One of the more important arguments between Bernie Sanders and Hillary Clinton during Sunday’s Democratic debate occurred over whether to push for “Medicare for all,” as Sanders insisted, or to build more slowly on the limited success of President Obama’s health care law.
In Europe, all the big economies there have universal health-care systems under which everyone is insured. Even the most conservative politicians support them.
Sanders’ critics say that expanding Medicare would cost too much and require much higher taxes. Without big changes in the structure of U.S. health care, that would be true. But European countries tend to deliver high-quality care while effectively controlling the cost.
In general, American taxpayers do pay less than their European counterparts, but not everywhere. Some of the EU’s biggest economies aren’t collecting much more tax revenue per capita than the U.S. does.
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In 2014, the U.S. collected about $3,000 less in taxes per capita than Germany, nearly as much as Britain and $4,000 more than Spain, according to the Organization for Economic Cooperation and Development. Those three countries, however, all have universal health-care systems that are mostly or entirely tax-funded. One can get private health insurance there, too, but generally it only guarantees quicker access to the same quality of service.
Europe’s example shows that universal health care doesn’t have to be about burdening people with more taxes. It’s not necessarily even about reconsidering the spending structure, as Sanders suggested during the debate when he said that the U.S. should be “investing in jobs and education, not in jails and incarceration.”
According to the OECD, the U.S. already spends a bigger share of its economic output on health care than any of the other advanced nations. It might help, of course, if some more of the country’s unusually high defense spending and higher-than-average public safety outlay were shifted toward health. That wouldn’t bring the U.S. into line with the European societies, though. It would need to simplify the funding systems for health care and education, and it would need to drive down costs in both sectors.
European governments have also carved out a smaller niche in the health industry for private insurance companies: serving those who want premium care. It makes sense: The profits are made from people who are willing and able to pay more.
Sanders sounds like a rabble-rousing socialist to Americans when he says: “What this is really about is not the rational way to go forward – it’s Medicare for all – it is whether we have the guts to stand up to the private insurance companies and all of their money, and the pharmaceutical industry.”
Sure, his approach is not as business-friendly as the current U.S. policies that Clinton wants to change only incrementally. But in Europe there’s nothing remotely radical-sounding about Sanders’ ideas.
Europeans often complain about the quality of their comprehensive health care. Yet the residents of European countries are generally in better health.
It is often said Americans are tired of mainstream politics, with the implication that Sanders is as far from the mainstream as the man he calls his “good friend,” Donald Trump. What Sanders suggests, however, is mainstream policy for any European center-right party. It’s not clear why Americans should settle for less.
Leonid Bershidsky, a Bloomberg View contributor, is a Berlin-based writer.