The US "too big" for universal healthcare.

Is the United States of America “too Big” For Universal HealthCare (like Single Payer) to Work?

Does the Size of the United States Affect its Ability to Implement a Universal Healthcare System?

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.

Some will argue that Australia, and other countries with Universal HealthCare, can’t be compared to the United States due their size (claiming that the nations with Universal HealthCare are smaller than the United States, and thus while universal healthcare works for them, it can’t work for us based on size alone.)[1][2][3]

While it is true that the United States has is bigger than a country like Australia (and most other countries with universal healthcare), the logic behind this argument is not sound (thus the myth that “size” alone can win an argument is easy to debunk with little more than basic logic).[4]

Consider, Australia has about 23 million people, and the United States has about 320 million (very roughly as of 2017).

However, the U.S. has 50 states with populations comparable to other countries.

Consider the logic, 320 million divided by 50 = 6.4 million per state on average.

Then consider states like Rhode Island are on the lower side at about 1 million (hard to argue that can’t work), the mean is about the size of New Zealand (which has universal coverage that works), and on the high-end states like Texas and California have population sizes of places like Canada and the U.K. (and we know their systems work; some say “their quality isn’t as good,” ok we can argue that at another point, but certainly their systems do “work”).

In other words, Universal healthcare works in Denmark with 5 million-plus people, why not in Connecticut with 3 million-plus?

So then, a United States-based federal solution that allowed state flexibility could not only work, but work 50 times over. One universal solution, applied at a state level to suit the tastes and needs of each of our 50 unique Republics, using other similar sized countries as models.

Other solutions: The United States could also simply scale up to a system like Denmark, Canada, or Singapore has. In other words, there is no real reason to think that size should be a factor (i.e. I’m fairly certain the whole size thing is just a talking point; although if you can prove me wrong, please do so in the comments below!) See another take on this Misconceptions: The United States is Not “Too Big” to be More Like Denmark by Benjamin Studebaker.

Are Systems like Australia’s Any Good? Australia outranks the United States by many measures, costs way less, insures more… and even calls its system Medicare. Literally, they have a Medicare for all system, and notably for our conversation have a population equivalent to Texas (both around 25 million). So, it doesn’t beat the U.S. by every measure, but it certainly works and outranks the U.S. by other measures. Learn more about Australian HealthCare from our sister site.

Medicare-for-all means all Australians are covered, and it costs less than U.S. healthcare. Put that on your barby mate.

The point being, although there are countless factors to consider when it comes to universal healthcare, and certainly a Union of 50 states needs a different solution than other nations, the idea that size alone can somehow win the universal healthcare argument is based on unsound logic (and likely originated as a talking point against universal healthcare).

Is Universal Healthcare Government HealthCare? Universal healthcare just means “everyone has access to at least basic coverage.” This can be a market-based system or a fully government-run system. The term universal healthcare, like single-payer don’t describe “government-run” healthcare. There are countless ways universal, single payer, or a public option could work. Learn more about what single payer and universal healthcare are, or see our page on single payer systems for more information on different Universal HealthCare systems. Or compare the following two videos.

Are factors like costs and quality of care better or worse in countries with a universal healthcare system? Some of the highest-ranked healthcare systems in the world are universal healthcare systems. Some systems outrank the U.S. by some measures, some don’t. However, on the measures of “how much does it cost in relation to GDP” and “how many uninsured are there,” the United States notably spends more and has a much higher uninsured rate.[5]

Australian Health Care. Australia has a “Medicare-for-all system.”

The Healthcare System of the United States. Labor markets, the who and what of the conversation.

BOTTOMLINE: It is a myth that universal healthcare systems like single payer don’t work in general (the data shows otherwise), but that isn’t the point of this page. The point is that it is a myth that America is “too big” to have universal coverage. People forget America is comprised of 50 different states. A one-size-fits-all solution might not work, but 50 different versions of universal healthcare, each designed by states for states with a general federal framework, would arguably work wonders! This would allow for all sorts of interesting market-based solutions and would ensure America was #1 again in terms of healthcare (we aren’t even close by most measures).

Single-Payer Health Care: America Already Has It. And to offer another opinion, here are the skeptics at PragerU pointing out that our current Medicare system is a single payer system (America does not however have universal healthcare, and not all universal healthcare has to be government-run)… which makes their argument a little bias. Still, good to have all sides of a story.


In terms of Universal healthcare, size is a factor, but it isn’t a factor that fully applies to the United States due to the fact that we are a Union of 50 different small Republics. This is just basic logic.

This isn’t to say there aren’t other factors to consider, it is just to say, “the idea that we have to ration care based on income and can’t deliver at least basic care to all our citizens, based on size alone, is not a logically sound argument.”


  1. Is the US “too big” for single-payer universal healthcare?
  2. Misconceptions: The United States is Not “Too Big” to be More Like Denmark
  3. The Parts of Medicare A, B, C, and D.
  4. List of countries with universal health care

"Universal HealthCare Can’t Work in the U.S. Due to Size" is tagged with: American Politics, United States of America

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Arthur H. Walker Jr. on

If the USA did not channel so much money to other countries for a number of reasons we could afford a top Medicare system. We should not be isolationists but still we do not need to be involved in so many other countries.
Let’s establish a good Medicare system and the cost that it needs then whatever monies are left over then we could look into what we should spend and other countries.
The money that we spend overseas in military conflicts that in a large part are a lost cause could really help paying towards a better Medicare system in the United States.
Take note I consider myself a conservative.

paul on

well Australia is made of a confederation of 8 states all with there own laws….. still works pretty well here, I work for a private company paid by public health funding…. we don’t even think of it as insurance, we just think of it as health care

Thomas DeMichele on

Interesting, thanks for the insight.

Nick on
Supports this as a Fact.

The devil is in the details.What “flexibility” would be allowed for states? If it’s COMPLETELY left up to each state then I agree it might work as effectively as all other countries, but that would no longer be single payer the healthcare of 320 million people, by definition. The second you give the federal government ANY overarching power over the system it’ll no longer be comparable to how other countries run their universal healthcare.

Thomas DeMichele on

Universal healthcare and single payer aren’t the same exact thing. We use a federal mandate to mandate that states expand coverage to all citizens, but let states implement this how they wish. That is one example of universal that isn’t single payer and isn’t run by the Federal government.

Martyn Baker on

If universal healthcare only works if the states do it separately then that supports the argument that America, as a whole, is too big. Basically the states need more autonomy, they need to become separate countries. If the EU had existed fifty years ago then European countries would not have universal healthcare since the EU is incapable of such organisation.

Thomas DeMichele on

With all due respect, in my opinion: United we stand, I can’t imagine any American being for US-exit. We fought a war over states trying to leave. I don’t see it happening. In fact I think one of the reasons for the success of the U.S. and U.K. is the UNITED part. Only our enemies want us divided.

Cristobal Morales on
Supports this as a Fact.

I’ve read some bullshit in my day but this piece takes the cake! Our national debt is already unsustainable and you are advocating that we are too big to fail despite the estimated cost of over 32 trillion within the first decade! Medicare is already in the tank at $40 Trillion in the red so free health care promoted by socialist would literally destroy the American economy and send this country spiraling into caos and destruction all because some lunatic moron believes it’s possible!

Thomas DeMichele on

This page doesn’t say what you said it says… but if you are talking about the last iteration of Bernie’s plan, I believe it takes what we already spend, cuts the cost a bit, cuts costs for most citizens, expands Medicare (which people already approve of), and would then help to reduce costs over time. I can get back with details on the plan.

Maybe it isn’t perfect, but that is almost an aside here because I am saying we can manage a form of universal like all the other devloped countries, not single payer Medicare for all specifically. My argument is more general.