Should the United States adopt a universal healthcare system?

Here is the number that ends the 'best system in the world' talk: the Commonwealth Fund's international comparisons rank the United States worst among high-income nations on maternal mortality, by a wide margin. We spend roughly twice what peer countries spend per person and mothers die at rates that would embarrass a developing nation. This is not about rare diseases or exotic treatments, it is about the most basic thing a health system does, keeping people alive through childbirth, and ours fails at it because access depends on coverage, coverage depends on employment, and employment is not a health plan. A universal system would not fix everything, but it would end the absurdity where your zip code and your job determine whether you survive having a baby. Commonwealth Fund

I run a 30-person company, and health insurance is my second-largest expense after payroll. Every year the broker comes back with a 12 percent increase and I have to choose between worse coverage and smaller raises. The Kaiser Family Foundation's annual survey shows the average family premium through employers now exceeds $25,000 a year. KFF. Universal coverage would take this albatross off every small business in America. My competitors in Canada and Germany do not spend their Octobers haggling with insurers; they spend it running their companies. American businesses are at a structural disadvantage because we tied health care to employment in the 1940s and never untied it. Decouple the two and watch entrepreneurship rise.

Americans die younger than citizens of every other high-income country. The Commonwealth Fund regularly ranks the US last among peer nations on access, equity, and outcomes despite spending far more per person. Commonwealth Fund. The UK's NHS and Canada's Medicare are not perfect, and their critics love wait-time anecdotes, but no Briton loses their house over a hospital bill and no Canadian gets a surprise $40,000 invoice. A universal system means negotiating drug prices nationally, which is why insulin costs a tenth as much across the border. We already run universal systems for seniors and veterans through Medicare and the VA. The question is not whether government can run health care. It already does, for the most expensive patients, while private insurers profit on the healthy.

The United States spent about $4.5 trillion on health care in 2022, roughly 17 percent of GDP, nearly double what peer nations spend, and still leaves tens of millions underinsured. CMS. I know a teacher who did everything right, had insurance through her district, and still ended up with $90,000 in bills after her husband's cancer because of deductibles, coinsurance, and one out-of-network anesthesiologist. Medical debt is the leading cause of personal bankruptcy in America. Every other wealthy country figured out that you do not let people go broke for getting sick. We pay more for the privilege of worse financial outcomes, and the only people who benefit are the intermediaries skimming between the patient and the doctor.

Against. In the American system, the government has the ability to tie funds to access to government resources. This is most famously done when the government withheld federal funding to various states unless they adopted a speed limit of 55mph. It was deeply unpopular. The government made a similar play by making it so that individuals under the age of 21 cannot purchase or publicly possess alcohol. Think about that: old enough to vote, or go to war but not able to drink. And the government can do whatever mandates they like after the fact once universal healthcare is adopted. We do not know what various constraints they will implement. However, we already saw what the government will do: the government will withhold life-saving care if you do not submit to government mandates. They demanded people take an unproven gene therapy which required the government definition to be changed THREE TIMES before it could be called a vaccine. And it turns out most of the claims of the vaccines turned out to be false... The government was willing to allow people to be refused or removed from organ transplants, die from neglect, sanctioned doctors and removed their licenses for refusing to follow government mandates even when there were viable alternative medicines. We cannot allow universal healthcare because we cannot trust our health to a government that has repeatedly shown to be motivated by political expediency and actors within that government to be motivated by financial convenience. Private medical policies are by no means perfect, however, government medical policies have been shown to be far more detrimental to national wellbeing.

Run the math honestly. Universal health care means the $4.5 trillion we spend now gets funded through taxes instead of premiums, and analyses of the major single-payer proposals show middle-class taxes rising by thousands a year. The money does not disappear; it moves to the IRS. And look at what single-payer systems ration: Canada's median wait for specialist treatment stretched past 27 weeks in recent Fraser Institute reports, and the UK's NHS has millions on waiting lists. Fraser Institute. Americans are used to getting an MRI this week, not next spring. You can promise universal coverage, but you cannot promise universal, immediate, free care. Something has to give, and it will be timeliness and choice.

The reason the newest cancer drug, the newest surgical robot, the newest mRNA platform comes from America is that our system pays for innovation. The US accounts for a hugely disproportionate share of global medical R&D because companies can earn returns here. Countries with price controls free-ride on American research: they cap what a drug costs while we funded the decade of trials that created it. OECD. A government-run system that sets prices by fiat will do what price controls always do: shrink the pipeline. The next Alzheimer's drug or gene therapy will not be developed by a committee optimizing a budget. If you want the cures of 2040, do not strangle the incentives that produce them.

I get my care through the VA, the closest thing America has to universal government health care, and I have waited four months for a referral that a private clinic would schedule in a week. The VA does good work and I am grateful, but it is also a preview of scale: a federal bureaucracy managing care for 330 million people. The states are already laboratories here: Massachusetts, Hawaii, and others have near-universal coverage through their own designs. Census. Let states keep experimenting instead of betting the entire country's health on one federal overhaul that cannot be undone if it fails. Washington struggles to run a website; I do not want it scheduling my surgery.