You hear it all the time: American health care spends more money and produces worse outcomes than many other developed countries’ systems. But why? What have other countries done to achieve universal health care, to cover everybody, that the United States has not? And what are the consequences of those choices?
To answer these questions, Vox reporters traveled the world last fall to see other health systems in action, talking with doctors, patients, and government officials to get the full and often complex picture. Everybody Covered takes a closer look at a single-payer plan in Taiwan, a private-public hybrid in Australia, supercharged Obamacare in the Netherlands, the vaunted National Health Service of Great Britain, and an innovative hospital budgeting scheme right here in Maryland. Our project was made possible by a grant from The Commonwealth Fund.
Each system provides its own lessons about how to improve health care — not only in designing a better system but in the societal choices and shared sacrifices that must be made to attain universal health care.
No health care system is perfect. But most of America’s economic peers have figured out a way to deliver truly universal coverage and quality care. The United States has not.
America can and should do better. The rest of the world can help show the way. We found at least 9 things Americans can learn from other countries’ health systems.
To better understand how health care really works elsewhere, check out the stories and podcasts below.
Taiwan overhauled its health care system 25 years ago, setting up a program as close to Sen. Bernie Sanders’s Medicare-for-all as exists in the real world. But it has been, and remains, a challenge to keep the single-payer plan sustainable. Difficult choices await the Taiwanese people, even as they’ve seen health care vastly improve.
The Aussies have developed a public-private hybrid: public insurance anybody is eligible for and private insurance for people who want more choices. On balance, it works well: Everybody has coverage, people who can afford private insurance like having options, and Australian health care ranks among the best in the world. But private insurance is facing a crisis, raising new questions about the viability of a two-tiered system.
The Dutch have Obamacare for everybody: mandatory private insurance that bars denying coverage based on preexisting conditions, a model of managed competition. By some metrics, they have built the best health care system in the world. Access to providers is exemplary. But costs to patients can be high compared to other countries, leading some critics to question how well the private market has worked in delivering more affordable care.
The Mid-Atlantic state has a payment system for hospitals unlike anything else in the United States: global budgets. By capping payments to hospitals on a yearly basis, the state has strived to incentivize more efficient, higher-quality health care. Some experts think cost containment, not coverage expansion, should be the next step for health care reform. Should Maryland’s all-payer model go nationwide?
Right now, the United States rations care in a simple, cruel way: If you can’t afford it, you can’t get it. In national health care systems, decisions do need to be made about who gets what, how much the government is willing to pay, and what happens when the government can’t or won’t cover treatments people want. The UK, in particular, offers a model for making these decisions in clear, transparent ways — but that very transparency is part of what makes it so politically controversial.
Everybody Covered on the Vox Media Podcast Network
Reporters: Dylan Scott, Tara Golshan, Ezra Klein
Photographers: Ashley Pon, Anne Moffat, Marlena Waldthausen, Andrew Mangum
Editors: Elbert Ventura, Libby Nelson, Laura McGann
Podcast producer/co-reporter: Byrd Pinkerton
Podcast editor: Amy Drozdowska
Podcast senior producer/host: Jillian Weinberger
Visuals editor: Kainaz Amaria
Graphics: Christina Animashaun, Zac Freeland
Copy editors: Tanya Pai, Tim Williams
Engagement: Lauren Katz
Fact checkers: Kayla Chen, Matt Giles
This series was made possible by a grant from The Commonwealth Fund. All content is editorially independent and produced by our journalists.