Medicare for All? Lessons from Abroad for Comprehensive Health-Care Reform

EXECUTIVE SUMMARY

The “Medicare for All” proposals espoused by various Democratic presidential candidates vary greatly in terms of benefits, provider payment arrangements, and the role of private insurance. In some versions, the government is the sole purchaser of medical services; in others, a publicly financed system would allow individuals to choose between a government plan and competing private insurers; in still others, a publicly managed option would be added to the wide variety of insurance and entitlement programs that already exist. There has also been a lively disagreement about whether individuals should be allowed to purchase private insurance to obtain better care than is available under a publicly financed plan.

In their variety, the various Medicare for All proposals reflect the diversity of arrangements by which medical care is financed in the Western world. In order to better evaluate U.S. Medicare for All proposals, this paper examines the varied roles that eight developed countries (including the U.S.) have afforded to private resources and insurance competition within their health-care systems.

There are four broad models:

• Single payer (Canada and U.K.): the government is the predominant purchaser of medical services.
• Dual payer (Australia and France): the government is the primary purchaser of medical services, with widespread private supplemental health insurance.
• Competing payer (Germany, the Netherlands, and Switzerland): the government publicly subsidizes individually purchased health insurance.
• Segmented payer (U.S.): a patchwork of employer-sponsored insurance, public entitlements, and individually purchased health insurance.

This report concludes that, across these eight countries, the ability of citizens to obtain expensive medical procedures tends to increase in proportion to their ability to purchase insurance for medical care beyond what public entitlements cover. Single-payer systems, which restrict the ability of individuals to purchase private insurance, deliver consistently worse access to specialty care or surgical procedures—without reducing individuals’ overall out-of-pocket health-care costs. Relative to countries that restrict private insurance, the U.S. provides good access to high-quality care, but individuals who fall in the gaps between employer-sponsored insurance and public entitlements are at risk of high costs. Systems that seamlessly integrate competitive private insurance with well-targeted public subsidies prove best able to make use of private resources with minimal gaps in coverage.

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https://www.manhattan-institute.org/using-lessons-from-international-health-care-medicare-for-all