We spend more for fragmented healthcare than comparable countries do for universal care, and get far worse outcomes.
“Medicare for All” is a phrase with a lot of political baggage, so set it aside. What it describes is simpler: extending a system Americans already built to the rest of the population. This piece uses “universal healthcare” from here on, because that’s what it is.
Medicare works. It covers every American over 65, regardless of employment status or health history. It operates with administrative overhead of roughly 2%, compared to 12-15% for private insurers. It negotiates prices, it pays claims, and it has done so for sixty years. We know how to do this because we already do it.
Healthcare doesn’t work like a normal market.
You can’t comparison shop during a cardiac event. You don’t choose when to have a stroke. Every wealthy country that looked honestly at these conditions reached the same conclusion: healthcare cannot be organized around market competition.
The American system has grown around a different goal. The administrative apparatus — prior authorizations, claim denials, billing complexity — exists to protect revenue, not deliver care. The clinical judgment of a trained physician is overruled by a clerk or algorithm with no medical expertise and every financial incentive to deny.
The clinical judgment of a trained physician is overruled by a clerk or algorithm with no medical expertise and every financial incentive to deny
The U.S. spends over $1,000 per person annually on healthcare administration alone, roughly five times the comparable-country average. Total healthcare spending runs 17.2% of GDP against an 11.2% peer-country average. The outcomes are worse: shorter life expectancy, higher infant mortality, more avoidable deaths than every comparable wealthy nation.
The evidence on universal systems is consistent, and it comes from across the ideological spectrum. A review of 22 analyses over 30 years found that every single one projected net savings from a single-payer system. A Yale study projected a 13% reduction in total spending while covering everyone who is currently uninsured. The Koch-funded Mercatus Center, opposed to the policy on principle, still found approximately $2 trillion in net savings over a decade. The numbers move in one direction regardless of who runs them.
The U.S. spends nearly $5,000 more per person than Switzerland — the second-highest spender in the world — and nearly $7,000 more than the average wealthy country.
We get 3.7 fewer years of life expectancy in return.
Americans built a system that works. It covers everyone over 65, it runs lean, and it has for sixty years. Every other wealthy country looked at the same problem and solved it. We spend more than any of them and get less.
For a deeper look at how the insurance system works and where it went wrong: What Does Medicare for All Mean?
This is a referenced cross post of the article https://lfitzhugh.substack.com/p/universal-healthcare-we-know-how
References
Centers for Medicare & Medicaid Services — National Health Expenditure Fact Sheet
“NHE grew 7.2% to $5.3 trillion in 2024, or $15,474 per person, and accounted for 18.0% of Gross Domestic Product (GDP).”
Health Affairs — Medicare Is More Efficient Than Private Insurance
“Contrary to claims made by John Goodman and Thomas Saving in an earlier Health Affairs Blog post, non-partisan data from the Congressional Budget Office (CBO) and the Center for Medicare and Medicaid Services (CMS) demonstrate definitively that private insurance is increasingly less efficient than Medicare.”
The Hill — 22 Studies Agree: Medicare for All Saves Money
“Christopher Cai and colleagues at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine. Every single study predicted that it would yield net savings over several years.”
People’s Policy Project — Mercatus Study Finds Medicare for All Saves $2 Trillion
“The US could insure 30 million more Americans and virtually eliminate out-of-pocket health care expenses while saving $2 trillion in the process, according to a new report about Medicare for All released by the libertarian Mercatus Center.”
KFF Health System Tracker — How Does Health Spending in the U.S. Compare to Other Countries?
“This chart collection examines how U.S. health spending compares to health spending in other OECD countries that are similarly large and wealthy.”