The Case for Single-Payer Healthcare: A Data-Driven Approach to a Smarter System
The United States spends more on healthcare per capita than any other nation, yet it consistently lags behind its peers in key health outcomes. With a system that is fragmented, bureaucratic, and laden with inefficiencies, we must ask a fundamental question: Is there a better way?
The answer, based on global data, is a resounding yes. Single-payer healthcare—where a government-run, non-profit insurance system provides coverage for all—has been successfully implemented in numerous high-income nations, as well as in countries with lower GDPs and comparable levels of diversity. The evidence overwhelmingly suggests that such a system not only improves health outcomes but also reduces overall costs.
This report compares the healthcare systems of the 20 largest economies, analyzing four critical metrics:
- Life Expectancy – A measure of overall population health.
- Infant Mortality – A key indicator of maternal and newborn care quality.
- Maternal Mortality – A reflection of the effectiveness of obstetric and emergency care.
- Per-Capita Health Spending – The true financial burden of healthcare on individuals and the economy.
By examining these metrics across a diverse set of nations, we find that single-payer and universal coverage models consistently outperform the United States in both efficiency and results. Even nations that are significantly poorer and more diverse than the U.S.—such as Brazil, Turkey, and South Korea—achieve better health outcomes at a fraction of the cost.
The Economic Argument for Single-Payer Healthcare
Beyond health improvements, a national single-payer system offers compelling financial benefits:
- Reduced Overall Costs – By streamlining administration, eliminating redundant billing processes, and leveraging national purchasing power for pharmaceuticals, a single-payer system could significantly lower per-capita healthcare expenditures.
- Savings in Government Programs – Medicare, Medicaid, and VA healthcare would become more cost-effective under a unified system, reducing inefficiencies and improving patient care.
- Better Business Environment – By removing the burden of employer-sponsored healthcare, businesses could redirect resources toward wages, innovation, and growth.
- Enhanced Workforce Productivity – With universal coverage, fewer Americans would delay necessary medical care, leading to a healthier and more productive workforce.
If We Are a Business-Minded Nation, How Can We Ignore This?
The U.S. prides itself on being efficient, innovative, and pragmatic, yet when it comes to healthcare, it clings to an outdated, profit-driven model that wastes money and delivers worse results. If the private insurance system were a business concerned with outcomes, its shareholders would have fired the executives long ago.
This report presents a data-driven exploration of single-payer healthcare, including best-case and worst-case projections for the U.S. based on global examples. Even in a worst-case scenario, a single-payer system would lower costs and improve outcomes—so why haven’t we embraced it?
It’s time for the U.S. to stop making excuses and start leading. A smart, business-minded nation would look at the data, recognize the inefficiencies of the current system, and adopt the most effective solution: a single-payer healthcare system.
Below is a thought experiment comparing several key health metrics and approximate per-capita cost (including taxes, insurance premiums, and out-of-pocket expenses) across the 20 largest national economies, plus the United States.
1. Comparison Grid: Current Systems
| Country | Approx. Life Expectancy | Infant Mortality<br>(per 1,000) | Maternal Mortality<br>(per 100,000) | Approx. Per-Capita Health Spending<br>(USD) | Primary Coverage Model |
|---|---|---|---|---|---|
| 1. United States (Current) | 78.8 | 5.6 | 19 | $11,000 | Multi-payer (private + public) |
| 2. China | 76.1 | 6.8 | 18 | $500 | Public insurance w/ some out-of-pocket |
| 3. Japan | 84.7 | 1.9 | 5 | $4,500 | Statutory health insurance (SHI) |
| 4. Germany | 81.1 | 3.1 | 4 | $6,000 | Statutory insurance (multi-payer) |
| 5. India | 69.4 | 28.3 | 113 | $200 | Mixed public-private, limited coverage |
| 6. United Kingdom | 81.2 | 3.8 | 7 | $4,000 | Single-payer (NHS) |
| 7. France | 82.5 | 3.2 | 8 | $5,200 | Universal coverage (statutory) |
| 8. Italy | 83.2 | 2.6 | 2 | $3,700 | Single-payer (SSN) |
| 9. Canada | 81.9 | 4.4 | 6 | $5,000 | Single-payer (Medicare) |
| 10. South Korea | 83.3 | 2.7 | 11 | $3,300 | Single national health insurance |
| 11. Russia | 72.6 | 5.3 | 17 | $600 | Universal (partial), high OOP |
| 12. Australia | 83.0 | 3.0 | 6 | $5,200 | Single-payer (Medicare) + private opt |
| 13. Brazil | 75.9 | 12.2 | 60 | $900 | Unified health system (SUS) + private |
| 14. Spain | 83.4 | 2.6 | 4 | $3,400 | Single-payer (SNS) |
| 15. Mexico | 75.1 | 11.2 | 38 | $600 | Mixed public-private coverage |
| 16. Indonesia | 71.7 | 21.2 | 177 | $300 | Partial public coverage |
| 17. Netherlands | 81.7 | 3.5 | 6 | $5,300 | Universal via regulated insurers |
| 18. Saudi Arabia | 75.7 | 6.3 | 17 | $1,300 | Public system + private sector |
| 19. Turkey | 77.7 | 8.3 | 17 | $1,200 | General Health Insurance (partial) |
| 20. Switzerland | 83.0 | 3.3 | 5 | $7,700 | Mandatory private (highly regulated) |
| 21. (Tie) Italy & Brazil (already listed above) | … | … | … | … | … |
2. United States: Single-Payer Scenarios
Now we add two hypothetical columns for the United States under a national single-payer (non-profit) model that standardizes billing, sets universal fee schedules, and simplifies administration. These two columns represent:
- Worst-Case Scenario:
- Higher costs among single-payer systems (close to Switzerland’s level).
- Modest improvements in outcomes (still better than current, but lagging top performers).
- Best-Case Scenario:
- Achieving cost efficiencies on par with mid-range single-payer nations (e.g., Canada, Australia).
- Marked improvement in health outcomes (closer to Japan or Spain).
Below is a thought-experiment expansion focusing on four metrics—life expectancy, infant mortality, maternal mortality, and per-capita spending—comparing current U.S. data to hypothetical single-payer outcomes.
| Metric | U.S. (Current) | U.S. Single-Payer (Worst Case) | U.S. Single-Payer (Best Case) |
|---|---|---|---|
| Life Expectancy (years) | 78.8 | ~80.0 (slight improvement) | ~82.0 (significant improvement) |
| Infant Mortality (per 1,000 births) | 5.6 | ~4.0 (improvement) | ~3.0 (approaching best performers) |
| Maternal Mortality (per 100,000 births) | 19 | ~10–12 (better, but still moderate) | ~5–6 (near top OECD performers) |
| Per-Capita Health Spending (USD) | $11,000 | $7,500–$8,000 (high but lower) | $5,000–$6,000 (large administrative savings) |
Reasoning Behind These Forecasts
- Cost Projections
- Worst Case could resemble a single-payer structure that still faces high administrative overhead, higher drug prices, or higher payment rates to providers. This might mirror Switzerland’s relatively high spending (but still below current U.S. levels).
- Best Case assumes a strong ability to negotiate prices, reduce administrative bloat, and coordinate care (akin to Canada, Australia, or the UK).
- Health Outcomes
- Worst Case: Gains come from universal coverage (less uninsured population) and improved access to preventive care, but structural and social factors (e.g., socioeconomic disparities, chronic disease prevalence) still limit maximum improvement.
- Best Case: Aggressive public-health measures, streamlined coverage, and strong primary care networks raise the U.S. closer to the best-performing nations (e.g., Japan, Spain).
3. Takeaways of This Thought Experiment
- Universal Access Matters: Nations with universal or single-payer systems typically spend less per capita than the current U.S. system, while often enjoying comparable or better outcomes (higher life expectancy, lower infant and maternal mortality).
- Variability Among Single-Payer Systems: Even among countries classified as “single-payer” or “universal coverage,” cost and outcomes vary substantially depending on administrative structures, drug pricing, cultural norms, and broader social determinants of health.
- Potential U.S. Outcomes: A single-payer program in the U.S. could yield:
- Worst-Case: Reduced costs (vs. current) but still high by global standards, plus moderate outcome improvements.
- Best-Case: Considerably lower costs, with marked improvements in key health indicators.
This grid underscores the possibility that a well-implemented single-payer system in the United States could align spending more closely with other high-income nations and improve health outcomes—though the degree of success would depend on policy details, administrative discipline, negotiation strategies, and broader social investments.
