The federal and state governments together finance the healthcare needs of more than a quarter d of the total population at a cost greater than all other government expenditures combined.

The largest single government insurer, covering the medical insurance needs of over forty million Americans is, of course, Medicare. Medicare pays most of the hospital and medical bills not only for the nation's retirees, but also for many disabled individuals of any age, for end-stage renal disease patients, and for both recipients and donors undergoing kidney transplants.

The second major federally-funded healthcare delivery system is the Veterans Administration, which operates a network of hospitals and medical service centers serving the medical needs of millions of veterans and their families, often without charge to the patient. For elderly, indigent veterans, the VA hospital is often their only medical resource, as they do not pay the necessary premiums for coverage under Medicare Part B, which covers medical services and supplies. (Medicare Part A covers hospital and some nursing home costs, and is paid for by a Medicare tax assessed along with payroll taxes on every worker's paycheck).

At the state level, every state funds some level of free healthcare available to low-income or indigent individuals or their dependents within their state, known generically as Medicaid programs. These programs are administered by the states, and funded jointly by each state and the federal government. Some states fund extremely generous programs (generous in scope, not in payment levels), covering a wide range of medical and dental services well beyond just preserving or extending life. Other states limit their medical assistance to their poor to basic care designed to combat active diseases or illnesses, or just basic pre and post partum services to mothers. Most states offer extended health services to minor children if the family's income falls above or below some multiple of the poverty threshold for that state. Emergency and life-saving medical services for non-citizens are also funded by some states' Medicaid programs whether the patient is residing in the country legally or not.

Additionally a number of states support 'charity care' programs that pay for medical services, usually restricted to emergency or life-saving situations, of individuals without any financial means who for one reason or another do not qualify for any of the above programs. These charity care programs are usually funded out of the state’s general revenues.

In the private sector, the range of companies providing coverage of medical bills is a crazy quilt of payers, programs, benefit levels, and healthcare provider participation. There are traditional fee-for-service plans, HMO’s, PPO’s, and EPO’s, along with an almost infinite variety of payment levels and coverage within each of these plans. There are the "Blues", the nationwide network of Blue Cross and Blue Shield programs that cross-honor coverage of members serviced in other states’ coverage area. There are medical insurance plans that are self-funded by employers or labor unions and plans that are offered by hospitals and medical groups to their own employees. Each of these plans is, in turn, broken down into uncountable sub-plans covered by a multitude of subscriber certificates, i.e. contracts.

And last but certainly not least in these months leading up to the 2008 elections, there is the matter of the ‘forty million’ Americans who have no medical insurance at all. Many of these uninsured individuals will most likely have little need to seek medical attention, particularly as this group tends to be younger and healthier than the medically-needy part of the population. Some of the uninsured, and this ‘some’ can number in the tens of thousands or even more, will be overwhelmed by medical expenses that they cannot afford or pay and will be driven into bankruptcy or, even worse, forced to avoid seeking medical care altogether until its too late.

This, in the proverbial nutshell, is the American healthcare system today. Solutions being proposed range from a complete takeover of the national healthcare system by the Federal government with funding out of general revenues to federal deregulation of the private healthcare industry permitting nationwide competition among private insurers to drive down the cost of healthcare insurance.

Like most things in life, the truth most likely lies somewhere in between both extremes.