A recurring complaint in American political discourse is the short-comings of the healthcare system in the US.  There are frequent cries for the government to do more to improve the system, with a significant faction desiring government-run healthcare of some sort.  This faction often compares the system in the United States negatively with systems in other countries, most frequently comparing the US healthcare system to the universal healthcare systems in Canada and the UK.  It is often said, hyperbolically, that the US doesn’t spend anything on the healthcare of its citizens.  The complaint that the US doesn’t spend money on the well-being of its citizens commonly arises in the context of discussions on military and foreign aid expenditures, with people lamenting that if only we did not spend the money elsewhere then we could spend it on ourselves here.  The fact of the matter is that the US does spend a significant amount (almost three-quarters of its budget) on purportedly helping its own citizens, as was discussed in the last feature of this series (link).  This generous spending extends to healthcare, so I thought it would be interesting to do a quick back of the napkin comparison of US government spending on healthcare to that of other governments’ spending on healthcare, to see how it measures up.

A fair comparison of government healthcare spending would consider the matter on a per-capita basis, so that is what I set out to find.  To compare the spending of the United States with that of the United Kingdom and of Canada, I used reports of their total healthcare spending in 2021 (source US, source UK, source Canada), converted to dollars using a currency conversion for the date Dec 31, 2021 (source), and divided this by their population (source).  Additionally, I also converted the local currency to Purchasing Power Parity (PPP) dollars using the ratios calculated by the OECD (source) and calculated this on a per capita basis as well.  The results are in the table below.

The result of this comparison is that the US federal government already spends as much or more money on healthcare for its citizens than the national governments of the UK and Canada, with their much vaunted universal healthcare systems.  Not only is the US not being less generous towards its citizens than its peers, given the amount of spending it already does it could already provide a universal healthcare system of similar quality to its peers.  The fact that it does not do this, despite the incessant clamor for a universal healthcare system among certain factions, points to the very real possibility that the citizens of the US would not be content with a healthcare system that matches the quality of that provided in the UK and Canada.  I suspect that for all the complaints of high prices of medical care in the US (and I would be among those complaining) that these prices do in fact buy greater services than can be found in a universal healthcare system the likes of which Canada and the UK provide.  If the US government were capable of providing a universal healthcare system that would satisfy its citizens on a budget similar to what its peers expend, it could already do so, as it already spends that much.  The fact that it doesn’t do so indicates, in my opinion, that it cannot.

Out of further interest I decided to expand the comparison to other countries that are often cited as having good healthcare systems or good healthcare outcomes for their citizens.  This was more difficult, as expenditure amounts were harder to find, so I often had to resort to reports from newspapers and some of the numbers available were suspiciously low.  To provide a check on this, I also included the numbers calculated by the OECD (source), but the caveat here is that they do not disaggregate government healthcare spending from compulsory private healthcare spending.  Perhaps this is the best way to look at it, as the various countries do have very different methods for structuring their healthcare systems, so this type of accounting does provide a comprehensive overview.  In any case, the results are below.

It is clear that the US government is one of the leading nations for government healthcare spending per-capita, and when the compulsory private spending is included (as per the OECD) there is no other nation which comes close.  The US healthcare system is already very well funded by government mandate, so the only conclusion to be drawn, in my view, on the question of healthcare in the US is that no more money need be expended, but that any remaining issues can and should be resolved through other reforms.