This is not because we have no need for it, but because Medicare does not work outside US borders. So we have paid 'out of pocket' for four (4) operations for my wife and four (4) for me. We did not realize, when we went to live abroad, that we would lose this insurance, even though we both are fully vested in it, So now, even living in Mexico - as we do - which is a little cheaper than at home, we have to be very careful with our income from Social Security. Now we are facing another operation (for my wife's meningioma, but we have been postponing it because Medicare does not pay. Going back for the operation to the States is impractical and expense, even with Medicare because then we face the 'out of pocket' expenses Medicare demands, plus travel for us both, and lodging and food for me. I do not know if, and how many, other countries do that to their citizens, but it stinks. A single payer system would cut out the profit motivation in healthcare within the US, and probably would allow Medicare to pay out whereever US citizens are and/or live.