Between the VA, Medicaid, Medicare, Private Insurance, cash patients, free clinics, HMOs…and then in the prescription world, private insurance, cash discount groups (i.e. GoodRX), store membership programs, and PBMs…America really has literally every type of insurance.

And unfortunately, the systems that the rest of the civilized world realized long ago are the “best” are, in America, the worst implemented and worst funded (state-funded (by a small flat tax) universal coverage and Medicare, which only covers the most sick and frail chunk of the population)…while the least efficient system (Private insurance) is not only the most common in working-age people, but also often either tied to employers or prohibitively expensive (quite a sticker shock looking at COBRA or Marketplace plans before realizing that healthcare is quite often the second most expensive part of payroll, and for low-wage workers may even be the most expensive).

And then there’s the VA, which could be a great system, except the government consistently fucks the doctors and the hospitals and surprised-pikachu’s when it falls on its face over and over again.