Single-Payer Healthcare is Already Affordable
The US federal government already spends enough on health care to provide decent health coverage to every man, woman, and child legally residing in the country. What we lack is the will to do it. This article is meant to be just a quick illustration with links to more info.
Average total (public/compulsory and private) spending on health care in OECD countries is $3,453 per person.
You can see that the US spends more than twice that. In fact, our public spending alone is higher than the OECD average total. Where does that spending come from?
The largest portion is Medicare, government-sponsored health insurance for residents over age 65, which cost around $583.5B in FY2016 (source). Next is Medicaid, including CHiP, at $348.9B, on which States spent an additional $204.5B (source). Subsidies for households purchasing their own insurance per the Affordable Care Act (“Obamacare”) were estimated to cost taxpayers $110B in 2016 (source). Finally, healthcare-related tax expenditures, including the exclusion of employer-sponsored health insurance from taxable income, cost around $258B for 2017 (source). That brings just government spending to $1.5T a year! ($1.3T if you exclude state-level Medicaid spending.) That means that with a 2017 population around 326.5 million people, the US federal and state governments are already spending about $4,600 per person.
Many people suggest that we spend more because we have better outcomes, but the US ranks 31st in life expectancy. We do rank near the top in many measured health outcomes, but are just slightly better than average in terms of infant mortality. So our health outcomes aren’t bad, but they’re nowhere near proportional to our spending. It’s possible that the uninsured are bringing down the average, which should make the next step obvious.
My point is that plenty of countries get better health outcomes while spending less. Sure, the rich will always be able to pay for private treatment, whether to get better or faster care or both, but the question is what happens to the rest. The current American system rations care just as surely as all the universal healthcare options, not by making you wait, but by income — as in, if you’re poor, or self-employed, or working two part-time jobs…you’re just out luck.
If we instead spread out all the money we’re spending over the whole population, we could improve outcomes across the board. I’m not sure what the best way would be (this series has some ideas), but lots of other countries are doing it, so we have plenty of models to study. Where is our American Exceptionalism? Where is our determination to look at them and make the uniquely American one that’s better than all of them? I don’t know if we could actually get better, but it’s sure worth more of a try than we’re giving it now.
Those people who can afford it or are in a job that provides insurance for them could continue to spend more to get better and/or faster care. But at least then everyone would get something, taking advantage of the old adage, “An ounce of prevention is worth a pound of cure.”
