I was at a dinner party once when someone said, with complete confidence, that the United States doesn’t have government healthcare. Several people nodded.
I didn’t know where to start.
We have an enormous amount of government healthcare. We have been building it, piece by piece, for sixty years. Most people just don’t know what it’s called or who it covers — because nobody ever sits you down and explains it.
Let me do that now.
The programs, plain and simple
Medicare is the big one. An estimated 63 million people — nearly 19% of the U.S. population — were enrolled in Medicare in 2024, and the program accounted for $1.1 trillion in spending. It covers people 65 and older, plus younger people with certain permanent disabilities. You pay into it your entire working life through payroll taxes. Then, when you turn 65, it’s yours. It has four parts: hospital care (Part A), doctor visits and outpatient care (Part B), private Medicare Advantage plans (Part C), and prescription drugs (Part D).
Medicaid covers low-income Americans — children, pregnant women, people with disabilities, elderly people who’ve exhausted their savings, and adults in states that chose to expand eligibility under the ACA. As of June 2025, total Medicaid and CHIP enrollment was 77.7 million people. It’s jointly funded: the federal government and states share the cost. The federal share alone was $691 billion in 2025. The state share adds hundreds of billions more on top of that.
CHIP — the Children’s Health Insurance Program — covers kids in families that earn too much for Medicaid but can’t afford private insurance. It was created in 1997 and covers roughly 7 million children. It’s included in the Medicaid enrollment figures above, but it runs as a separate program with its own federal funding stream.
The ACA Marketplace is not exactly a government insurance program — it’s a regulated marketplace where people buy private plans, often with federal help. About 22.8 million people enrolled for 2026. The government subsidizes premiums through tax credits. That subsidy cost the federal government $140 billion in 2025. Those enhanced credits expired at the end of 2025, and enrollment is already falling.
TRICARE covers active duty military, their families, and military retirees. About 9 million people had TRICARE coverage in 2024. It’s run by the Department of Defense and provides comprehensive coverage — most active duty members pay nothing out of pocket.
The VA — the Department of Veterans Affairs — runs its own fully integrated healthcare system: hospitals, clinics, doctors, and pharmacies, all government-owned and operated. Over 9.1 million veterans were enrolled in VA healthcare in 2025. The VA’s 2026 medical care budget is $171.2 billion. It is, by definition, the closest thing to socialized medicine we have in this country — and veterans fiercely defend it.
Indian Health Service (IHS) is the one most people haven’t heard of. It provides healthcare to approximately 2.6 million enrolled members of federally recognized tribes. It is chronically underfunded — spending per patient is roughly one-third of what Medicare spends — and it represents one of the most significant gaps in government provided healthcare.
Add it up. The US government is spending well over $2 trillion a year in federal dollars alone on government healthcare programs. Total net federal spending on Medicare, Medicaid, ACA subsidies, and CHIP is greater than spending on Social Security, defense, or interest on the debt.
We already have government healthcare. Enormous amounts of it. The question we should be arguing about is not whether the government should be involved in healthcare — it already is, massively — but whether the system we’ve built is working, who it’s leaving out, and whether the cuts currently moving through Congress will make things better or worse.