The United States is alone among developed nations in not yet having a universal health care system, although 2010 legislation has laid the ground for one to be fully functioning by 2014. Healthcare in the U.S. does, however, have significant publicly funded components. Medicare covers the elderly and disabled with a historical work record, Medicaid is available for some, but not all of the poor, and the State Children's Health Insurance Program covers children of low-income families. The Veterans Health Administration directly provides health care to U.S. military veterans through a nationwide network of government hospitals; while active duty service members, retired service members and their dependents are eligible for benefits through TRICARE. Together, these tax-financed programs cover 27.8% of the population and make the government the largest health insurer in the nation.
Roughly two thirds of urban hospitals in the U.S. are non-profit hospitals and the balance evenly divided between for-profit hospitals and public hospitals. The urban public hospitals are often associated with medical schools. For example, the largest public hospital system in America is the New York City Health and Hospitals Corporation, which is associated with the New York University School of Medicine.
Although public hospitals constitute the greatest percentage of non-federal hospitals, care in the U.S. is generally provided by physicians in private practice and private hospitals. Just over 59% of Americans receive health insurance through an employer, although this number is declining and the employee's expected contribution to these plans varies widely and is increasing as costs escalate. A significant number of people cannot obtain health insurance through their employer or are unable to afford individual coverage. The U.S. Census Bureau estimated that 15.3% of the U.S. population, or 45.7 million people, were uninsured at some time in 2007. More than 38% of the uninsured are in households earning $50,000 or more per year. The census also states that 16.7% of the 39.6 million on Medicaid incorrectly reported they were uninsured. A few states have taken serious steps toward universal health care coverage, most notably Minnesota, Massachusetts and Connecticut, with recent examples being the Massachusetts 2006 Health Reform Statuteand Connecticut's SustiNet plan to provide quality, affordable health care to state residents In 2005, the United States spent 15.2% of GDP on health care, or US$6,347 per capita. Of that, approximately 45% was government expenditure.
The U.S. Congress is currently debating many options for further reforming the U.S. health care system.
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