Compare the Affordable Care Act with the German Bismarck system

The Affordable Care Act launched the first major expansion of health care social welfare legislation since the prescription drug benefit enacted in 2003 . It initiated a multiyear overhaul of the health-insurance industry, which by 2018 will extend coverage to nearly all American citizens. This law, which requires Americans to purchase health insurance, will extend coverage to 32 million uninsured people by expanding Medicaid rolls, establishing new health-insurance exchanges to provide more competitive rates, and providing subsidies to the poor and middle-class families to assist them in purchasing a private plan. The law will outlaw many methods health insurers use to avoid paying people's health care expenses and will substantially expand health insurance coverage in the United States. It will impose billions in new taxes, mainly on the rich and the health care industry. Even with this reform, the U.S. will still have the most complicated, most expensive, and the most inequitable health care system in the developed nations. With the Bismarck model, providers and payers are private entities. On the surface, this model looks familiar to Americans. The plan uses for-profit by employees and employers through payroll deductions. However, unlike American health care insurance plans, these non-profit entities are basically charities and cover everybody. Doctors' offices are private businesses and many hospitals are privately owned. This is a multipayer model, with about 240 different insurance funds that compete for customers. Cost-control within these funds is gained by the government's tight regulation of medical services provided and allowable fees.