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.)
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).
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.
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.
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.