The many roads to universal health care in the USA

Health-care systems in different countries have evolved along different paths, with some countries offering private insurance, some universal health care, and some a mixture between the two. In most high-income countries, health care is considered a human right and is provided universally, typically free at the point-of-care. The USA has developed a fractured for-profit system that is substantially more expensive than those of its European counterparts and delivers poorer outcomes than the health-care systems in other high-income countries, while leaving a substantial proportion of Americans without health coverage. This Personal View discusses the current health-care system in the USA and offers a roadmap towards the achievement of universal health care for the USA. Three key components of the roadmap are: support and improve the Affordable Care Act; maintain the existing private insurance system; offer in parallel a government-sponsored health-care insurance, or gradually expand Medicare to more people, and ultimately to all Americans not covered under existing health-care insurances.