With the 2020 Democratic presidential primary season coming into full swing, candidates are putting forward a variety of policy proposals that tackle an important issue on American voters’ minds: healthcare. Democrats won control of the House of Representatives in 2018 in part due to their healthcare policy, so its rise to the forefront of primary debates is not surprising as it could be the key to winning the presidency. From Elizabeth Warren and Bernie Sanders’s “Medicare for All” plan to Pete Buttigieg’s public option plan dubbed “Medicare for All Who Want It,” voters have a wide array of options from which to choose. With over 28 million Americans lacking health care coverage in 2018, the current American system has failed to do what every other developed nation in the world has achieved: universal healthcare (US Census, 2019).
To get a sense of perspective on the candidates’ proposals, we should examine the healthcare systems of other nations throughout the world and understand the similarities and differences between them. No two countries completely share the same healthcare system, and the variety of systems out there indicate that no single perfect formula exists for implementing universal healthcare in America.
Take Canada for instance, a country with universal healthcare that Democratic presidential candidate Bernie Sanders has frequently pointed out. Even though he has repeatedly praised the Canadian model, his Medicare for All proposal (S. 1804) significantly differs from it. His plan would make Medicare a national health insurance system administered by the federal government for people of all ages. In contrast, Canada does not employ a national health insurance system as healthcare is administered by the provinces (the Canadian equivalent of states) which are financed from money grants allocated by the federal government with basic requirements that the provincial healthcare plan be universal, comprehensive and have a not-for-profit motive (Norris, 2018). Medicare for All also differs from the Canadian model as it provides coverage for dental care, vision care and pharmaceutical drugs, none of which are covered by the Canadian public healthcare system. These aspects of healthcare are left to private insurance companies, which are used by 75% of Canadians (Chen, 2018).
While Medicare for All advocates such as Warren and Sanders promote the elimination of private insurance, other universal healthcare countries such as the Netherlands maintain the use of private insurance companies, albeit under different conditions. The Dutch government funds the healthcare system system through public money while the administration and management of it is done by competing private insurance companies who use these funds. Residents of the country are required to opt into one of these private health insurance plans that are usually priced at 1,421 euros (roughly $1500) per year, far less than the average health insurance premiums of $7,188 per year in America (Aldermen Dagblad, 2019; Kaiser Family Foundation, 2018). Just like in Canada, the basic health insurance plans offered by the Dutch system do not include vision and dental care, which Sanders’s Medicare for All covers.
Down under in Australia, Pete Buttigieg’s “Medicare for All Who Want It” finds familiar territory. With a hybrid public-private healthcare system, Australian residents have the option of opting into Medicare–Australia’s universal public health insurance program–or using private health insurance. Medicare operates in a similar way to that of Canada’s healthcare system as the states receive the funding from the federal government and provide the healthcare services (Department of the Prime Minister and Cabinet, Australian Government, 2014). What is unique to Australia’s system is that it provides incentives to encourage the use of private insurance through tax rebates and upholds a penalty surcharge for high income earners who don’t opt into a private health insurance plan. The country’s Lifetime Health Insurance program gives Australians who switch to a private health insurance plan before the age of 31, lower premiums for life (Australian Tax Office, 2019).
Regardless which universal healthcare country you choose, the country’s spending per capita on healthcare remains staggeringly less. America spends over $10,000 per person for less healthcare coverage while other developed countries achieve universal coverage for nearly half that price tag (OECD, 2019). Whether it be a president who supports Medicare for All or a president who supports a public option, it is clear that there lies a long road ahead of them as they must try to confront the inefficacies that plague America’s current healthcare system.
Edited by: Sophia Xiao