Unlike every other developed country on earth (those with very high human development on the Human Development index) the United States of America does not have Universal HealthCare.

Is the United States of America Really the Only Major Developed Industrialized Country in the World Without Universal HealthCare?

The United States of America is the only “very highly developed country” that doesn’t have universal healthcare out of over 50 nations.[1][2][3]

More specifically, when we look at the top 33 major industrialized and developed countries in the world according to the Human Development Index (which measures “development” based on like GDP, GNP, per capita income, and standard of living), we can confirm:

  • All the top 33 very highly developed countries except for the U.S. have a form of universal healthcare that is generally working to “cover substantially all of their population,”
  • The same is generally true for the top 34 – 51 countries with very high development (with that note that some of the 34 – 51 are in a transition stage, like Qatar, and some have notable problems with healthcare delivery like Russia; meaning some of these countries don’t effectively “cover substantially all of their population” even though they have universal coverage or are moving toward it on-paper).

With that in mind, the list of highly developed countries (who also have some form of universal healthcare) includes: 1 Norway 2 Australia 2 Switzerland 4 Germany 5 Denmark 5 Singapore 7 Netherlands 8 Ireland 9 Iceland 10 Canada 10 United States 12 Hong Kong 13 New Zealand 14 Sweden 15 Liechtenstein 16 United Kingdom 17 Japan 18 South Korea 19 Israel 20 Luxembourg 21 France 22 Belgium 23 Finland 24 Austria 25 Slovenia 26 Italy 27 Spain 28 Czech Republic 29 Greece 30 Brunei 30 Estonia 32 Andorra 33 Cyprus 33 Malta 33 Qatar 36 Poland 37 Lithuania 38 Chile 39 Saudi Arabia 40 Slovakia 41 Portugal 42 United Arab Emirates 43 Hungary 44 Latvia 45 Argentina 45 Croatia 47 Bahrain 48 Montenegro 49 Russia 50 Romania 51 Kuwait.

Not only that, but one can keep going down the list of countries by Human Development Index, and look at all 196 countries, and it won’t be until somewhere mid-way through the high development list that we find a country with as many uninsured as the United States of America.

TIP: To be very clear, the above doesn’t mean that every one of these 50 systems delivers the quality of care the U.S. does, and that doesn’t mean everyone of these systems is “working perfectly,” it simply means every other very highly developed country on earth except the United States of America has some form of universal coverage (on-paper at least).

TIP: Sometimes people phrase this as “the only major country,” “the only developed country,” or “the only major industrialized country.” To avoid being vague, one can say, “of the top 51 countries with very high human development according to the Human Development Index[4], the United States is the only country without a Universal HealthCare system [with the note that a few countries are in the process of implementing their universal systems].” The reason we want to say it like this is because the list also includes countries with “high development,” “medium development,” and “low development” (and semantically we could call any stage of development “developed;” so “major” or another qualifier makes sense to use).  In other words, the factoid we often hear that “the U.S. is the only major/developed/industrialized country without universal healthcare” is very much correct, but its accuracy depends on being specific (after-all, speaking loosely, some “developed and industrialized” countries [“developed” not “very highly developed” countries] don’t have universal healthcare, like Mexico for example; although, to be fair, Mexico is making headway).

What is Universal HealthCare?

Universal healthcare is any healthcare system which provides at least basic coverage to substantially all its citizens (some developed countries use models that cover “almost all” citizens; like Slovakia).

It doesn’t mean that coverage is free, it doesn’t mean all out-of-pocket costs are covered, it is about providing at least basic health services and ensuring against financial catastrophe due to healthcare costs.

TIP: Learn more about Universal health coverage (UHC) from the World Health Organization.

FACTS: According to the World Health Organization in 2016, every year 100 million people are pushed into poverty and 150 million people suffer financial catastrophe because of out-of-pocket expenditure on health services.[5] Before the Affordable Care Act medical debt was estimated to be the number one cause of bankruptcy. Under the Affordable Care Act filings for bankruptcy dropped about 50 percent, from 1,536,799 in 2010 to 770,846 in 2016.[6]

WHO: Universal Health Coverage – What does it mean?.

TIP: To be clear not all other countries have “single payer,” they all have some form of universal coverage. Single payer is not exactly the same as universal.

TIP: Don’t confuse universal healthcare with single payer or a fully socialized system. Some countries with universal healthcare use a public fund (single payer), some use a hybrid system of public and private insurance, some use public healthcare, some use a mix of public and private providers, some simply subsidize the private system.

Healthcare Around the World.

Why Isn’t the United States HealthCare System Considered Universal?

The American healthcare system isn’t universal because it excludes tens of millions of people based on cost.

The Affordable Care Act (ACA or ObamaCare) made steps toward universal coverage, but the states that blocked Medicaid expansion (which expanded basic coverage to those with lower incomes) ensured that the ACA was not able to cover “substantially all” Americans.

Now, with the ACA being repealed, the United States is moving away even further away from universal healthcare.

What the U.S. Can Learn About Health Care from Other Countries.

FACT: In 2017 the CBO and JCT estimated that enacting the Better Care Reconciliation Act of 2017 (the repeal and replace plan for the ACA) would reduce federal deficits by $321 billion over the coming decade and increase the number of people who are uninsured by 22 million in 2026 relative to current law (for a total of 49 million uninsured). 49 million uninsured out of 320 million citizens isn’t just not universal coverage, it is more uninsured than many undeveloped countries.

“As I see it, the task of government in its relation to business is to assist the development of an economic declaration of rights, an economic constitutional order. This is the common task of statesman and business man. It is the minimum requirement of a more permanently safe order of things.” – FDR talking about “Second Rights“.

FDR Second Bill of Rights Speech Footage.

MYTH: The idea that universal healthcare can’t work in the U.S. due to size alone is a myth. The U.S. has 50 states, each with populations equivalent to nations with universal coverage. It is also a myth that universal healthcare isn’t working in other countries, some systems work better than others, but in general countries with universal healthcare have some of the best healthcare in the world (and many spend less per capita than the U.S.).[7]

FACT: Healthcare was declared a universal human right after America helped the Allies win WWII. The U.K. immediately adopted a universal healthcare system (NIH), and most major countries followed suit (including most of the Axis; Germany, Turkey, and Japan, all have universal healthcare). Today in America we still argue over whether or not healthcare is a human right. The side that says it is not won the 2016 election and has sought to dismantle the current healthcare system (which will result in even more uninsured).

What is a Developed Country?

A developed country (AKA an industrialized country with a developed economy) is a sovereign state that has a highly developed economy and advanced technological infrastructure relative to other less industrialized nations.

Although the criteria for denoting a country as developed is a little vague, we can generally point to 39 countries who meet this standard here in 2017 based on factors like gross domestic product (GDP), gross national product (GNP), the per capita income, level of industrialization, amount of widespread infrastructure and general standard of living (see a definition of “Developed Economy“).

Of those who meet this standard, the United States is the only country that doesn’t have a universal healthcare system.

Below is a list of the top 51 highly developed countries (a wikipedia list pulled from the UNDP Human Development Report 2016), literally every country except the United States on the very high human development list has a universal healthcare system.[8]

NOTE: Some of these countries use a hybrid model where basic care is free and better care comes at a cost. With that said, you can google any country on the list with the term “healthcare” and see proof they have some form of universal healthcare system (I did this for every country on the list already, I can confirm they do). The only other notes is that some countries, like Qatar for example, are transitioning into a universal system.[9]

Very high human development (see List of countries by Human Development Index)

For another list, here is the CIA’s list of 33 developed countries [10]

 Andorra  Faroe Islands  Ireland  Monaco  Spain
 Australia  Finland  Israel  Netherlands  Sweden
 Austria  France  Italy  New Zealand   Switzerland
 Belgium  Germany  Japan  Norway  Turkey
 Bermuda  Greece  Liechtenstein  Portugal  United Kingdom
 Canada  Holy See  Luxembourg  India  United States
 Denmark  Iceland  Malta

FACT: According to the World Health Organization UN Member States (many of which are not on the “very high development” list) have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals.


Of the top 51 countries with very high human development according to the Human Development Index[11], the United States is the only country without a Universal HealthCare system [with the note that a few countries are in the process of implementing their universal systems].


  1. Dan Gecker says U.S. only wealthy nation without universal health care
  2. Bernie Sanders: U.S. ‘only major country’ that doesn’t guarantee right to health care
  3. Developed country
  4. the Human Development Index – official list
  5. Universal health coverage (UHC)
  6. How the Affordable Care Act Drove Down Personal Bankruptcy Expanded health insurance helped cut the number of filings by half
  7. List of countries by total health expenditure per capita
  8. UNDP Human Development Report 2016
  9. List of countries by Human Development Index
  11. the Human Development Index – official list

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The strong American ethic of individualism is contrary to universal healthcare coverage. The Calvinist notion persists that God-fearing, hard workers will take care of their own needs. If not, it is due to earned punishment by God. Another factor is the widespread myth that people who don’t work and are lazy, especially minorities, should not be indulged and enabled. The Ayn Rand books package these ideas as survivaĺ of the fittest. The weak are on their own, and that’s just life. Finally, the history of health insurance as a work benefit fuels the myth that only the lazy and on-the-dole Americans don’t have such insurance. Many, if not most, Americans ignore the possibility of catastrophic illness to themselves or family members. Funny how people suddenly impoverished for the rest of their lives due to astronomical medical costs not covered by their
insurance, reconsider and regret their stance agaist universal coverage. Many Americans are willing to gamble that they won’t need health insurance until they are 35 or 40 years old. “I’m alright, Jack. I’ll take my chances.” I hope I live to see universal health care.