Key points
- The United States runs a mixed system: private insurance and public programmes, with no universal system.
- About two-thirds of the population had private coverage in 2024 (66.1%), most of it through an employer; 35.5% had public coverage (US Census Bureau).
- Care is delivered mostly by private providers; public delivery runs through the Veterans Health Administration and the Indian Health Service.
- Nothing is free at the point of use for everyone: Medicare and Medicaid cover their own populations with premiums, deductibles and co-payments, and 8.0% of people were uninsured in 2024 (US Census Bureau).
- Life expectancy at birth was 78.4 years in 2023, and health spending was 17.2% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: The United States runs a mixed system: private insurance and public programmes, with no universal system. About two-thirds of the population had private coverage in 2024 (66.1%), most of it through an employer (53.8% employment-based), and 35.5% had public coverage (US Census Bureau). Care is delivered mostly by private providers. Nothing is free at the point of use for everyone: Medicare and Medicaid cover their own populations with premiums, deductibles and co-payments, and 8.0% of people were uninsured in 2024. Life expectancy at birth was 78.4 years in 2023, and health spending was 17.2% of GDP in 2024 (OECD Health at a Glance 2025).
At a glance
| Item | Detail |
|---|---|
| Model | Mixed — no universal system |
| Who pays | Employer-sponsored private insurance and public programmes (Medicare, Medicaid, CHIP); premiums and out-of-pocket payments |
| Who delivers | Mostly private providers; public delivery via the Veterans Health Administration and the Indian Health Service |
| What is free at the point of use | Nothing universally free at the point of use; Medicare and Medicaid cover their populations with premiums, deductibles and co-payments |
| Life expectancy at birth | 78.4 years (2023, OECD Health at a Glance 2025) |
| Health spending | 17.2% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | Commonwealth Fund — United States country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
The United States has no single health system. Instead, several systems run side by side. Most working-age people get insurance through their employer, which pays part of the premium and the worker pays the rest. People aged 65 and over, and some people with disabilities, are covered by Medicare, the federal programme established in 1965. People on low incomes may qualify for Medicaid, the joint federal-state programme also established in 1965, or for the Children’s Health Insurance Program (CHIP). Others buy a plan directly, often through the marketplaces created by the Affordable Care Act of 2010. Veterans can use the Veterans Health Administration, and Native Americans can use the Indian Health Service.
The Affordable Care Act cut the uninsured rate from about 16% in 2010 to about 9% in 2016, mainly through the marketplaces and Medicaid expansion. As of 2025, 10 states had not adopted Medicaid expansion, leaving a coverage gap for some people on low incomes in those states. In July 2025 the One Big Beautiful Bill Act cut federal Medicaid funding by $793 billion over ten years, and the Congressional Budget Office projects it will add 7.8 million uninsured people (Commonwealth Fund).
Who pays, and what people pay
The money comes from employers, workers, taxpayers and patients. Employer-sponsored insurance is the largest source of cover: 53.8% of the population had employment-based insurance in 2024, and 66.1% had some form of private coverage (US Census Bureau). Public programmes covered 35.5% — Medicare 19.1% and Medicaid 17.8% in 2024, with some people covered by both. The shares add to more than 100% because some people hold more than one type of cover. Out-of-pocket spending was 10.9% of total health spending in 2023 (WHO Global Health Expenditure Database), a smaller share than in most countries in this set — but because total spending is so high, the amounts people pay are large in absolute terms.
What is free, and what is not
Nothing is free at the point of use for everyone. What a person pays depends on which programme or plan covers them: a Medicare beneficiary pays premiums, a deductible and co-payments; a Medicaid beneficiary usually pays little or nothing; a person with employer insurance pays a share of the premium plus deductibles and co-payments that vary widely by plan. People without insurance pay the full bill, or go without care: 8.0% of people were uninsured in 2024, about 27 million people (US Census Bureau). The boundary between what is covered and what is charged is set plan by plan, not nationally.
How it compares
The United States spends 17.2% of GDP on health — the highest share in this set and well above the OECD average of 9.3% — and $14,885 per person, more than twice the OECD average of $5,967 (USD PPP, 2024). Yet its life expectancy of 78.4 years is the eighth-lowest among the OECD profiles in this set — tied with Poland — after Mexico (75.5 years in 2024), Latvia (75.6), Hungary (76.7), Türkiye (77.3 years in 2022), Colombia (77.5 years in 2024), Lithuania (77.6) and the Slovak Republic (78.2) and 2.7 years below the OECD average of 81.1 years (OECD Health at a Glance 2025). Its distinguishing feature is the absence of a universal system: the only OECD profile in this set with no universal system — Ireland’s hospital care is universal, though free GP care there is means-tested — where whether a person has cover at all depends on employment, income, age or state of residence, and where a substantial share of the population has no cover at all. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Does the United States have universal healthcare?
No. There is no single system covering everyone. Most people get cover through an employer, a public programme such as Medicare or Medicaid, or a plan bought directly; 8.0% of people were uninsured in 2024, according to the US Census Bureau.
What are Medicare and Medicaid?
Medicare is the federal programme for people aged 65 and over and some people with disabilities. Medicaid is the joint federal-state programme for people on low incomes. Both were established in 1965.
Why does the United States spend so much on health?
It spends 17.2% of GDP — the highest share in this set — and $14,885 per person in 2024 (OECD Health at a Glance 2025), with prices, administration and the mix of private and public payers all contributing. High spending does not by itself mean better outcomes: life expectancy was 78.4 years in 2023, the eighth-lowest among the OECD profiles in this set — tied with Poland — after Mexico (75.5 years in 2024), Latvia (75.6), Hungary (76.7), Türkiye (77.3 years in 2022), Colombia (77.5 years in 2024), Lithuania (77.6) and the Slovak Republic (78.2).