A number of Democratic members of Congress, Senator Bernie Sanders being the most prominent, support a Canadian-style single-payer system where doctors and hospitals are private, but health insurance is run by the government. But my question is, are there any members of Congress who support a British-style socialized healthcare system, where not just health insurance but healthcare providers like doctors and hospitals are part of the government?

Does Congresswoman Alexandria Ocasio-Cortez support such a system, for instance?

  • 3
    The question is a little odd as almost all European countries have free universal healthcare and none of have the British system. Are you really interested in the idiosyncratic British health care system or is your real interest in free universal healthcare?
    – Simd
    Jan 8, 2019 at 2:16
  • 4
    I mentioned this in a comment below, but you have some misconceptions about the British system: primary care under the NHS is delivered by private practices (along with pharmacy and dentistry). Additionally, unlike Canada, the British have a parallel private insurance, primary care, and hospital system which covers ~10% of the population, who opt-out of NHS. Also, unlike Canada, doctors can work in both private and public systems.
    – user71659
    Jan 8, 2019 at 4:34
  • 1
    @user71659 UK NHS GP practices are privately run, but they all operate under an NHS contract. They are heavily tied to the NHS - they cannot provide additional private medical care for instance. The NHS tells them when to jump and how high, and the only recourse for the GP practice is to withdraw from their NHS contract, which is a complicated and messy process. The fact that NHS GP practices are privately owned is an idiosyncracy that dates back to when the NHS was first created - GPs didnt want to be owned by the NHS.
    – user16741
    Jan 8, 2019 at 7:38
  • 2
    @user71659 my wifes an NHS GP - she cant legally work for anyone else when holding an NHS GP practice service provision contract. Those contracts also limit what contracted GPs to the practice can do in a similar vein. The only GP which can flit between NHS and private is a locum. The NHS does indeed allow public specialists to work privately, but the NHS relationship with GPs is entirely different to that of a doctor in a hospital contract - junior doctors under a hospital contract are also required to first offer any hours over 40 to their NHS employer first.
    – user16741
    Jan 8, 2019 at 8:05
  • 1
    @user71659 People don't "opt out" of the NHS, it's funded by general taxation. They purchase additional healthcare privately
    – Caleth
    Jan 8, 2019 at 9:59

1 Answer 1


What the Government Provides Today

In the US as of January 2019, the government provides healthcare both directly and indirectly. Its direct programs (i.e. state ownership and employment of facilities and providers) are exclusively for members of the military, veterans or Native Americans, and are managed by the Department of Defense (through the services themselves), the Department of Veterans Affairs or the Department of Health and Human Services. Indirect care (i.e. health insurance) is provided through Medicare for the elderly; Medicaid for the poor (administered by the several states); Tricare for active duty or retired military; and a patchwork of other programs (e.g. CHIP, SCHIP).

Party Platforms & Politicians

As a party, the Democrats tend to favor either the existing ACA system or a "single-payer"/"Medicare-for-All" plan (which is typically loosely defined). The Republicans, for their part, tend to advocate for a more market-centered plan that relies on federalism and streamlining legal issues. Given the failure of the GOP in the last Congress to coalesce around any particular system, we can only say for sure that they oppose the ACA and single-payer.

Given that there are 435 members of the House and 100 senators, I would guess at least one advocates for or has advocated for a VA-for-all type of system. However, several web searches have turned up nothing. "Medicare-for-All" is a much more common phrase.


Since the question asked about Ocasio-Cortez, during a recent interview with Jake Tapper on CNN, she stated:

Well, one of the things we need to realize when we look at something like Medicare-for-All, Medicare-for-all would save the American People a very large amount of money, and what we see as well is that these systems are not just pie-in-the-sky. Many of them are accomplished by every modern civilized democracy in the Western world. The United Kingdom has a form of single-payer health care, Canada, France, Germany. [Emphasis added]

What does she mean?

The UK, Canada, France and Germany each have quite different models for how they provide health care to their populations. The UK itself has a heavily-nationalized system (albeit with certain private providers) and Canada has a single universal insurance plan (i.e. true single-payer). Furthermore, France and Germany are both "universal multi-payer," with the state paying a large percentage of medical bills and citizens or supplemental insurance being responsible for the remainder. Given that, a fair interpretation is that Ocasio-Cortez is using "single-payer" as a shorthand for all "universal" systems, with the exception of the current universal American system under the ACA.


Without a concrete proposal, we can only speculate on what "single-payer" or "Medicare-for-All" actually mean, but a fair guess is something on the spectrum between France/Germany and Canada. While the UK is sometimes mentioned as having a "single-payer" system, it usually is mentioned alongside Canada and other Western countries, which have diverse health care systems. Few or no politicians are advocating "VA-for-All," which would be the closest American analogue to Britain's National Health Service, so we can fairly assume that direct nationalization only has marginal support in the US.

  • 4
    "we can fairly assume that direct nationalization only has marginal support in the US" - agreed, and with good reason. The US's direct care services -- by which I mainly mean the VA -- have been notoriously problematic, with recent scandals primarily involving excessive waits for care and falsification of records, at multiple VA hospitals. There are some things that the VA reputedly does well, but although Medicare-for-All may have some traction, nothing that smells like VA-for-All is likely to be well received any time soon. Jan 7, 2019 at 20:44
  • 4
    It's incorrect to say the UK has "outright nationalization", it's rather complex. First, public primary care practices (GP) are independent private entities, like in the US (excluding Kaiser), under contract to the NHS. Second, about 10% of the UK has opted-out of the NHS system and purchases private insurance. There exists private hospitals and private primary care. NHS does contract some services to this private sector and vice versa. A doctor can work in both sectors, charging different rates, unlike Canada's "all or nothing" policy.
    – user71659
    Jan 8, 2019 at 0:05
  • 2
    @Andrew The UK general practice system involves essentially no govt ownership. It is however "free at the point of delivery" and taxpayer funded.
    – Simd
    Jan 8, 2019 at 2:18
  • 2
    Correction: In Germany the state doesn't pay a large percentage of medical bills etc; the systems is mostly financed by the insured (and their employers). Jan 8, 2019 at 8:02
  • 2
    @user71659 You do not opt out of the UK NS you can pay to have some things done ut not opt out. e/g/ my parents used NHS for most things but for somethings .g. removal of wisdom teeth used a private hospital.
    – mmmmmm
    Jan 8, 2019 at 10:58

You must log in to answer this question.

Not the answer you're looking for? Browse other questions tagged .