Back in 2009, President Barack Obama could have proposed a program as comprehensive as the one initiated by Bismarck. Such a program could have allowed, encouraged, and made it affordable for uninsured Americans to obtain health insurance similar to what members of Congress have; or it simply could have expanded the existing Medicare system for those over 65 to cover all Americans.
2014年1月1日，美国将部分完成一项法律——平价医疗法（Affordable Care Act，ACA），该法不建立国民健康保险，但据国会预算办公室测算，将会让美国没有健康保险的人数下降近一半。若是在2009年，总统奥巴马本可以提出完整如俾斯麦的计划。这一计划或能让无保险美国人获得与国会议员同等水平的健康保险，并将鼓励他们以可承受的负担得到这一福利；也有可能只是把现有覆盖65岁以上人口的医疗保险（Medicare）制度推广到全体美国人。