Is the USA the only developed nation without a “single payer health system?”


When Bernie Sanders stumps around the country he commonly says that the developed world operates under “single payer health systems.” The United States is the odd man out. Single payer healthcare, of the sort Bernie Sanders proposes, isn’t “universal” in the developed world. A single payer healthcare system is one where a single entity, a government-run insurance plan, pays all bills for medical care, and private payment for these same services is, for all intents and purposes, banned.

[Source: No, the Rest of the World Doesn’t Use “Single Payer,” by Eli Lehrer]

[From the Lehrer article] Among the G-7 countries, only one nation, Canada, actually maintains such a system. (However, a majority of Canadians have some form of private health insurance, typically provided as a benefit by employers – RF). One other, Italy, has a pretty similar system but allows much more private payment, and, because of the low standards of public hospitals, nearly everyone who can afford private insurance carries it.

 (Further, Canadians with private health insurance not uncommonly cross our northern border to avail themselves of US medicine and short waiting lines. For example, in one study, the nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment in the US in 2011, as wait times had increased 104 percent. As well, the premier of Canada’s east coast province underwent heart surgery in the United States because the treatment he was seeking was not available in his home province – RF).

Japan maintains a government-run healthcare plan, but it has so many gaps that most families find a need to carry private insurance to cover things like cancer-treatment related costs the public system excludes.



Germany, like the United States, has an employer-state hybrid system with heavy regulation of insurance companies.



France has a “dominant payer” system, where one quasi-governmental entity (CNAMTS) pays many bills, but about 90 percent of the population maintains private coverage as well, and most people pay something out of pocket each year.


The United Kingdom, finally, directly administers almost all medical personnel and facilities through a single governmental entity in each of the home countries. This is a “single provider” system.



There are significant numbers of people in all of these countries who report problems paying for needed medical care. This percentage is higher in the United States and Germany, intermediate in France, and lower in Canada. The UK only achieves its apparently enviable results because of long waiting lists for many procedures and health care rationing systems that are pretty close to the “fictional death panels.”

So let’s get the facts straight, Bernie.

Roy Filly

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About Roy Filly

Please read my first blog in which I describe myself and my goals.
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