One of the most common concerns about the implementation of a universal healthcare system, sometimes called Medicare for All, is that wait times will increase drastically under a government-run system. The President himself has made many comments to this effect, including on the White House website, stating that “Medicare-for-All would force patients to face massive wait times for treatments and destroy access to quality care.” Anecdotes abound on both sides of the issue: Canadians waiting months in agonizing pain for a hip replacement, a young American man dies because he can’t afford his insulin. But what is truth and what is fiction?

Universal Healthcare Around the World

Universal Healthcare is defined by the WHO as a healthcare system in which all citizens are guaranteed access to healthcare without risk of financial hardship. Since 1948, it has been considered by the UN to be an essential human right. There are over 100 countries in the world with policies for universal healthcare, thought the Organization for Economic Cooperation and Development (OECD) recognizes only 18 that have achieved true, 100% coverage: Australia, Canada, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, the Netherlands, New Zealand, Norway, Portugal, the Slovak Republic, Slovenia, Sweden, Switzerland and the United Kingdom. But Universal Healthcare is not a catch-all diagnosis. Every country’s policies are different, tailored to that country’s values and population. But it is possible to sort them into three general categories.

The first and best-known model is the single-payer system. Funded by taxes, a local, regional or national health system provides all healthcare to the population in countries like the United Kingdom, New Zealand and Sweden.  This system is most comparable (though not identical to) to the ‘Medicare for All’ plan proposed by Democratic Presidential candidate, Bernie Sanders. But this is not the only path to Universal Healthcare. The Netherlands and Switzerland utilize a regulated healthcare market, also known as Social Health Insurance. Like the Affordable Care Act, or ‘Obamacare,’ this model requires everyone to buy private health insurance, but controls insurance prices through the government. Finally, a National Health Insurance plan utilizes a public insurance system to pay for private healthcare services. Utilized in Canada and Germany, this system is the model for the current Medicare system in the USA. According to a recent study by the CommonWealth Fund, private health insurance can be incorporated into all of these models, and that many countries utilize a mixture of healthcare systems. Australia for instance utilizes a single-payer system, but allows those who can afford it to purchase private insurance to ensure higher quality and faster care. The wide variety of different healthcare systems makes direct comparisons difficult, but it is important to first understand where we, as Americans, fit into this system.       

Compared to the USA

The United States spends more on healthcare than any other country in the world, but this doesn’t mean Americans are any healthier. Utilizing a mix of private and public insurance, 67% of Americans receive insurance through the private sector, mainly their employer, according to the US Census Bureau. 37% who receive government insurance through Medicare, Medicaid, military or other government services. However 9% of Americans, over 44 million people, have no health coverage at all. Of those with insurance, an estimated 38 million are underinsured, meaning that they have high-deductible or coinsurance plans which cause them to struggle with payments or skip treatment altogether. This creates a two-tiered system, in which those who can afford insurance enjoy access to high-quality private healthcare, while those without are forced to do without.    

Wait Times

Average wait times are broad indicators of the quality of a healthcare system. It can include wait times to see Primary Care Physicians (PCPs), time to imaging, or even time to an elective procedure. A 2017 study utilized wait times as one of more than 70 indicators of healthcare performance, comparing the US to ten other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. In this study, the US ranked dead last in access to medical care, equity and healthcare outcomes. On measures of timeliness, it ranked third to last, behind Canada and Sweden. On some indicators, however, the US did quite well. It ranked 4th for fewest patients waiting more than 2 hours in the emergency room; 2nd for fewest patients waiting 2 or more months to see a specialist; and tied for 3rd for fewest patients waiting 4 or more months for an elective surgery. However, it did terribly on several other measures, ranking in the bottom third for patients having access to a regular doctor, after-hours or same-day care, and specialized tests such as CT or MRI. In terms of overall timeliness, the US ranked 8th out of 11. Canada received last place by a large margin, due to long wait times for elective surgery and specialist appointments. However once affordability was considered, the US pretty much dropped out of the race.

With an appallingly high percentage of people unable to pay a medical bill, being denied insurance reimbursement, or simply skipping treatment due to inability to pay, the United States scored dead last in the category of affordability. In other words, many Americans are simply unable to afford healthcare. This two-tiered system means that people who can afford high quality health insurance enjoy slightly better than average access to elective procedures and specialists, while those of lesser means may not be able to access healthcare at all. Finally, it is important to note that that increased access for some did not result in better outcomes. The US also ranked last in terms of health outcomes, in categories such as infant and maternal mortality, chronic conditions, mortality amenable to healthcare, 5-year colon cancer survival and life expectancy after age sixty, among others.  In other words, slightly better wait times did not improve overall outcomes.   

Conclusion

When it comes to wait times in the American Healthcare system, the picture is mixed. Those who can afford it enjoy slightly better than average wait times when it comes to scheduling elective procedures or appointments with specialists. But wait times to see a PCP or receive specialty testing are much longer. These averages do not take into account the 82 million people who are uninsured or underinsured. For them, the wait may be indefinite.

For those concerned about wait times associated with universal healthcare, it is important to understand that the United States is neither the best nor the worst. Countries with universal healthcare like France and Germany have shorter wait times for elective surgeries and specialist appointments, while in Canada and New Zealand the wait is longer. Every country has their own system, with the resultant strengths and weaknesses. Would switching to a universal healthcare system mean longer wait times for the average American? Maybe. Maybe not. It depends on the system we choose and the success of its implementation. The real question is: does it matter? As Americans, we are the proud owners of the most expensive, least effective healthcare system in the world. Is a slight increase in wait times worth ensuring that every American has access to the healthcare they need? I certainly believe so. But ultimately, it will be up to voters to decide.

Works Cited

  1. “President Donald J. Trump Stands Against the Lies of Medicare-For-None.” The White House, The United States Government, 3 Oct. 2019, www.whitehouse.gov/briefings-statements/president-donald-j-trump-stands-lies-medicare-none/.
  2. “Questions and Answers on Universal Health Coverage.” World Health Organization, World Health Organization, 11 June 2013, www.who.int/healthsystems/topics/financing/uhc_qa/en/.
  3. Tikkanen, Roosa. “Variations on a Theme: A Look at Universal Health Coverage in Eight Countries.” Commonwealth Fund, Commonwealth Fund, 22 Mar. 2019, www.commonwealthfund.org/blog/2019/universal-health-coverage-eight-countries.
  4. Berchick, Edward, et al. “Health Insurance Coverage in the United States: 2017.” The United States Census Bureau, 16 Apr. 2019, www.census.gov/library/publications/2018/demo/p60-264.html.
  5. “Underinsured Rate Rose From 2014-2018, With Greatest Growth Among People in Employer Health Plans.” Commonwealth Fund, 7 Feb. 2019, www.commonwealthfund.org/press-release/2019/underinsured-rate-rose-2014-2018-greatest-growth-among-people-employer-health.
  6. Ridic, Goran, et al. “Comparisons of Health Care Systems in the United States, Germany and Canada.” Materia Socio Medica, vol. 24, no. 2, 2012, p. 112., doi:10.5455/msm.2012.24.112-120.
  7. Doty, Michelle M. Doty, et al. “Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care.” The Commonwealth Fund, 2017, doi:10.15868/socialsector.27698.