Hardly unique to the US. The (well- functioning) health care systems of most European countries are based on insurance. Single-payer government health systems like UK NHS are the exception, not the rule. What is unique to the US, among western countries, is the extent to which private health insurers are unregulated, and the lack of effective government subsidies to offset premium costs where necessary. In countries where insurance is properly regulated, and subsidized at least for those of lower income, the system works fine, arguably better than NHS type systems currently do.