The US spends the most per capita of any industrialized nation, yet has health outcomes more consistent with those in the developing world. Given the great dysfunction in the American system of healthcare what constitutes meaningful and effective reform? Reforms of the Affordable Care Act (Obamacare) like the Healthy America Program from the Urban Institute and “Medicare–X Choice Act” a 2017 public option plan from Senators Tim Kaine and Michael Bennett will be examined. We will briefly survey the other industrialized countries which have socialized, single payer or multi-payers systems. How is it that the other advanced industrialized countries cover their entire populations and have better health outcomes, all while paying less than sixty percent of what the US pays?