Are There “Multiple Pathways” to Universal Healthcare? Evidence from Europe

Are the German and Dutch health insurance systems really private? What would it actually take to transition to a social insurance model? Once and for all, we debunk the myth that we can “build on the current public-private healthcare system” to achieve universal coverage. 

Show Notes

Ben and Stephanie discuss Healthcare-NOW’s recently-completed comprehensive comparison of public healthcare systems in the European Union.

Much to the chagrin of the establishment – Medicare for All is the campaign that won’t die. First in 2016, back when Bernie Sanders dared to run on the policy, the media tried to cancel M4A “puppies and rainbows.” That did not work.

This argument, beloved by wonks, pundits and moderates alike, claims that most EU countries achieve universal coverage without single payer. They accomplish this with competing private health insurance, along with tight regulation and government subsidies that make premiums affordable for everyone. Is this true?

So now instead of arguing against M4A, they’re saying that we don’t have to “blow up” the whole healthcare system to get to universal healthcare, there are “other pathways” that look shockingly like the system we already have: one in which some people have really comprehensive private healthcare, some have an ACA plan with a $15k deductible, some have their healthcare plan as an employee of Hobby Lobby, some have Medicaid, Medicare, whatever.


Depending on how you count them, there are between 30 and 35 countries in Europe. 

  • 27 of those countries have a fully public health insurance system. Either one single fund that’s run by the national government (England, all of Scandinavia, Italy, Spain, Portugal, Cyprus, etc.) or there could be several administrators of the one public plan, like in France or Austria, where you’ve got one government-defined package that is delivered for historical reasons by 4 or 5 big quasi public insurance funds, depending on your occupation. They’re noncompetitive, you don’t choose which system you get in, etc. A sort of corollary to this is Canada. Because of the way the system was developed, it isn’t actually one single national plan but are separate plans administered by the provinces. But we still call it single payer. 
  • 6 countries use a hybrid model, where “sickness funds” or quasi-public, third-party entities provide primary healthcare coverage. In this option, the government assumes the risk, the government pools healthcare taxes and premiums, profits are illegal, and the sickness funds are heavily regulated by a nationally-set benefits package.
  • Only 1 country (Slovakia) runs on a for-profit, private insurer network. (And this is actually in violation of EU law). 

As the movement for Medicare for All has heated up since 2017, and increasing pressure placed on Democrats to support it, centrist/corporate Dems have started fetishizing these 6 countries, portraying them as “the ACA on steroids” and potential models for achieving universal healthcare WITHOUT having to take on the health insurance industry.

Even more troubling, almost every healthcare reporter at every major “liberal” newspaper, radio outlet, and major news blog, has taken the same position – and they’ve been pumping out extraordinarily inaccurate coverage. Respected healthcare journalists like Margot Sanger-Katz, Julie Rovner, Dylan Scott, and Paul Krugman have written multiple inaccurate articles mischaracterizing European healthcare as private, premium-based and universal healthcare system (while in fact they are publicly funded through taxes).

Ben and Stephanie bust myths that are well-loved by moderate Democrats, who claim that Medicare for All is too politically difficult to pass, and we could arrive at our goal with Euro-style private system. These narratives tend to gloss over elements of European plans that are essentially like Medicare for all:

  • Mostly or entirely publicly financed
  • No one profits off of health insurance
  • Publicly-set provider rates
  • Money that’s saved is invested back into the healthcare system, not into profits

The notion that European plans feature private, competing insurance companies similar to the ACA is a total sham. The way that European countries have managed to cover everyone and control costs was by eliminating most market-based, market-driven dynamics in their systems.

Oddly, the only time these narratives came up was when support for Medicare for All makes gains. There is no actual legislation or movement to transition the US to a European-style so-called hybrid system. They’re all anti-Medicare for All talking points, and nothing more.

Please read Healthcare-NOW’s recently published report on European healthcare for much more information, and use it as a resource when you’re talking to your own elected officials. Bust those myths!

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