Recent polls show a majority of Americans support “Medicare for all,” but few seem to realize that no other system in the world operates like the current single-payer proposals in Congress. Recently, I addressed the concept of single-payer healthcare, with Cuba’s system as an example. Today, I’m writing more about the ideas being discussed now in our country and how those compare to other nations that provide some type of universal care.
There are four significant misconceptions about universal healthcare systems that should initially be addressed:
- Most universal healthcare systems are not highly centralized
- Most universal coverage systems offer narrow benefit packages and incorporate cost-sharing for patients
- Private health insurance plays a major role in most developed countries with universal coverage
- Countries with universal coverage have strict immigration policies to control healthcare expenditures
Bearing these differences in mind, the Commonwealth Fund recently compared universal healthcare systems found in other countries with the U.S. single-payer bills proposed in Congress.
The country that most closely resembles the U.S. proposal, where decision-making is centralized, is France, with the French government responsible for 77% of total health expenditures. There is an out-of-pocket cost share for patients, though it is relatively low (7% percent annually). The Netherlands, Singapore, and Taiwan are also highly centralized. However, they are smaller in scale — with populations similar to those of individual U.S. states — and their relative affluence allows them to sidestep long wait times.
In reality, “hybrid” systems, where decision-making and financing are shared among federal, provincial/regional, or local governments are the most cost-effective way to deliver universal healthcare coverage to a large population. In Australia, Denmark, the U.K., and Norway, policymaking and resource allocation decisions remain centralized, yet there is flexibility within a region to distribute funds in a more individualized manner best suited to local needs.