[A version of this article was previously published here]
Americans think that a simple doctor’s visit in Britain means waiting in a Soviet-style bread line. British people think that the poorest Americans can’t afford to go to a hospital if they are sick, while the richest buy ever more expensive but unnecessary interventions.
The debate over healthcare access and affordability is one of the most contentious of the ongoing presidential race. This is partly because of the legacy of Obamacare and partly because of the appearance of a self-defined “socialist” candidate in the race. Democratic candidate Bernie Sanders is running on the promise that his healthcare plan will “leave no one behind.” He wants to establish a federally administered public system that would cover all costs and guarantee care to all citizens. Despite accusations that these plans are economically unrealistic, Sanders is on to a good idea—one that has been proven to work in many European countries for decades.
While the United States has a market-based insurance system where most citizens pay through private insurance schemes, Britain provides free public healthcare to every citizen through the tax-funded National Health Service (NHS). Although the United States has come a long way towards improving coverage with the passage of the Affordable Care Act in 2010, reforms need to go much further if America wants to curb prices and improve public health.
The insurance system is socially unprogressive and wasteful. America spends more on healthcare than the next ten biggest spenders in the world combined. In 2013, spending on health in the United States was 17.1 percent of gross domestic product, the highest of any industrialized country. By contrast, Britain spent just 9.1 percent of its GDP on healthcare in 2013.
Despite huge healthcare spending, America compares unfavorably with other industrialized countries in mortality from common diseases, according to research by the Organization for Economic Cooperation and Development. Since 2000, the United States achieved only a two-year increase in life expectancy, whilst other OECD countries averaged a three-year gain. This poor performance was attributed to gaps in insurance coverage and proper primary care.
The United States can provide a more expansive and inclusive healthcare system for the same amount as Britain and other European countries by moving from the fee-for-service model to a single-payer system. In a single-payer system, a public agency—like Britain’s NHS—organizes healthcare financing. All Americans would be covered for medically necessary services including doctor’s visits, long-term care and prescription drugs.
Countries with the least inequality in healthcare access have the healthiest populations, the OECD found. Unfortunately, access in the United States is far from universal. In 2014, 33 million Americans went without health insurance for the entirety of the year. That’s more than ten percent of the population. The number is even bigger for those who were uninsured for part of the year. The largest groups of uninsured people were immigrants, young adults, and people in the “Medicaid gap” (19 states have not expanded Medicaid eligibility to specific low income individuals after a 2012 Supreme Court ruling made it optional, creating what some people call the “medicaid gap”). By removing barriers to access, universal health coverage would reduce healthcare inequality.
Even those with insurance often face crippling medical costs. The medical journal Health Affairs says 700,000 families go bankrupt each year trying to pay their medical bills, even though three-quarters of them are insured. Many people are under-covered or forego treatment because of high deductibles and co-payments, which force even insured customers to pay for part of their treatment.
A centrally organized system would regulate prices. Compared to their British counterparts, Americans are paying much higher prices for the same care. Basic healthcare services are drastically more expensive in the United States. For example, an MRI scan costs $1,121 in the United States but just $335 in Britain. A hip replacement, one of the most common operations, costs over $40,000 in America but just $12,000 in Britain.
In a single-payer system, the government (and, by extension, consumers) would save on bulk purchases of supplies and streamlined administration. Most importantly a free alternative for services provided by a private company would encourage competition in pricing—saving ordinary Americans money. In a country where unpaid medical bills are the leading cause of bankruptcy, this is an essential reform.
Americans tend to distrust government intervention, but, as the United States is already expanding healthcare access across the board, now is the time for more decisive action. Many of the most attractive countries, like Sweden, Canada, Britain and Japan, have single-payer systems. It’s time for America to join the club.