Universal health care is more myth than reality. Medicare for all is a decent step toward it

Millions of Americans live with health care coverage that is either incredibly expensive or poor to nonexistent. It’s no surprise, then, that the push is on throughout the country for some form of universal health care, such as the Medicare for All plan promoted by Sen. Bernie Sanders (I-Vt.). Is the idea of a universal health care system that’s paid for and run by the government and has only trivial out-of-pocket costs truly plausible? I’ve been following health care for some 35 years. So just out of curiosity, I decided to look at European countries with universal health care. They’ve appeared to be the utopian goal for health care for many of us over the years, thinking “If we could only get there!”

I was surprised to discover two unsettling realities. One of them is that there is no such thing as universal health care, if by that we mean full and free health care paid for by the government. The other is that the U.S. is in an odd position. Our government pays a larger per-capita percentage of our health care costs than any other country, yet we have out-of-pocket costs that aren’t greatly out of line with other countries.

Here is a brief summary of data compiled by the Commonwealth Fund of 13 mostly European high-income countries that tells the story. Health care spending as a percent of gross domestic product is highest in the U.S., at 17 percent. That is 50 percent higher than in runner-up France, at 11.6 percent. As in the U.S., all of the European systems have out-of-pocket costs. In this category, Switzerland topped the list, averaging at $1,630 per person per year, followed by the U.S at $1,074. The lowest out-of-pocket spending by far was the U.K., at $321 (see the table below).

When it comes to public financing of health care, the U.S. is the leader, with per-capita spending of $9,086. Yet despite that investment plus modest out-of-pocket spending, life expectancy in the U.S. is lower than it is in any European country. It is also worth noting that one can easily find Europeans bemoaning the state of their health care systems. A 2017 report by the British House of Lords said that “Our NHS, our ‘national religion’ is in crisis and the adult social care system is on the brink of collapse.” Another analysis found that that, “Across the world, universal care is in bad shape.” The greatest obstacle to a Medicare-for-all plan is that it would, not surprisingly, be prohibitively costly. Neither Sanders nor the Congressional Budget Office has calculated its costs.


A recent estimate from the Mercatus Center projected that it would increase the federal budget by approximately $36.6 trillion in its first 10 years, although Sanders and others dispute the findings. Enthusiasm for a single-payer plan has been strong in California, but legislative progress in that direction has stalled because of its projected costs. What I find most disturbing is the comparatively low U.S. life expectancy despite high government spending. The culprit is at least three-headed: inefficiency, high labor and technology costs, and political and other barriers to government control of drug costs and expensive technologies. There is hardly any guarantee that a Medicare for all plan could cut through all those obstacles, or even come close to doing so.

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