of health coverage through a multi-payer system.[56]State proposals[edit]Several single-payer state referendums and bills from state legislatures have been proposed, but, with the exception of Vermont,[57] all have failed. In December 2014, Vermont canceled its plan for single payer health care.[42]California[edit]California attempted passage of a single-payer bill as early as 1994,[58]and the first successful passages of legislation through the California State Legislature, SB 840 or "The California Universal Healthcare Act" (authored by Sheila Kuehl), occurred in 2006 and again in 2008.[59]Both times, Governor Arnold Schwarzenegger vetoed the bill.[60]State Senator Mark Leno has reintroduced the bill in each legislative session since.[61]Colorado[edit]Colorado Amendment 69, will have a ballot proposal in November 2016 to vote on a single payer healthcare system funded by a 10% payroll tax split 2:1 between employers and employees. This would replace the private health insurance premiums currently paid by employees and companies.[62]Hawaii[edit]In 2009, the Hawaii state legislature passed a single-payer healthcare bill that was vetoed by Republican Governor Linda Lingle. While the veto was overridden by the legislature, the bill was not implemented.[63]Illinois[edit]In 2007, the Health Care for All Illinois Act was introduced and the Illinois House of Representatives' Health Availability Access Committee passed the single-payer bill favorably out of committee by an 8–4 vote. The legislation was eventually referred back to the House rules committee and not taken up again during that session.[64]Massachusetts[edit]Massachusetts had passed a universal healthcare program in 1986, but budget constraints and partisan control of the legislature resulted in its repeal before the legislation could be enacted.[65]Question 4, a nonbinding referendum, was on the ballot in 14 state districts in November 2010, asking voters, "[S]hall the representative from this district be instructed to support legislation that would establish healthcare as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?" The ballot question passed in all 14 districts that offered the question.[66][67]Minnesota[edit]The Minnesota Health Act, which would establish a statewide single payer health plan, has been presented to the Minnesota legislature regularly since 2009. The bill was passed out of both the Senate Health Housing and Family Security Committee[68] and the Senate Commerce and Consumer Protection Committee[69] in 2009, but the House version was ultimately tabled.[70]In 2010, the bill passed the Senate Judiciary Committee on a voice vote[71] as well as the House Health Care & Human Services Policy and Oversight Committee.[72]In 2011, the bill was introduced as a two-year bill in both the Senate[73] and House,[74] but did not progress. It has been introduced again in the 2013 session in both chambers.[75][76]Montana[edit]In September 2011, Governor Brian Schweitzer announced his intention to seek a waiver from the federal government allowing Montana to set up a single payer healthcare system.[77]Governor Schweitzer was unable to implement single-payer health care in Montana, but did make moves to open government-run clinics[78] and, in his final budget as governor, increased coverage for lower-income Montana residents.[79]New York[edit]New York State has been attempting passage of the New York Health Act, which would establish a statewide single-payer health plan, since 1992. The New York Health Act has passed the Assembly twice, once in 1992 and again in 2015, but has failed to advance through the Senate after referrals to the Health Committee. On both occasions, the legislation passed the Assembly by an almost two-to-one ratio of support.[80]Oregon[edit]The state of Oregon attempted to pass single payer healthcare via Oregon Ballot Measure 23 in 2002, and the measure was rejected by a significant majority.[81]Previous bills, including the Affordable Health Care for All Oregon Act, have been introduced in the legislature but have never left committee. The Affordable Health Care Act may be reintroduced in the 2013 session.[82]Pennsylvania[edit]The Family Business and Healthcare Security Act has been introduced in the Pennsylvania legislature numerous times, but has never been able to pass.[83][84][85]Vermont[edit]In December 2014, Vermont canceled its plan for single payer healthcare.[42]Vermont passed legislation in 2011 creating Green Mountain Care.[86]When Governor Peter Shumlin signed the bill into law, Vermont became the first state to functionally have a single payer health care system.[87]While the bill is considered a single-payer bill, private insurers can continue to operate in the state indefinitely, meaning it does not fit the strict definition of single-payer. Representative Mark Larson, the initial sponsor of the bill, has described Green Mountain Care's provisions "as close as we can get [to single-payer] at the state level."[88][89]Vermont abandoned the plan in 2014, citing costs and tax increases as too high to implement.[90]Public opinion[edit]Advocates for single payer point to support in polls, although the polling is mixed depending on how the question is asked.[91]Polls from Harvard University in 1988,[92] the Los Angeles Times in 1990,[93] and the Wall Street Journal in 1991[94] all showed strong support for a health care system comparable to the system in Canada. More recently, however, polling support has declined.[91][95]A 2007 Yahoo/AP poll showed a majority of respondents considered themselves supporters of "single-payer health care,"[96] and a plurality of respondents in a 2009 poll for Time Magazine showed support for "a national single-payer plan similar to Medicare for all."[97]Polls by Rasmussen Reports in 2011[98] and 2012[99] showed pluralities opposed to single payer health care.A 2001 article in the public health journal Health Affairs studied fifty years of American public opinion of various health care plans and concluded that, while there appears to be general support of a "national health care plan," poll respondents "remain satisfied with their current medical arrangements, do not trust the federal government to do what is right, and do not favor a single-payer type of national health plan."[95]Politifact rated a statement by Michael Moore "false" when he stated that "[t]he majority actually want single-payer health care." According to Politifact, responses on these polls largely depend on the wording. For example, people respond more favorably when they are asked if they want a system "like Medicare."[91]Advocacy groups[edit]This section needs to be updated. Please update this article to reflect recent events or newly available information. (February 2014)Physicians for a National Health Program[100] the American Medical Student Association[101] and the California Nurses Association[102] are among advocacy groups that have called for the introduction of a single payer healthcare program in the United States. A study published in the Annals of Internal Medicine found that 59% of physicians "supported legislation to establish national health insurance" while 9% were neutral on the topic, and 32% opposed it.[103]Universal health coverage by countryFrom Wikipedia, the free encyclopediaSee also: Health systems by country 58 countries with universal health care in 2009.[1]58 countries with legislation mandating universal health care, along with >90% health insurance coverage, and >90% skilled birth attendance.Main article: Universal health careUniversal health coverage is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others tax revenues are used either to fund insurance for the very poor or for those needing long term chronic care. The UK government's National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the U.S.), and their relative costs and key health outcomes.[2]A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004[3]In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.The UN has adopted a resolution on universal health care. It may be the next stage after the Millennium Development Goals.[4]Africa[edit]Algeria[edit]Algeria operates a public healthcare system. A network of hospitals, clinics, and dispensaries provide treatment to the population, with the Social Security system funding health services, although many people must still cover part of their costs due to the rates paid by the Social Security system unchanged since 1987. The poor are generally entitled to health services free of charge, while the wealthy pay for treatment according to a sliding scale.[5][6]Botswana[edit]Botswana operates a system of public medical centers, with 98% of health facilities in the country run by the government. All citizens are entitled to be treated in public facilities free of charge, though a nominal fee of $70 is typically charged for public health services except for sexual reproductive health services and antiretroviral therapy services, which are free.[7]Burkina Faso[edit]Burkina Faso operates a scheme called Universal Health Insurance (AMU) which provides universal healthcare to citizens. It is administered by two separate bodies, one for civilians and the other for the armed forces.[8]Egypt[edit]Egypt operates a system of public hospitals and clinics through the Ministry of Health. Egyptian citizens can receive treatment at these facilities free of charge. However, those Egyptians who can afford it prefer to pay out of pocket for private healthcare.[9]Ghana[edit]Ghana operates the National Health Insurance Scheme to provide citizens with health insurance. The level of premiums citizens must pay varies according to their level of income. Most medical facilities are run directly by the Ministry of Health or Ghana Health Service.[10]Mauritius[edit]The Government of Mauritius operates a system of medical facilities that provide treatment to citizens free of charge.[11]Morocco[edit]Morocco operates a public health sector run by the government that operates 85% of the country's hospital beds. It deals mainly with the poor and rural populations, who cannot afford private healthcare. In addition, there is a non-profit health sector operated by the National Social Security Fund which covers 16% of the population. There is also a private sector for those who can afford it.[12]Rwanda[edit]Rwanda operates a system of universal health insurance through the Ministry of Health called Mutuelle de Santé (Mutual Health), a system of community-based insurance where people pay premiums based on their income level into local health insurance funds, with the wealthiest paying the highest premiums and required to cover a small percentage of their medical expenses, while those at the lowest income levels are exempt from paying premiums and can still utilize the services of their local health fund. In 2012, this system insured all but 4% of the population.[13]South Africa[edit]South Africa has a public healthcare system that provides services to the vast majority of the population, though it is chronically underfunded and understaffed, and a private system that is far better equipped, which covers the wealthier sectors of society.[14]Tunisia[edit]Tunisia operates a public healthcare system under the National Health Insurance Fund (Caisse Nationale d'Assurance Maladie). All Tunisian citizens and residents can receive treatment in state-run hospitals and clinics free of charge.[15]Asia[edit]Countries that provide public healthcare in Asia include Bhutan,[16]Bahrain,[17]China, Hong Kong, India, Iran,[18]Israel[19](see below), Jordan,[20]Kazakhstan,[21]Macau (see below), Malaysia,[22]Mongolia,[23]Oman,[24][25]Singapore, Sri Lanka,[26]Syria,[27]Taiwan (R.O.C.)[28](see below), Tajikistan,[29]Thailand (see below), Turkey,[30]and Turkmenistan[31]have universal health care.Bhutan[edit]The Royal Government of Bhutan maintains a policy of free and universal access to primary health care. As hospital facilities in the country are limited, patients with diseases that cannot be treated in Bhutan, such as cancer, are normally referred to hospitals in India for treatment. Such referral treatment is also carried out at the cost of the Royal Government.[32]Hong Kong[edit]Hong Kong has early health education, professional health services, and well-developed health care and medication system. The life expectancy is 84 for females and 78 for males,[33]which is the second highest in the world, and 2.94 infant mortality rate, the fourth lowest in the world.[34][35]There are two medical schools in Hong Kong, and several schools offering courses in traditional Chinese medicine. The Hospital Authority is a statutory body that operates and manages all public hospitals. Hong Kong has high standards of medical practice. It has contributed to the development of liver transplantation, being the first in the world to carry out an adult to adult live donor liver transplant in 1993.[36]India[edit]India's healthcare system is dominated by the private sector, although there are various public healthcare systems like Rajiv Gandhi Jeevandayee Arogya Yojana in Maharashtra that provides free healthcare to those below the poverty line.[37][38]Currently, the majority of Indian citizens do not have health insurance, and must pay out of pocket for treatment. There are government hospitals that provide treatment at taxpayer expense. Some essential drugs are offered free of charge in these hospitals.An outpatient card at AIIMS costs a one-time fee of 10 rupees (around 20 cents U.S.) and thereafter outpatient medical advice is free. In-hospital treatment costs depend on the financial condition of the patient and the facilities utilized, but are usually much less than the private sector. For instance, a patient is waived treatment costs if their income is below the poverty line. However, getting treatment at high quality government hospitals is very tough due to the high number of people needing healthcare and the lack of sufficient facilities.Primary health care is provided by city and district hospitals and rural primary health centres (PHCs). These hospitals provide treatment free of cost, but only if they are functional. Primary care is focused on immunization, prevention of malnutrition, pregnancy, child birth, postnatal care, and treatment of common illnesses.Patients who receive specialized care or have complicated illnesses are referred to secondary (often located in district and taluk headquarters) and tertiary care hospitals (located in district and state headquarters or those that are teaching hospitals).Now organizations like Hindustan Latex Family Planning Promotional Trust and other private organizations have started creating hospitals and clinics in India, which also provide free or subsidized health care and subsidized insurance plans.The government-run healthcare suffers from a lack of hygiene; the rich avoid the government hospitals and go to private hospitals. With the advent of privatized healthcare, this situation has changed. India now has medical tourism for people from other countries while its own poor find high-quality healthcare either inaccessible or unaffordable.The current Indian government is planning to unveil a national universal healthcare system called the National Health Assurance Mission, which will provide all Indian citizens with insurance coverage for serious illnesses, and free drugs and diagnostic treatments.[39]Israel[edit]Health care in Israel as a percentage of GDPIsrael has a system of universal healthcare as set out by the 1995 National Health Insurance Law. The state is responsible for providing health services to all residents of the country, who can register with one of the four national health service funds. To be eligible, a citizen must pay a health insurance tax. Coverage includes medical diagnosis and treatment, preventive medicine, hospitalization (general, maternity, psychiatric and chronic), surgery and transplants, preventive dental care for children, first aid and transportation to a hospital or clinic, medical services at the workplace, treatment for drug abuse and alcoholism, medical equipment and appliances, obstetrics and fertility treatment, medication, treatment of chronic diseases and paramedical services such as physiotherapy and occupational therapy.[40]In Israel, the National Health Insurance Law (or National Health Insurance Act) is the legal framework which enables and facilitates basic, compulsory universal health care. The Law was put into effect by the Knesset on January 1, 1995, and was based on recommendations put forward by a National Committee of Inquiry headed by Shoshana Netanyahu which examined restructuring the health care system in Israel in the late 1980s. Prior to the law's passage over 90% of the population was already covered by voluntarily belonging to one of four nationwide, not-for-profit sickness funds which operated some of their own medical facilities and were funded in part by employers and the government and in part by the insured by levies which varied according to income. However, there were three problems associated with this arrangement. First, membership in the largest fund, Clalit, required one to belong to the Histadrut labor organization, even if a person did not wish to (or could not) have such an affiliation while other funds restricted entry to new members based on age, pre-existing conditions or other factors. Second, different funds provided different levels of benefit coverage or services to their members and lastly was the issue mentioned above whereby a certain percentage of the population, albeit a small one, did not have health insurance coverage at all.Before the law went into effect, all the funds collected premiums directly from members. However, upon passage of the law, a new progressive national health insurance tax was levied through Israel's social security agency which then re-distributes the proceeds to the sickness funds based on their membership and its demographic makeup. This ensured that all citizens would now have health coverage. While membership in one of the funds now became compulsory for all, free choice was introduced into movement of members between funds (a change is allowed once every six months), effectively making the various sickness funds compete equally for members among the populace. Annually, a committee appointed by the ministry of health publishes a "basket" or uniform package of medical services and prescription formulary which all funds must provide as a minimum service to all their members. Achieving this level of equality ensured that all citizens are guaranteed to receive basic healthcare regardless of their fund affiliation which was one of the principal aims of the law. An appeals process was put in place to handle rejection of treatments and procedures by the funds and evaluating cases falling outside the "basket" of services or prescription formulary.While the law is generally considered a success and Israeli citizens enjoy a high standard of medical care comparatively, with more competition having been introduced into the field of health care in the country, and order having been brought into what was once a somewhat disorganized system, the law nevertheless does have its critics. First and foremost among the criticisms raised is that the "basket" may not provide enough coverage. To partly address this issue, the HMOs and insurance companies began offering additional "supplementary" insurance to cover certain additional services not included in the basket. However, since this insurance is optional (though usually very modestly priced, costing the equivalent of about US$10 to $20 a month), critics argue that it goes against the spirit of the new law which stressed equality among all citizens with respect to healthcare. Another criticism is that in order to provide universal coverage to all, the tax income base amount (the maximum amount of yearly earnings that are subject to the tax) was set rather high, causing many high-income taxpayers to see the amount they pay for their health premiums (now health tax) skyrocket. Finally, some complain about the constantly rising costs of copayments for certain services.Macau[edit]Macau offers universally accessible single-payer system funded by taxes. Health care is provided by the Bureau for Health.People's Republic of China[edit]Since the founding of the People's Republic of China, the goal of health care programs has been to provide care to every member of the population and to make maximum use of limited health-care personnel, equipment, and financial resources.China is undertaking a reform on its health care system, which was largely privatized in the 1990s. The New Rural Co-operative Medical Care System (NRCMCS), is a new 2005 initiative to overhaul the healthcare system, particularly intended to make it more affordable for the rural poor. Under the NRCMCS, the annual cost of medical coverage is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient. As of September 2007, around 80% of the whole rural population of China had signed up (about 685 million people). The system is tiered, depending on the location. If patients go to a small hospital or clinic in their local town, the scheme will cover from 70–80% of their bill. If they go to a county one, the percentage of the cost being covered falls to about 60%. And if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves, the scheme would cover about 30% of the bill.[41]On January 21, 2009, the Chinese government announced that a total of 850 billion yuan (US$127.5 billion) will be provided between 2009 and 2011 in order to improve the existing health care system.[42]At the end of 2008, the government published its reform plan clarifying government's responsibility by saying that it would play a dominant role in providing public health and basic medical service. It declared "Both central and local governments should increase health funding. The percentage of government's input in total health expenditure should be increased gradually so that the financial burden of individuals can be reduced," The plan listed public health, rural areas, city community health services and basic medical insurance as four key areas for government investment. It also promised to tighten government control over medical fees in public hospitals and to set up a "basic medicine system" to quell public complaints of rising drug costs.[43]The plan was passed by the Chinese Cabinet in January 2009. The long-awaited medical reform plan promised to spend 850 billion yuan by 2011 to provide universal medical service and that measures would be taken to provide basic medical security to all Chinese.[44]Singapore[edit]Singapore has a universal health care system where government ensures affordability, largely through compulsory savings and price controls, while the private sector provides most care. Overall spending on health care amounts to only 3% of annual GDP. Of that, 66% comes from private sources.[45]Singapore currently has the second lowest infant mortality rate in the world and among the highest life expectancies from birth, according to the World Health Organization.[46]Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt.[47]Singapore's system uses a combination of compulsory savings from payroll deductions (funded by both employers and workers) a nationalized health insurance plan, and government subsidies, as well as "actively regulating the supply and prices of healthcare services in the country" to keep costs in check; the specific features have been described as potentially a "very difficult system to replicate in many other countries." Many Singaporeans also have supplemental private health insurance (often provided by employers) for services not covered by the government's programs.[47]Taiwan[edit]The current health care system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health care dollars. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004.[48]NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers.NHI delivers universal coverage offered by a government-run insurer. The working population pays premiums split with their employers, others pay a flat rate with government help and the poor or veterans are fully subsidized.[49]Under this model, citizens have free range to choose hospitals and physicians without using a gatekeeper and do not have to worry about waiting lists. NHI offers a comprehensive benefit package that covers preventive medical services, prescription drugs, dentalservices, Chinese medicine, home nurse visits and many more. Since NHI, the previously uninsured have increased their usage of medical services. Most preventive services are free such as annual checkups and maternal and child care. Regular office visits have co-payments as low as US $5 per visit. Co-payments are fixed and unvaried by the person's income.[50]Thailand[edit]Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to do so at the time. Means-tested health care for low income households was replaced by a new and more comprehensive insurance scheme, originally known as the 30 baht project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allows them to access services in their health district, and, if necessary, be referred for specialist treatment elsewhere. The bulk of finance comes from public revenues, with funding allocated to Contracting Units for Primary Care annually on a population basis. According to the WHO, 65% of Thailand's health care expenditure in 2004 came from the government, 35% was from private sources.[45]Although the reforms have received a good deal of critical comment, they have proved popular with poorer Thais, especially in rural areas, and survived the change of government after the 2006 military coup. The then Public Health Minister, Mongkol Na Songkhla, abolished the 30 baht co-payment and made the UC scheme free. It is not yet clear whether the scheme will be modified further under the coalition government that came to power in January 2008.[51][52][53]Europe[edit]Virtually all of Europe has either publicly sponsored and regulated universal health care or publicly provided universal healthcare. The public plans in some countries provide basic or "sick" coverage only, with their citizens being able to purchase supplemental insurance for additional coverage. Countries with universal health care include Austria, Belarus,[54]Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, Moldova,[55]the Netherlands, Norway, Portugal,[56]Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine,[57]and the United Kingdom.[58]Austria[edit]Healthcare in Austria is universal for residents of Austria as well as those from other EU countries.[59]Austria has a two-tier health care system in which many individuals receive publicly funded care; they also have the option to purchase supplementary private health insurance.Croatia[edit]Croatia has a universal health care system that provides high quality medical services and is coordinated by the Ministry of Health. The population is covered by a basic health insurance plan provided by statute and optional insurance and administered by the Croatian Health Insurance Fund. In 2012, annual compulsory healthcare related expenditures reached 21.0 billion kunas (c. 2.8 billion euro). There are hundreds of healthcare institutions in Croatia, including 79 hospitals and clinics with 25,285 beds, caring for more than 760 thousand patients per year, 5,792 private practice offices and 79 emergency medical service units.Czech Republic[edit]Czech Republic has a universal public health system paid largely from taxation. Private health care systems do co-exist freely alongside public ones, sometimes offering better quality or faster service. Almost all medical services are covered by health insurance and insurance companies, though certain services such as prescription drugs or vision and dental care are only covered partially.Denmark[edit]Denmark has a universal public health system paid largely from taxation with local municipalities delivering health care services in the same way as other Scandinavian countries. Primary care is provided by a general practitioner service run by private doctors contracting with the local municipalities with payment on a mixed per capita and fee for service basis. Most hospitals are run by the municipalities (only 1% of hospital beds are in the private sector).Finland[edit]In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and 4% by others. Private provision is mainly in the primary care sector. There are a few private hospitals.[60]The main hospitals are either municipally owned (funded from local taxes) or run by the medical teaching universities (funded jointly by the municipalities and the national government). According to a survey published by the European Commission in 2000, Finland's is in the top 4 of EU countries in terms of satisfaction with their hospital care system: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%.[61]Finnish health care expenditures are below the European average.[62]The private medical sector accounts for about 14 percent of total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector.Taxation funding is partly local and partly nationally based. The national social insurance institution KELA reimburses part of patients prescription costs and makes a contribution towards private medical costs (including dentistry) if they choose to be treated in the private sector rather than the public sector. Patient access charges are subject to annual caps. For example, GP visits cost €11 per visit with annual €33 cap; hospital outpatient treatment €22 per visit; a hospital stay, including food, medical care and medicines €26 per 24 hours, or €12 if in a psychiatric hospital. After a patient has spent €590 per year on public medical services (including prescription drugs), all treatment and medications thereafter in that year are free.Finland has a highly decentralized three-level public system of health care and alongside this, a much smaller private health-care system.[63]Overall, the municipalities (funded by taxation, local and national) meet about two thirds of all medical-care costs, with the remaining one third paid by the national insurance system (nationally funded), and by private finance (either employer-funded or met by patients themselves).[63]Private inpatient care forms about 3–4% of all inpatient care.[63]In 1999 only 17 per cent of total funding for health care came from insurance, comprising 14.9% statutory (government) insurance and 2.1% private health insurance. Spectacles are not publicly subsidized at all, although dentistry is available as a municipal service or can be obtained privately with partial reimbursement from the state.[63]The government announced in 2009 that Kela would re-imburse the cost of private dental-hygiene work, starting in 2010.[64]The percentage of total health expenditure financed by taxation in Finland (78%)[65]is above the OECD average and similar to the levels seen in Germany (77%) and France (80%) but below the level seen in the UK (87%). The quality of service in Finnish health care, as measured by patient satisfaction, is excellent. According to a survey published by the European Commission in 2000, Finland has one of the highest ratings of patient satisfaction with their hospital care system in the EU: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%.[66]There are caps on total medical expenses that are met out-of-pocket for drugs and hospital treatments. The National Insurance system pays all necessary costs over these caps. Public spending on health care in 2006 was 13.6 billion euros (equivalent to US$338 per person per month). The increase over 2005 at 8.2 per cent was below the OECD average of 9 percent. Household budgets directly met 18.7 per cent of all health-care costs.[67]France[edit]France has a system of universal health care largely financed by government through a system of national health insurance. It is consistently ranked as one of the best in the world.[68]Germany[edit]Germany has the world's oldest national social health insurance system,[69][70][71]with origins dating back to Otto von Bismarck's Sickness Insurance Law of 1883.[72][73]The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Approximately 92% of the population is covered by a 'Statutory Health Insurance' plan, which provides a standardized level of coverage through any one of approximately 1100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level. Higher income workers sometimes choose to pay a tax and opt out of the standard plan, in favor of 'private' insurance. The latter's premiums are not linked to income level but instead to health status.[74]Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician's associations and sickness funds. Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries.[75]The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986 expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases. Although reimbursement of providers is on a fee-for-service basis the amount to be reimbursed for each service is determined retrospectively to ensure that spending targets are not exceeded. Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost containment mechanism but would require consent of regional medical associations, and has not materialized.[76]Copayments were introduced in the 1980s in an attempt to prevent overutilization and control costs. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the U.S. (5 to 6 days).[77][78]The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the number of hospital days as opposed to procedures or the patient's diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP).[79]Greece[edit]The Greek healthcare system provides high quality medical services to insured citizens and is coordinated by the Ministry for Health and Social Solidarity. Public health services are provided by the National Healthcare Service, or ESY (Greek: Εθνικό Σύστημα Υγείας, ΕΣΥ). In 2010 there were 35,000 hospital beds and 131 hospitals in the country.The Greek healthcare system has received high rankings by the World Health Organization, ranked 14th in the overall assessment and 11th in quality of service in a 2000 report by the WHO.Guernsey / Jersey[edit]The medical care system in the Channel Islands is very similar to that of the UK in that many of the doctors and nurses have been trained from the UK health perspective. There is universal health care for residents of the islands.[80]Iceland[edit]Iceland has a universal public health system paid largely from taxation with local municipalities delivering health care services in the same way as other Scandinavian countries. Iceland's entire population has equal access to health care services.Ireland[edit]The public health care system of the Republic of Ireland is governed by the Health Act 2004,[81]which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on January 1, 2005; however the new structures are currently in the process of being established as the reform program continues. In addition to the public-sector, there is also a large private health care market.Isle of Man[edit]The Isle of Man provides universal public health coverage to its residents.[82]Italy[edit]Italy has a public health care service for all the residents called "Servizio Sanitario Nazionale" or SSN (National Health Service) which is similar to the UK National Health Service. It is publicly run and funded mostly from taxation: some services requires small co-pays, while other services (like the emergency medicine and the general doctor) are completely free of charge. Like the UK, there is a small parallel private health care system, especially in the field of Dental Medicine.Luxembourg[edit]Luxembourg provides universal health care coverage to all residents (Luxembourgers and foreigners) by the National Health Insurance (CNS - Caisse nationale de santé (French) or National Gesondheetskeess (Luxembourgish)) which is funded by mandatory contributions of employers and the workforce and by government subsidies for insuring jobseekers, the poor and for financing medical infrastructure. It exists as well a mandatory public long-term care insurance.[83][84]Netherlands[edit]The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.[45]Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductibles, co-pays etc., or refuse to fund treatments which a doctor has determined to be medically necessary). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees' premiums as an employment benefit). All insurance companies receive additional funding from the regulator's fund. The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders. Thus insurers with high payouts will receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than might be expected. Insurance companies compete with each other on price for the 45% direct premium part of the funding and try to negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medically disadvantaged by his or her choice of insurer.Hospitals in the Netherlands are also regulated and inspected but are mostly privately run and not for profit, as are many of the insurance companies. Patients can choose where they want to be treated and have access to information on the internet about the performance and waiting times at each hospital. Patients dissatisfied with their insurer and choice of hospital can cancel at any time but must make a new agreement with another insurer.Insurance companies can offer additional services at extra cost over and above the universal system laid down by the regulator, e.g. for dental care. The standard monthly premium for health care paid by individual adults is about €100 per month. Persons on low incomes can get assistance from the government if they cannot afford these payments. Children under 18 are insured by the system at no additional cost to them or their families because the insurance company receives the cost of this from the regulator's fund. There is a fixed yearly threshold of €375 for each adult person, excluding first visits for diagnosis to general physicians.Norway[edit]Norway has a universal public health system paid largely from taxation in the same way as other Scandinavian countries. Norway's entire population has equal access to health care services. The Norwegian health care system is government-funded and heavily decentralized. The health care system in Norway is financed primarily through taxes levied by county councils and municipalities. Dental care is included for children until 18 years old, and is covered for adults for some ailments.[85]Norway regularly comes top or close to the top of worldwide healthcare rankings.Portugal[edit]Portugal's National Healthcare Service, known nationally as Serviço Nacional de Saúde (SNS), is a universal and free healthcare service, provided nationwide since 1979, and is available to both Portuguese and foreigner residents. In 2014, Portugal SNS ranked 13th best healthcare service in Europe.[86]The National Medical Emergency Institute (INEM) is the main emergency medical serviced and can be activated by calling 112.Romania[edit]According to Article 34 of the Constitution of Romania, the state is obliged "to guarantee the protection of healthcare". Romania has a fully universal health care system, which covers up medical check-ups, any surgical interventions, and any post-operator medical care, as well as free or subsidized medicine for a range of diseases. The state is also obliged to fund public hospitals and clinics. Dental care is not funded by the state, although there are public dental clinics in some hospitals, which treat patients free of charge. However, due to inadequate funding and corruption, it is estimated that a third of medical expenses are, in some cases, supported by the patient.[87][clarification needed]Furthermore, Romania spends, per capita, less than any other EU state on medical care.Russia and Soviet Union[edit]In the Soviet Union, the preferred term was "socialist medicine"; the Russian language has no term to distinguish between "socialist" and "socialized" (other than "public", Rus: obshchestvenniy/общественный, sometimes "collectivized" or "nationalized", Rus: obobshchestvlenniy/обобществленный).[88][89]Russia in Soviet times (between 1917 and the early 1990s) had a totally socialist model of health care with a centralised, integrated, hierarchically organised with the government providing free health care to all citizens. Initially successful at combating infectious diseases, the effectiveness of the socialized model declined with underinvestment. Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the quality of care began to decline by the early 1980s and medical care and health outcomes were below western standards.The new mixed economy Russia has switched to a mixed model of health care with private financing and provision running alongside state financing and provision. The OECD reported that unfortunately, none of this has worked out as planned and the reforms have in many respects made the system worse.[90]The population's health has deteriorated on virtually every measure. The resulting system is overly complex and very inefficient. It has little in common with the model envisaged by the reformers. Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.Article 41 of the Constitution of the Russian Federation confirms a citizen's right to state healthcare and medical assistance free of charge.[91]This is achieved through state compulsory medical insurance (OMS) which is free to Russian citizens, funded by obligatory medical insurance payments made by companies and government subsidies.[92][93]Introduction in 1993 reform of new free market providers in addition to the state-run institutions intended to promote both efficiency and patient choice. A purchaser-provider split help facilitate the restructuring of care, as resources would migrate to where there was greatest demand, reduce the excess capacity in the hospital sector and stimulate the development of primary care. Russian Prime Minister Vladimir Putin announced a new large-scale health care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billion) in the next few years to improve health care in the country.[94]He also said that obligatory medical insurance tax paid by companies will increase from current 3.1% to 5.1% starting from 2011.[94]Serbia[edit]The Constitution of the Republic of Serbia states that it is a right of every citizen to seek medical assistance free of charge.[95]This is achieved by mutual contribution to the Compulsory Social Healthcare Fund of RZZO (Republički Zavod za Zdravstveno Osiguranje or National Health Insurance Institution). The amount of contribution depends on the amount of money the person is making. During the 1990s, Serbia's healthcare system has been of a poor quality due to severe underfunding. In the recent years, however, that has changed and the Serbian government has invested heavily in new medical infrastructure, completely remodeling existing hospitals and building two new hospitals in Novi Sad and Kragujevac.Sweden[edit]Sweden has a universal public health system paid largely from taxation in the same way as other Scandinavian countries. Sweden's entire population has equal access to health care services. The Swedish public health system is funded through taxes levied by the county councils, but partly run by private companies. Government-paid dental care for children under 21 years old is included in the system, and dental care for adults is somewhat subsidised by it.Sweden also has a smaller private health care sector, mainly in larger cities or as centers for preventive health care financed by employers.Sweden regularly comes in top in worldwide healthcare rankings.[96]Switzerland[edit]Healthcare in Switzerland is universal and is regulated by the Federal Health Insurance Act of 1994. Basic health insurance is mandatory for all persons residing in Switzerland (within three months of taking up residence or being born in the country). Insurers are required to offer insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.[97]United Kingdom[edit]Each of the Countries of the United Kingdom has a National Health Service that provides public healthcare to all UK permanent residents that was originally designed to be free at the point of need and paid for from general taxation; but changes included introducing charging for prescription medicines and dentistry (those below 16 and those on certain benefits may still get free treatment). However, since Health is now a devolved matter, considerable differences are developing between the systems in each of the countries as for example Scotland abolished prescription charges.[98]Private healthcare companies are free to operate alongside the public one.England[edit]Norfolk and Norwich University Hospital, a National Health Service hospital.The National Health Service (NHS), created by the National Health Service Act 1946, has provided the majority of healthcare in England since its launch on 5 July 1948.The NHS Constitution for England documents, at high level, the objectives of the NHS, the legal rights and responsibilities of the various parties (patients, staff, NHS trust boards), and the guiding principles which govern the service.[99]The NHS constitution makes it clear that it provides a comprehensive service, available to all irrespective of age, gender, disability, race, sexual orientation, religion, or belief; that access to NHS services is based on clinical need and not an individual's ability to pay; and that care is never refused on unreasonable grounds. Patient choice in terms of doctor, care, treatments, and place of treatment is an important aspect of the NHS's ambition, and in some cases patients can elect for treatment in other European countries at the NHS's expense. Waiting times are low, with most people able to see their primary care doctor on the same day or the following day.[100]Only 36.1% of hospital admissions are from a waiting list, with the remainder being either emergencies admitted immediately or else pre-booked admissions or the like (e.g., child birth).[101]One of the main goals of care management is to ensure that patients do not experience a delay of more than 18 weeks from initial hospital referral to final treatment, inclusive of time for all associated investigative tests and consultations.102]At present, two-thirds of patients are treated in under 12 weeks.[103]Although centrally funded, the NHS is not managed by a large central bureaucracy. Responsibility is highly devolved to geographical areas through Strategic Health Authorities and even more locally through NHS primary care trusts, NHS hospital trusts and increasingly to NHS foundation trusts which are providing even more decentralized services within the NHS framework, with more decision making taken by local people, patients, and staff. The central government office, the Department of Health, is not involved in day-to-day decision making in either the Strategic Health Authorities or the individual local trusts (primarily health, hospital, or ambulance) or the national specialist trusts such as NHS Blood and Transplant, but it does lay down general guidelines for them to follow. Local trusts are accountable to their local populations, whilst government ministers are accountable to Parliament for the service overall.The NHS provides, among other things, primary care, in-patient care, long-term healthcare, psychiatric care and treatments, ophthalmology, and dentistry. All treatment is free with the exception of certain charges for prescriptions, dentistry and ophthalmology (which themselves are free to children, certain students in full-time education, the elderly, the unemployed and those on low incomes). Around 89 pc of NHS prescriptions are obtained free of charge, mostly for children, pensioners, and pregnant women. Others pay a flat rate of £8.20,[104]and others may cap their annual charges by purchasing an NHS Prescription Prepayment Certificate. Private health care has continued parallel to the NHS, paid for largely by private insurance. Private insurance accounts for only 4 percent of health expenditure and covers little more than a tenth of the population.[105]Private insurers in the UK only cover acute care from specialists. They do not cover generalist consultations, pre-existing conditions, medical emergencies, organ transplants, chronic conditions such as diabetes, or conditions such as pregnancy or HIV.[106]Most NHS general practitioners are private doctors who contract to provide NHS services, but most hospitals are publicly owned and run through NHS Trusts. A few NHS medical services (such as "surgicentres") are sub-contracted to private providers[107]as are some non-medical services (such as catering). Some capital projects such as new hospitals have been funded through the Private Finance Initiative, enabling investment without (in the short term) increasing the public sector borrowing requirement, because long-term contractually obligated PFI spending commitments are not counted as government liabilities.Northern Ireland[edit]Health and Social Care in Northern Ireland is the designation of the national public health service in Northern Ireland.Scotland[edit]The Royal Aberdeen Children's Hospitalis a specialist children's hospital within NHS Scotland.NHS Scotland, created by the National Health Service (Scotland) Act 1947, was also launched on 5 July 1948, although it has always been a separate organization. Since devolution, NHS Scotland has followed the policies and priorities of the Scottish Government, including the phasing out of all prescription charges by 2011.[citation needed]Wales[edit]NHS Wales was originally formed as part of the same NHS structure created by the National Health Service Act 1946 but powers over the NHS in Wales came under the Secretary of State for Wales in 1969,[108]in turn being transferred under devolution to what is now the Welsh Government.North America[edit]The Bahamas,Barbados, Canada, Costa Rica, Cuba, Mexico, Panama, and Trinidad and Tobago all provide some level of universal health coverage.The Bahamas[edit]The Bahamas approved the National Health Insurance Act in August 2016. The legislation allows for the establishment of a universal health coverage system that will begin with universal coverage of primary health care services and later expand to include a wide set of benefits including all specialized care. The system will all for universal coverage of a basic benefit package and for voluntary insurance to be purchased as a top up policy to cover services or amenities that are not included in the government plan.[109]Canada[edit]In 1984, the Canada Health Act was passed, which prohibited extra billing by doctors on patients while at the same time billing the public insurance system. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."[110]The system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations, although most hospitals are public. Most doctors do not receive an annual salary, but receive a fee per visit or service.[111]About 29% of Canadians' health care is paid for by the private sector or individuals.[112]This mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and vision care.[113]Many Canadians have private health insurance, often through their employers, that cover these expenses.[114]The Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so. "Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed," according to a report in the New England Journal of Medicine.[115][116]The legality of the ban was considered in a decision of the Supreme Court of Canada which ruled in Chaoulli v. Quebec that "the prohibition on obtaining private health insurance, while it might be constitutional in circumstances where health care services are reasonable as to both quality and timeliness, is not constitutional where the public system fails to deliver reasonable services." The appellant contended that waiting times in Quebec violated a right to life and security in the Quebec Charter of Human Rights and Freedoms. The Court agreed, but acknowledged the importance and validity of the Canada Health Act, and at least four of the seven judges explicitly recognized the right of governments to enact laws and policies which favour the public over the private system and preserve the integrity of the public system.Costa Rica[edit]Universal healthcare and pensions are run by the Caja Costarricense de Seguro Social (CCSS). In 1941, Costa Rica established Caja Costarricense de Seguro Social (CCSS), a social security insurance system for wage-earning workers. In 1961, coverage was expanded to include workers’ dependents and from 1961 to 1975, a series of expansions extended coverage for primary care and outpatient and inpatient specialized services to people in rural areas, the low-income population, and certain vulnerable populations. Further expansions during the late 1970s extended insurance coverage to farmers, peasants, and independent contract workers. Additionally, CCSS mandates free health service provision to mothers, children, indigenous people, the elderly, and people living with disabilities, regardless of insurance coverage. By 2000, 82 percent of the population was eligible for CCSS, which has continued to expand in the ensuing period. By covering all population groups through the same system, Costa Rica has avoided social insurance stratification and inequity common in many other countries in the region.[117]CCSS is funded by a 15 percent payroll tax, as well as payments from retiree pensions [6]. Taxes on luxury goods, alcohol, soda, and imported products also help to cover poor households who do otherwise pay into the system. All CCSS funds are merged into a single pool, which is managed by the central financial administration of CCSS. In 1973, the Ministry of Health decided to move away from direct service provision and adopt a steering role. Responsibility for the provision of most care was transferred to the CCSS, although the Ministry retained responsibility for disease control, food and drug regulation, environmental sanitation, child nutrition, and primary care for the poor. Through the CCSS, health care is now essentially free to nearly all Costa Ricans. Private health care is also widely available and INS offers private health insurance plans to supplement CCSS insurance.[118]Cuba[edit]The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. There are no private hospitals or clinics as all health services are government-run. The present Minister for Public Health is Roberto Morales Ojeda. However, although the coverage is wide, the system is underfunded and recently also understaffed. The government organized medical missions in other countries has taken a very significant amount of doctors and other personal. In 2005 there were 25000 Cuban doctors only in Venezuela.Mexico[edit]Public health care delivery is accomplished via an elaborate provisioning and delivery system instituted by the Mexican Federal Government. Public health care is provided to all Mexican citizens as guaranteed via Article 4 of the Constitution. Public care is either fully or partially subsidized by the federal government, depending on the person's (Spanish: derechohabiente's) employment status. All Mexican citizens are eligible for subsidized health care regardless of their work status via a system of health care facilities operating under the federal Secretariat of Health (formerly the Secretaria de Salubridad y Asistencia, or SSA) agency. Employed citizens and their dependents, however, are further eligible to use the health care program administered and operated by the Instituto Mexicano del Seguro Social (IMSS) (English: Mexican Social Security Institute). The IMSS health care program is a tripartite system funded equally by the employee, its private employer, and the federal government. The IMSS does not provide service to employees of the public sector. Employees in the public sector are serviced by the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (English: Institute for Social Security and Services for State Workers), which attends to the health and social care needs of government employees. This includes local, state, and federal government employees. The government of the states in Mexico also provide health services independently of those services provided by the federal government programs. In most states, the state government has established free or subsidized healthcare to all their citizens.On December 1, 2006, the Mexican government created the Health Insurance for a New Generation also known as "life insurance for babies".[119][120][121]On May 16, 2009, Mexico to Achieve Universal Health Coverage by 2011.[122]On May 28, 2009, Mexico announced Universal Care Coverage for Pregnant Women.[123]On August 2012 Mexico installed a universal healthcare system.[124]Trinidad and Tobago[edit]Main article: Healthcare in Trinidad and TobagoA universal health care system is used in Trinidad and Tobago and is the primary form of health-care available in the country. It is used by the majority of the population seeking medical assistance, as it is free for all citizens.United States[edit]Main article: Patient Protection and Affordable Care ActSee also: Health care reform in the United States and Health care in the United StatesThe United States does not have a universal health care system. However, the Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act of 2010, seeks to have expanded insurance coverage to legal residents by 2014. It provides for federally mandated health insurance to be implemented in the United States during the 2010–2019 decade with the Federal government subsidizing legal resident households with income up to 400% of the Federal poverty level.[125]This threshold varies according to State and household size, but for an average family of four, subsidies would be available for families whose income was about $88,000 or lower.[126]In June 2010 adults with pre-existing conditions became eligible to join a temporary high-risk pool.[127]In 2014, applicants of the same age began to be able to obtain health insurance at the same published rate regardless of health status — the first time in U.S. history that insurers no longer had the right to load the premium or deny coverage prior to contract, or cancel a policy after contractdue to an adverse health condition, or test result indicating that one may be imminent. The law prohibits insurers from capping their liability for a person's health care needs, a move which is expected to rectify medically induced bankruptcy. As of April 13, 2015, the U.S. uninsured rate fell to 11.9% from the 17.1% recorded at the end of the fourth quarter of 2013. This is the lowest quarterly average recorded since Gallup and Healthwaysbegan tracking the percentage of uninsured Americans in 2008. Gallup attributed this sharp decline to the Affordable Care Act's requirements for most Americans to have healthcare in the beginning of the first quarter of 2014.[128]The Congressional Budget Office and related government agencies scored the cost of a universal health care system several times since 1991, and have uniformly predicted cost savings,[129]partly from the elimination of insurance company overhead costs.[130]In 2009, a universal health care proposal was pending in Congress, the United States National Health Care Act (H.R. 676, formerly the "Medicare for All Act").The Congressional Budget Office (CBO) estimated that the bill would reduce the number of nonelderly people who are uninsured by about 32 million, leaving about 23 million nonelderly residents uninsured (about one-third of whom would be illegal immigrants). Under the legislation, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent in 2010 to about 94 percent by 2019.[131]In May 2011, the state of Vermont became the first state to pass legislation establishing a single-payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. The proposal was shelved not long after the main provisions of the law took effect in 2014.[132]A revised estimate in July 2012 by the CBO stated 30 million people would gain access to health insurance under the law.[133]Discussion in the United States commonly uses the term socialized medicine to impart a pejorative meaning to the idea of universal health care.South America[edit]Argentina, Brazil, Chile, Colombia, Peru, Uruguay, and Venezuela all have public universal health care provided.Argentina[edit]Health care is provided through a combination of employer and labor union-sponsored plans (Obras Sociales), government insurance plans, public hospitals and clinics and through private health insurance plans. It costs almost 10% of GDP and is available to anyone regardless of ideology, beliefs, race or nationality.Brazil[edit]The universal health care system was adopted in Brazil in 1988 after the end of the military regime's rule. However, universalized/socialized health care was available many years before, in some cities, once the 27th amendment to the 1969 Constitution imposed the duty of applying 6% of their income in healthcare on the municipalities.[134]Chile[edit]Health care in Chile is provided by the government (via Fonasa) and by private insurers (via Isapre). All workers and pensioners are mandated to pay 7% of their income for health care insurance (the poorest pensioners are exempt from this payment). Workers who choose not to join an Isapre, are automatically covered by Fonasa. Fonasa also covers unemployed people receiving unemployment benefits, uninsured pregnant women, insured worker's dependant family, people with mental or physical disabilities and people who are considered poor or indigent.Fonasa costs vary depending on income, disability or age. Attention at public health facilities via Fonasa is free for low-income earners, people with mental or physical disabilities and people over the age of 60. Others pay 10% or 20% of the costs, depending on income and number of dependants. Fonasa beneficiaries may also seek attention in the private sector, for a designated fee.Additionally, there are a number of high-mortality illnesses (currently 69) that have special attention guarantees for both Isapre and Fonasa affiliates, in relation to access to treatment, waiting times, maximum costs and quality of service.Colombia[edit]In 1993 a reform transformed the health care system in Colombia, trying to provide a better, sustainable, health care system and to reach every Colombian citizen.Peru[edit]On April 10, 2009, the Government of Peru published the Law on Health Insurance to enable all Peruvians to access quality health services, and contribute to regulate the financing and supervision of these services. The law enables all population to access diverse health services to prevent illnesses, and promote and rehabilitate people, under a Health Basic Plan (PEAS).[135][136]On April 2, 2010, President Alan Garcia Perez on Friday signed a supreme ordinance approving the regulations for the framework law on the Universal Health Insurance, which seeks to provide access to quality health care for all Peruvian citizens.Peru's Universal Health Insurance law aims to increase access to timely and quality health care services, emphasizes maternal and child health promotion, and provides the poor with protection from financial ruin due to illness.[137]The regulation states that membership of the Universal Health Insurance (AUS for its Spanish acronym) is compulsory for the entire population living in the country. To that end, the Ministry of Health will approve, by supreme ordinance, the mechanisms leading to compulsory membership, as well as escalation and implementation.[138]Oceania[edit]Australia and New Zealand have universal health care.Australia[edit]In Australia, Medibank — as it was then known — was introduced, by the Whitlam Labor government on July 1, 1975, through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 double dissolution election. However, Medibank was supported by the subsequent Fraser Coalition (Australia) government and became a key feature of Australia's public policy landscape. The exact structure of Medibank/Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medibank program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medibank was funded from general taxation. In 1976, the Fraser Government introduced a 2.5% levy and split Medibank in two: a universal scheme called Medibank Public and a government-owned private health insurance company, Medibank Private.During the 1980s, Medibank Public was renamed Medicare by the Hawke Labor government, which also changed the funding model, to an income tax surcharge, known as the Medicare Levy, which was set at 1.5%, with exemptions for low income earners.[139]The Howard Coalition government introduced an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($70,000) and do not have adequate levels of private hospital coverage.[140]This was part of an effort by the Coalition to encourage take-up of private health insurance. According to WHO, government funding covered 67.5% of Australia's health care expenditures in 2004; private sources covered the remaining 32.5% of expenditures.[45]New Zealand[edit]As with Australia, New Zealand's healthcare system is funded through general taxation. According to the WHO, government sources covered 77.4% of New Zealand's health care costs in 2004; private expenditures covered the remaining 22.6%.[45]

“Did you know that I never paid taxes before I came here? The Edema don’t own property, as a rule.” He gestured at the inn. “I never understood how galling it was. Some smug bastard with a ledger comes into town, makes you pay for the privilege of owning something.”Kvothe gestured for Chronicler to pick up his pen. “Now, of course, I understand the truth of things. I know what sort of dark desires lead a group of men to wait beside the road, killing tax collectors in open defiance of the king.Patrick Rothfuss, The Wise Man’s FearThis is actually a pretty great question, Dave. I apologize in advance, this answer might get a little on the lengthy side for today’s TL;DR culture, but I know you’re personally likely to read the whole thing and would most likely appreciate the depth.Why are people so averse to tax increases, when those increases would lead to a much higher quality of life for themselves and others?This depends on where you live, what station in life you occupy, and what your perceptions of the quality of government and politics are.And it really depends on whether or not tax increases do lead to a perceptibly higher standard of living for yourself.I was just having this very conversation with two relatives about two weeks ago.We were discussing the economy and the relative fragility of it if some bubble were to burst right now (which I think will be either student debt or another dotcom bubble in FAANG stocks,) the government is currently not taking in enough revenue to adequately fund the kind of spending it will need to prevent it from being a deep recession, possibly even depression. That led to discussions of taxes, which quickly led to Ocasio-Cortez and the marginal tax rate.For context, I grew up in a rural, heavily Republican area that broke about 62–32 for Trump. My family was in leadership in the Grange when that still existed. I was probably in college before I met a Democrat. And while my family tends to think Trump is a terrible human being and pray that someone confiscates his phone, they’re generally supportive of conservative policies.I’m a slightly center-right person and a never-Trumper, myself. In certain parts of my family, that has put their perception of me somewhere on the left roughly between Marx and Chavez as of late.The first question I was asked in this conversation after I suggested that we are not taxing the wealthiest enough was why I want to punish rich people for being successful.It is important for me to give a brief primer on the three basic types of taxes: regressive, flat, and progressive taxes, for those who are not already familiar with them.Regressive taxes are where the lower your income, the higher a percentage of your income the tax takes. Flat fees are regressive taxes. The policy here is equality: everyone pays the same amount.Example:A poor person making $1000 a month who has to pay a $100 fee pays 10% of their income. They have $900 remaining to budget for the month.A middle-class person making $10,000 a month who has to pay a $100 fee pays just one percent of their income. This person has $9,900 remaining to budget for the month.A wealthy person making $100,000 per months who has to pay a $100 fee pays just one tenth of a percent of their income. They have $99,900 left to budget for the month.Note that this tends to be hard on poor people and almost meaningless to a wealthy person. Each order of magnitude up in income doesn’t increase income by 10x after the tax, it’s greater than 10x.Flat taxes are a flat rate. The percent remains unchanged as the income increases or decreases. The policy here is fairness; everyone pays the same percentage.Example:Our poor person making $1,000 a month paying a 10% tax pays $100. They have $900 a month to live off of.Our middle-class person pays $1,000. They still have $9,000 left to budget for the month. They’re paying in taxes what our poor person makes in a month.Our wealthy person pays $10,000 in taxes, ten times the total income of the poor person and ten times the taxes of the middle class person. They still have $90,000 remaining to budget for the month.Note that our wealthy person has seven and a half times as much remaining for the month as our poor person would make in income in a year if we didn’t tax our poor person at all. Our person in poverty is still in poverty.But, from the perspective of our wealthy person, he’s shouldering the same tax burden as half a dozen other less well-off individuals.Progressive taxes are where the higher your income, the higher your percentage of your income it takes. The policy here is ability to pay; everyone pays what they can afford.Example:Our poor person pays 0% taxes. They have $1,000 for the month to budget.Our middle class person pays 10% in taxes. They still have $9,000 remaining for the month to budget, 9x more than the person in poverty.Our wealthy person pays 40% in taxes, because the math is easy and it’s a nice big number. They still have $60,000 remaining for the month to budget.Our wealthy person is footing a massive tax bill, but still has five times more per month than our person in poverty has in a year. They have as much left over after taxes in three months what the person in the middle class has left over after taxes in twenty.Now, in reality, these are usually taxed in brackets. Our wealthy person isn’t really paying the full 40% in taxes. Assuming our brackets are just between our hypothetical people, they would pay 0% on the first $1,000 per month, 10% on the amount between $1,000 and $10,000 per month, and 40% on the amount over $10,000 per month. The math gets slightly tricky, but the effective overall rate would be somewhere closer to 30% here.Certain flat taxes function more regressively, particularly “consumption taxes” such as sales taxes, value-added taxes, etc. While the wealthy pay the same sales tax on a product, that product and associated tax are a comparatively smaller proportion of their income than for the poor, simply because it’s just not possible for them to consume a proportionately greater share of products than the corresponding increase in their income.The gasoline tax, for example, is a flat tax that functions regressively, particularly on populations that need to drive more as a function of living such as rural populations.These can be hybridized to an extent. For example, one way to make flat taxes more progressive and less impactful on poor people is to exempt a certain amount; say 25% on everything over $50,000. A person making less than $50,000 pays no tax at all. A person making over $50,000 pays 25% only on what they make over $50,000; i.e. if they make $100,000, they pay tax only on $50,000, or $12,500 in tax rather than $25,000.It sadly needs to be explained that this is how marginal tax rates work, which is what progressives are suggesting be raised. Nobody is seriously suggesting that we tax the wealthy at a full 70% total; the first ten million dollars annually would be exempted.First person that starts bitching about Ocasio-Cortez and socialism in the comments because they read that last bit, skipped the rest of the answer, and jumped straight to the comments to argue gets put out the airlock.Higher taxes generally provide very little increased standards of living to the rural poor.Americans, particularly rural Americans, have a few things working against them.First, they’re often less educated in particular when it comes to civics.Not a single member of my family knew the difference between the basic types of taxes. They have vaguely heard of the idea of a flat tax replacing all the various sales taxes and stuff, and they like that idea, but that is the extent of their knowledge regarding tax policy. The argument with my relatives started because they were trying to figure out whether certain retirement account dollars are taxed when they are taken out and how the economy will affect their retirement.Very few people from my home area have any trust or love of government and see it at best as keeping the roads plowed and salted.And they have reasons.[1]Many of them have bought into the idea that gubbmint takes their money and sends it all down to Madison and Milwaukee to the lazy people who don’t work and live fat off the public trough.Whether this is true or not, it feels true to them. Why?You have to understand, where I grew up, most people live hand to mouth and struggle for that. It’s mostly manufacturing and small dairy, both industries that have been especially hard hit in the last thirty years. Milk prices are lower than they were when I was a child, and when you figure in inflation and the increasing cost of overhead (diesel fuel, electricity, etc.) it’s impossible to keep a small dairy running these days. One of the largest manufacturers in my hometown folded and took probably a quarter of the local economy with it.These people are utterly convinced and have been since Reagan that government, particularly regulation, is the problem.The farmers constantly complain about how those idjits in Madison who wouldn’t know one end of a cow from another come out and tell ’em how to do things when any person with common sense coulda toldja that was stupid and costly for no actual benefit.The schools are largely funded by property taxes. In rural areas, who are the biggest landowners? And who are the ones whose land values keep going up? Farmers.My grandfather used to talk about being land-rich, money-poor. And he’s right.Land is a valuable asset, but not a liquid one. So, every year the assessor comes out and tell you that your land is worth 2% more, so your taxes are going up 2%. And you’re sitting there knowing that milk prices haven’t budged, soybeans and corn are down, seed is going up, and you’re out of notches on the tight end of the belt.And then the school says they’re broke and needs a referendum for a new auditorium. It’ll raise your taxes another 1% this year. Another couple of thousand bucks. That could be an acre’s worth of soybean seed.Do those taxes feel enough like a punishment yet?Even if you’ve got kids in school and you know that auditorium is in disrepair or hasn’t been updated since it was built in 1965, how are you going to pay for that tax increase? Sell some land? Sell some cows? Sell some equipment?Most folks where I grew up ain’t got it to spare.So, when that “smug bastard with a ledger comes into town, makes you pay for the privilege of owning something,” yeah, it sure feels like a punishment for having anything of value.Now, add to that the perception that these people feel at least like they’re not getting a fair shake at life and government isn’t doing much to help it.What are they getting? Their roads are crumbling.[2] [3] Their schools are failing if not just plain closing, and teachers are fleeing in droves from rural districts to better paying urban ones.[4] [5] Health insurance premiums and deductibles have continued to go up.[6] Their kids are dying of suicides and overdoses.[7] [8]My people don’t feel like their quality of life is improving with higher taxes.And then some guy from Milwaukee wants to take tax dollars and build a choo-choo that’ll never go anywhere near their farm.[9]That’s what these folks see.Now, it is also true that the rural poor benefit a great deal in ways they don’t consider from the higher taxes. The New Deal built the vast majority of the infrastructure where I grew up. My grandfather remembers when their farm got hooked up to electricity and telephone thanks to the rural electrification efforts. Rural roads all over the state were paved to keep dust out of the milk; there are more miles of gravel roads in one non-dairy county in the western part of the state than the rest of the state combined. The CCC planted millions of red pine hedgerows to slow down the dust storms and erosion in the Central Sands region and practically built the town of Stevens Point. Kids still go to school in buildings constructed through WPA grants.A large tax push in the 1960’s also built a substantial piece of educational infrastructure; the University of Wisconsin System constructed the vast majority of the classroom and dorm buildings for both four-year universities and two-year community colleges in the late 1960’s, and many communities around the state built new elementary and secondary school buildings, particularly in rural areas, at the same time. Many of those rural schools now sit vacant, sold off to private businesses, or converted into local government centers as districts consolidated buildings. (When I was in first grade, I started at a rural school south of town and our class moved to a renovated school in town over Christmas break; the building was eventually sold to a local construction company that still uses it.)Tack on the Farm Bill and agriculture subsidies, the fact that many of those people are in school districts that are well over 50% on free and reduced lunch, many qualifying for the earned income tax credit, and more, and it adds up quickly to rural poor getting far more back in benefits than they pay in.The three major urban centers in the state (Milwaukee, Madison, and the Fox Valley area) generate a significant majority of the state’s revenue, and receive less back than they generate, even after taking into account major road projects such as several recent interstate overhauls.Not only that, but Wisconsin made a deal in 1911 with the municipalities of the state: in exchange for a state law prohibiting cities and municipalities from instituting local income taxes, they would get more state aid. Since the 1990’s, the state legislature has reneged on that deal, and state aid to counties and municipalities has continued to decrease. In 1995, 53% of Milwaukee’s budget consisted of state aid. For fiscal year 2017, it was 36%. Urban areas are losing a greater share of state aid every fiscal year, while paying in more.But rural counties have also been heavily hit.This reduction in local aid was drastically heightened under the Scott Walker administration, who reduced county aid so significantly that many rural counties had to cut mowing county road ditches down to perhaps once in the summer. One county where I have a friend on the county board has had to start asking for farmers to volunteer to mow their areas. The school aid formula hasn’t been updated in nearly 30 years and doesn’t account for transportation costs, which have been hammering rural districts with rising fuel prices to bus kids in from long distances.And that’s with taxes continuing to stay flat or only rise a little bit.Rural health care options have been declining for a long period of time, in part because they aren’t profitable, and in part because some complex procedures just aren’t performed often enough that health care providers are able to keep the staff trained; even birth services are being dropped because of the risk of complications or c-sections.[10] [11] [12] [13] There just isn’t a lot of trust in government to keep things like this from happening.Essentially, these folks might see the cost of their health insurance decrease with a switch to universal health care, since the rural areas are largely already poor enough that they’re heavily subsidized through the current ACA system[14][15], (though they still generally have higher premiums anyway,)[16] but likely wouldn’t see any increase in quality of care.Most of the tax benefit they see just doesn’t seem terribly visible to them, while any increase in taxes is quite visible. Thus, these folks have no reason to believe that their quality of life will increase if they pay higher taxes, even if they could afford it.And ultimately, the tax increase necessary to fund the kind of infrastructure, public utilities and services, and programs such as universal health care for rural populations would be massive if the burden fell on them alone, simply because of population density.Higher taxes don’t improve the standard of living for the already-wealthy.The vast majority of the economic recovery in the United States after the 2008 recession went to a) the largest urban areas of the country, and b) to the already wealthy.[17]For the wealthy, higher taxes are not only highly unlikely to result in a higher standard of living, they’d be prone to decreasing the standard of living that a wealthy person already enjoys.For the most wealthy, what they would receive from social programs such as Social Security is less than a rounding error in their annual income just from carried interest on their assets. The benefit from a buy-in option for Medicare is meaningless when a person can pay for platinum-level insurance plans with the change in their couch cushions, if not simply outright own the hospital.For them, universal health care is probably a step down. They’d likely have to maintain supplemental insurance to cover what they currently have. They’d basically get the same care they get now at more or less the same price, except now it wouldn’t be optional for them to pay in.They benefit somewhat from public investments into infrastructure; after all, what’s the use in driving a Bentley or Beamer around if the roads are terrible? Private jets don’t work as well without GPS and traffic control towers at the airports, even if you have a private hangar.Edit: Kagan Hudayar brought up a couple of very good points about ways that I had not listed that the wealthy benefit from higher taxes put back into national investment. Better infrastructure reduces the friction costs for business - this is why we have an interstate system. (Contrary to popular myth, Eisenhower didn’t come up with it as a way to move military forces quickly; he saw how it improved German industry with its ability to quickly move resources.)Public infrastructure such as transit also reduces employment costs. Employees that can get to work efficiently are more productive for the wage costs, and allows employers to get labor from a wider geographical region, which improves their ability to recruit better workers.Poverty is more heavily correlated with crime than anything else. People in poverty are more desperate, more likely to be willing to turn to illicit means to make things happen. There’s little good in having a million dollar mansion on a hill when you’re afraid to leave it or get robbed. And if things are bad enough, all the security forces in the world are not going to protect you when the mob with torches and pitchforks decides they’ve had enough with the plutocrats.[18]Kagan also worded this better than I think I could paraphrase it:And additionally, the ONLY way the wealthy can keep their wealth and grow it from generation to generation is by ensuring a well educated, well fed, and economically advantaged middle class. It doesn’t matter how I make my money. If the masses can’t buy more and more widgets, my business will shrink, my stocks in companies who sell widgets will diminish in value, and ultimately, we will enter a recession that is impossible to get out of. It seems to me, what the wealthy conservatives actually want is a system more in line with banana republics and under-developed nations. What they fail to realize is that the end-result will also be the same as it has been for these impoverished nations.He’s exactly right. If you want to grow the economy, give money to poor people. They will buy things. When people can’t buy things, the whole system falls apart. The wealthy can only stay wealthy, and continue to grow that wealth, if there is sufficient distribution of it to the rest of the world to support it.That perspective, however, is tempered with the idea that they shoulder the vast majority of the tax burden - as much as 70% of it.[19] [20] [21] [22]That feels heavily unfair to them. As a percentage, they’re basically subsidizing the rest of us poor schmucks.On the other hand, the richest 10% of Americans control more than 90% of the overall wealth.[23]Depending on what side you look at it from, it can either seem totally unfair to place the tax burden on the wealthy, or that they are not shouldering their fair share.One way to look at it is that fewer than 10,000 people control 90% of the nation’s wealth - shouldn’t they pay 90% of the nation’s tax burden? Or, alternatively, fewer than 10,000 people are effectively paying for all of the rest of us to have Social Security and Medicare and don’t benefit hardly at all from those programs.If you’re already wealthy, what perspective would you be prone to taking?This is why they fight tooth and nail to keep the carried interest loophole[24], repeal or raise the exemption amounts for the estate tax[25], use offshore accounts to disguise their assets[26] [27] [28], and to raise the amount of pass-through income for LLPs and LLCs.[29]These people see no standard of living increase from higher taxes, and for the ultra-wealthy, would probably mean having only the smaller yacht to get to their villa in Tuscany for the winter. The shame. What will the Carlisles say?The main people who visibly see a rise in the standard of living from higher taxes are the urban poor and the suburban middle class.The urban poor generally see small percent increases in taxes, but because of the overall concentration of people in one area, tend to get the most benefit from reinvestment back in the community.For example, urban areas are more likely to have public transit systems which make it possible for the urban poor to move about without the costs of owning a vehicle and insuring it. The rural poor do not have this advantage; no car = walking, biking, or getting a ride.To keep public transit systems affordable for riders, they are generally subsidized with tax dollars and are not self-sustaining. So, the urban poor get a comparatively higher benefit from that tax investment.The urban poor are much less likely to be landowners[30][31], and if they are, the value of the properties owned by the urban poor is significantly less than rural landowners simply by virtue of location and size.[32] An urban poor to lower-middle-class person might own a home, but it is unlikely to be larger than half an acre of property or valued at higher than $250,000. A rural poor farmer with almost any acreage very likely has an asset valued at at least as much; a rural poor farmer with 360 acres of total land may have a net worth on paper of several million dollars, but often with very little net income.This significantly impacts property taxes, which are the most common way that local municipalities are funded.The urban poor combined pay a lot in property taxes, in smaller individual amounts, and receive back infrastructure that simply due to density and availability is more tangibly and visibly raising their standard of living.The rural poor, on the other hand, pay larger individual amounts of property taxes that simply due to density issues don’t amount to as much, and end up supporting comparatively less immediately visible infrastructure.Both urban and rural poor would probably benefit significantly from social programs such as universal health care. But, as discussed above, the rural poor are more likely to be significantly distrustful of whether they will actually benefit from that program.The urban poor, on the other hand, are unlikely to be working jobs that have health benefits at all. Universal health care would be an enormous benefit to them, and because of the population density, they are more likely to have access to excellent medical options in metro-area hospitals.The suburban middle class is who really sees a lot of benefit for their tax dollars.Their density is slightly less than the urban poor, but the value of their properties is likely to be double. (This is highly dependent on geography; it is far more true in the Midwest than on the East Coast, for example. But, the overall trend is this direction.) Overall, the combined tax revenue from the suburbs compared to its population density means that almost everything in the municipality is likely to be better funded and require less infrastructure in some ways.For example, suburbs generally do not require a public transit system - most people there are in the lower-middle-class and likely have a car and a garage to park it in. So, that’s one big urban government expense municipalities don’t have to worry about.Smaller population densities means fewer police, fire, and EMS are required to service the same area. Schools can service a greater area without being overcrowded, but without having to extend themselves into such a great area as to require substantial student transportation in order to have enough students to justify having a school at all. Suburbs are dense enough to justify public works infrastructure such as centralized water and sewage treatment, but not so dense as to make such works difficult to construct, maintain, and run.That all means more money per capita that can go into schools, police, fire, and public works and services.Universal health care would be an enormous benefit to the suburban middle. These people are more likely to be working full-time with benefits including health insurance, but are also very likely to have seen drastically rising costs associated with that insurance.[33] [34] [35] This group of people is most likely going to see a significant decrease in overall personal costs if the nation were to move into universal health care. They would gladly pay more in taxes because it would likely mean a greater increase in compensation from full-time employment and less than the projected tax in current payment of deductibles and premium co-pays.Additionally, they’re likely to be close to major metro area hospitals that provide full-service care, much unlike the rural areas that are seeing care options decline significantly, which means that universal health care would provide them with advanced care at a cheaper price than they’re paying right now.All of this combined means a significantly more visibly higher standard of living for a comparatively small tax increase than urban or rural areas.Overall, higher taxes generally tangibly increase the standard of living for the suburban middle class and urban poor, but not for the rural populations or the wealthy.Now, there are lots of ways we can take this into account and tax intelligently to spread the burdens out based on ability to pay, but there simply will be wealth redistribution, particularly to the rural population, for any kind of efforts. It’s just absolutely unavoidable if you want to give them the same or comparable standard of living as suburban populations with a lower population density.But as it stands, just raising taxes would not provide enough revenue to significantly improve the rural standard of living (if placed only on rural populations, at least), raising taxes on the wealthy to pay for improved standards of living for any other population will justifiably feel to the wealthy like they’re subsidizing the standard of living increase for the rest of the population, and raising taxes just in general will most tangibly benefit the suburban middle class and urban poor.I’ll give you three guesses as to which of those two populations are most represented in Congress as Republicans and which two are represented as Democrats, and the first two guesses don’t count.You’ve read a long answer with no pictures. Here, enjoy a picture of a fuzzy kitten as a reward.Mostly Standard Addendum and Disclaimer: read this before you comment, goddammit.I welcome rational, reasoned debate on the merits with reliable, credible sources.But coming on here and calling me names, pissing and moaning about how biased I am, telling me to go push my commie values in Venezuela, et cetera and so forth, will result in a swift one-way frogmarch out the airlock. Doing the same to others will result in the same treatment.Essentially, act like an adult and don’t be a dick about it.Additionally, as aforementioned and because it bears repeating, first person that starts bitching about Ocasio-Cortez and Elizabeth Warren and socialism and taxation is theft! gets the airlock. Walk down the road to Galt’s Gulch and you’re out the door. These are bad faith arguments that have been repeatedly debunked, and I am ornery enough not to put up with it today.If you want to discuss, rationally and with reliable, credible sources, what kinds of tax policy would actually have a meaningful impact on the standard of living, fine. I will even let you argue supply-side economics if you think you’ve got a line of reasoning that hasn’t already been proven wrong by the annals of history, so long as you’re making good faith arguments about it.Also, getting cute with me about my commenting rules and how my answer doesn’t follow my rules and blah, blah, whine, blah is getting old. Again, ornery enough today to not put up with it. Stay on topic or you’ll get to watch the debate from the outside.If you want to argue and you’re not sure how to not be a dick about it, just post a picture of a cute baby animal instead, all right? Your displeasure and disagreement will be duly noted. Pinkie swear.I’m done with warnings. If you have to consider whether or not you’re over the line, the answer is most likely yes. I’ll just delete your comment and probably block you, and frankly, I won’t lose a minute of sleep over it.Debate responsibly.Footnotes[1] Amazon.com: The Politics of Resentment: Rural Consciousness in Wisconsin and the Rise of Scott Walker (Chicago Studies in American Politics) eBook: Katherine J. Cramer: Kindle Store[2] Audit: Wisconsin DOT significantly underestimated highway project costs[3] Infrastructure spending: Which state is falling apart the worst?[4] School’s Closed. Forever.[5] Western Wisconsin Schools Grapple With Falling Status Of Teachers[6] Health Costs A Burden For Wisconsin's Middle-Income Families[7] Wisconsin suicide rate has increased 25 percent since '99, mirroring national problem[8] ER Visits For Opioid Overdose Double In Wisconsin[9] Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com[10] Rural hospitals retreat from delivering babies; small towns pay the price[11] Only 42% of Texas' rural hospitals will still deliver babies: A majority of rural hospitals in Texas are opting to discontinue delivery services as the number of births fall and the cost of providing the service rises, reports the Texas Tribune.[12] Another Thing Disappearing From Rural America: Maternal Care — ProPublica[13] Rural Hospitals Are Dying and Pregnant Women Are Paying the Price[14] Health Insurance Coverage in Small Towns and Rural America: The Role of Medicaid Expansion[15] The Role of Medicaid in Rural America[16] ACA Premiums Costlier in Rural America[17] Poorest Areas Have Missed Out on Boons of Recovery, Study Finds[18] The Pitchforks Are Coming… For Us Plutocrats[19] Diving into the rich pool[20] http://www.aei.org/publication/cbo-study-shows-that-the-rich-dont-just-pay-a-fair-share-of-federal-taxes-they-pay-almost-everybodys-share/[21] High-income Americans pay most income taxes, but enough to be 'fair'?[22] Tax burden on the wealthy has trebled since the 1970s, Telegraph analysis shows[23] Wealth Inequality - Inequality.org[24] What is carried interest, and should it be taxed as capital gain?[25] The GOP wants to repeal the estate tax—here's how to know if that affects you[26] How rich people avoid taxes by parking money offshore (legally)[27] Opinion | How Corporations and the Wealthy Avoid Taxes (and How to Stop Them)[28] Paradise Papers Expose Rich And Famous Using Tax Havens  [29] What you need to know about the Senate's pass-through tax debate[30] The Definitive Guide to Who Rents and Who Buys in America[31] The Incredible Rise of Renting in the U.S.[32] https://www.jstor.org/stable/1017275?seq=1#page_scan_tab_contents[33] Cost of Employer Insurance Growing Burden Middle-Income Families[34] Middle-Income Americans Take The Biggest Hit With Obamacare[35] Steep Premiums Challenge People Who Buy Health Insurance Without Subsidies