- We are often told by advocates of universal government health care that “other developed nations have universal coverage, and they spend less and get better health outcomes”
- This claim is designed to persuade people that universal coverage would fix what ails the U.S. health care system
- Under even minimal scrutiny, however, these claims fall apart
Note: A similar version of this article was originally published by Law & Liberty.
The affordability issue is taking center stage in national political discourse this year. Foremost in this debate is what to do about our health care system, which nearly everyone agrees is unaffordable for far too many.
Those who point to government intervention as the main culprit in rapidly rising costs and advocate for market-based reforms, however, have become quite familiar with this common objection: “every other developed nation has universal (government) health care coverage, and they spend less and get better health outcomes.”
This comment is used as evidence that the U.S. should increase government control over our health care system. Because if it works in all these other countries, it will work here. Who doesn’t want better outcomes and lower costs?
But is this claim true?
When you scratch beneath the surface, you quickly discover that the claim lacks credibility.
First, the claim of other countries enjoying better health outcomes is very dubious. The main, and often only, data point raised is life expectancy. It is true, according to recent data reported by health policy analysis group Peterson/KFF, that “Americans had a life expectancy of 78.4 years, compared to an average of 82.5 among peer countries.”
But is that proof positive of superior quality of the delivery of health care thanks to those other nations’ universal coverage?
Not exactly. Determinants of life expectancy can’t be reduced exclusively to “health system quality.” Not even close. Instead, such measures are heavily influenced by nonmedical causes of death — including higher rates of death at a young age — attributable to how people live and other societal factors.
For instance, a 2019 study by The Commonwealth Fund of developed countries found that “The U.S. has the highest obesity rate among the countries studied — two times higher than the OECD average and approximately four times higher than in Switzerland and Norway.”
Peterson/KFF also reported that “the U.S. diabetes death rate is about 2.5 times that of comparable countries.” Obesity is a leading cause of diabetes.
This discrepancy is more a reflection of the U.S. food supply along with dietary and lifestyle choices of people, not the health care system itself.
Moreover, Peterson/KFF reports that “Another 12% of the difference between the U.S. and its peers’ premature death rates is due to substance use” and also that “homicide and transport accidents (which includes car, bicycle, motorcycle, pedestrian and aircraft accidents) in the U.S. also had more than triple the death rates of peer countries.”
A 2022 Commonwealth Fund report observed, “The U.S. is an outlier in deaths from physical assault, which includes gun violence. Its 7.4 deaths per 100,000 people is far above the OECD average of 2.7, and at least seven times higher than all other high-income countries in our study, except New Zealand.”
People point to the relatively small difference in life expectancy to “prove” that other developed countries have better health outcomes. But much, if not all, of that difference can be attributed to lifestyle and societal factors like diet, car accidents, and gun violence, not the health care system itself.
There’s much more analysis that could be applied to the flaws in these comparisons, but the above examples will suffice for this article.
Now I’d like to explore some often-cited examples of countries with universal health care supposedly enjoying superior levels of care at low cost. Are these countries really the utopias they are made out to be?
Canada
Given their close proximity and frequent reference as a universal health care success story, it’s worthwhile to take a closer look at our northern neighbors.
Turns out the picture is not so rosy after all.
In a January 2025 interview, the head of the Canadian Medical Association said about their health care system, “It’s very clear that the system is still in crisis. There’s a lot to be frustrated about.”
Unsurprisingly, the universal system that provides care for 99.7 percent of Canadians free at the point of service for “most essential medical treatments” along with most other typical treatments like doctor visits and hospital stays, is struggling with wait times.
With no cost at the point of service, there’s little limit to the demands people will put on the system.
This 2025 report by Canadian think tank Fraser Institute revealed that “physicians across Canada reported a median wait time of 28.6 weeks (7 months) between a referral from a GP (general practitioner) and receipt of treatment” (emphasis added). The problem has been growing unabated, with current wait times “208% longer than the 9.3 week wait Canadian patients could expect in 1993.”
A 2023 Venture Surgical survey on wait times reported an astonishing 1.2 million patients waiting for procedures — roughly 3 percent of the Canadian population at the time. Nova Scotia reported the longest wait times for surgical care at 56.7 weeks.
These delays have real consequences for patients. This 2025 health index report discovered, “More than one-quarter (27%) report worsening health due to not seeing a doctor sooner, and 1 in 5 (19%) have been admitted to a hospital because of long waiting times.”
Canadians pay heavy taxes to pay for their universal care, but when it’s needed it is scarcely available in a timely manner. Instead of paying for services, they pay in time, pain, suffering, and missed work due to severely delayed care.
Wait times are exacerbated by underinvestment in the availability of care. This 2020 Heritage Foundation paper reported, “Canada has 35 percent fewer acute care beds than the U.S., and only one-fourth as many magnetic resonance imaging (MRI) units per capita.”
A 2024 National Post article reported that, according to a national survey, “6.5 million people in Canada, more than one in five, don’t have a family doctor or nurse practitioner they can see regularly.”
The lack of available care in the government system has more Canadians seeking alternatives. Despite 99.7 percent of Canadians being covered by the universal system, nearly three-fourths of Canadians have supplemental insurance through private markets. “Canadians use private health insurance to cover potential expenses not covered by the public healthcare system, which include prescription medicines, vision care, dental care, and ambulance services,” according to this Made in Canada article.
A growing number of Canadians are also opting to pay out of pocket for private surgical procedures.
Not only are Canadians so desperate for alternatives that they’ll pay out of pocket for coverage and services — in addition to the taxes they have to pay to prop up the government system — but many are leaving the country to find timely care.
Medical tourism is so prevalent the Canadian government itself offers guidance on traveling to other countries to receive medical care.
Indeed, just across the border in Detroit, Michigan, Henry Ford hospital has a page on their website dedicated specifically to welcoming patients from Canada.
Imagine how bad this universal system must be for people to literally flee to other countries and pay out of pocket for travel expenses — in addition to the medical care itself — when they can get the care “free” at home.
And how is this universal system doing at keeping costs down? This 2025 Canadian Institute for Health Information report showed that total spending on health care more than doubled from 2010 to 2025, exceeding the pace of inflation by 47 percentage points.
Intolerable wait times, shortages of medical practitioners and equipment, patients so desperate that they leave the country for care, and spiraling costs that place ever increasing strain on taxpayers characterize this system. Yet American progressives want you to believe this is a system worthy of adopting here.
In Part 2 of this article, I’ll continue to expose the truth behind universal care in England, Sweden, and other countries.
