Whenever Democratic presidential front-runner Bernie Sanders is confronted about the cost of his $ 34 trillion proposal to replace all health insurance with a single government plan, he likes to point to other countries that manage to offer coverage to their populations at a lower cost than the United States.
“Somehow or another, Canada can provide universal healthcare to all their people at half the cost,” the Vermont senator said in the most recent Democratic debate. “U.K. can do it. France can do it. Germany can do it. All of Europe can do it. Gee-whiz, somehow or another, we are the only major country on Earth that can’t do it.”
While there are a number of reasons for the relatively high spending on healthcare in the U.S., Sanders’s invocation of foreign countries is irrelevant when evaluating his sweeping proposal. The reason is that it would go much further than any other system. All other systems have various limits on coverage that are not a feature of the Sanders approach.
Not only does Sanders promise to cover everybody in the country, whether here legally or illegally, but he is promising to do so without premiums, deductibles, or copayments. He is proposing to cover not just basic medical care, but also prescription drugs, vision, dental, and long-term care.
Other countries he cites do not operate the same way.
In Canada, two-thirds of residents have private insurance to cover medical needs not paid for by the government system, including vision, dental, and prescription drugs. At 14%, out-of-pocket-spending was higher there than in the U.S., where it accounts for just 11% of all health expenditures.
In the United Kingdom, the government will deny care to sick patients based on an assessment of how much spending is justified relative to how much a given treatment would extend somebody’s longevity or quality of life. A 2019 study from the Institute of Cancer Research found that 1-in-6 cancer patients there were being denied drugs that had been recommended by their doctors by government rationing boards.
Other systems also do not let illegal immigrants on their government-run plans, as Sanders has promised to do here.
Countries that Sanders frequently likes to cite do not control costs through magical pixie dust. They do so by rationing care to the sick and paying medical providers a lot less.
In the Sanders tirades about the cost of healthcare in the U.S., he frequently attacks the healthcare industry in general, or drug companies specifically. But spending on prescriptions only accounts for 9% of healthcare spending, whereas the majority of spending is on doctors and hospitals. Sanders doesn’t talk about the drastic cuts to payments to both that would be required just to keep the cost of his healthcare proposal to $ 34 trillion.
By way of comparison, U.S. doctors, on average, earn about twice what their counterparts do in the U.K. or Germany; two and a half times what French doctors earn; and nearly five times as much as doctors in Spain, according to a survey by Medscape.
It’s also worth noting that while the U.S. is starting with a larger base and enjoyed faster growth in healthcare spending in the 1980s, since the 1990s, U.S. healthcare spending has been growing at an average annual rate that’s nearly identical to the average of comparable OECD countries.
So when Sanders invokes other countries as proof of concept for his sweeping vision for healthcare, people should keep in mind that other countries make a lot of decisions to limit consumption of healthcare that he does not, and they still have struggled to contain cost growth relative to the U.S. over the past 30 years.