The payment of contributions is different depending on regions and the health insurance payer.

At a minimum, Western governments and corporations should not be complicit. Every bribe that is taken has a payer, and too often the bribe payer is a corporation from an advanced industrial country or someone acting on its behalf.

The specific form of non cash transactions and the transaction documents between the payer and the recipient of the funds is determined independently, depending on the contract (agreement) concluded.

Canada has a single public payer but mostly private providers. Obamacare establishes a public mandate to buy private insurance (with public subsidies for the poor) to finance services provided by (mostly) private hospitals and clinics.

The wait to insure option could cause the number of insured individuals to decline rapidly as premiums rise for those who remain insured. In this scenario, the unraveling of Obamacare could lead to renewed political pressure from the left for a European style single payer health care system.

Hence the necessity of something like the individual health insurance mandate of the 2010 Patient Protection and Affordable Care Act ( Obamacare ), or of biting the bullet and adopting a single payer system for financing health care. Either way, America needs to gets something comparable to other OECD countries value out of its enormous health care expenditures.

This was originally a conservative approach. The two major alternatives to it are much further removed from the marketplace a single payer system, as in Canada (or America s Medicare system for the elderly), with the government providing health insurance, or socialized medicine, as in the United Kingdom (or the US Veterans Health Administration), with the government providing health care directly.