Kevin Drum, citing a NYT report that Public spending accounts for “45 percent of all health spending in the United States, compared with a 72 percent average in O.E.C.D. countries,” argues

The government already pays for 45% of healthcare costs in America, which means that public healthcare spending accounts for 45% of 15% of GDP, or 6.75%.

In other western countries healthcare costs are about 10% of GDP, which means that public spending accounts for about 72% of 10%, or 7.2%. That’s barely more than we spend in percentage terms and less than we spend in actual dollars per person. And by most conventional measures they deliver care that’s as good or better than ours. For everyone.

A long discussion follows in the comments section, with many pointing out that it is certainly arguable as to whether health care is comparable in other countries, given long delays, denial of access to expensive technologies, etc.

I’m rather leery of going to a single payer system although I agree that our current one is deeply flawed as well. If we take profit out of it, I’m not sure what incentives there would be toward invening new techologies, drugs, and the like, for example. For those who can afford it–which is to say, most of us–the U.S. system is almost certainly better than that in Canada or Western Europe. Even rural hospitals here have up-to-date technology and near-instant availability of care. But for those without deep pockets or decent health insurance, our system is less desirable than that of our peers.

Yeah, yeah, I know, it’s socialism. But wouldn’t it be nice if we could put the scary namecalling aside and instead just work together on building a real healthcare system to replace the creaky, dysfunctional, and out of control one we have now?

I agree that calling socialized medicine “socialized medicine” shouldn’t be the end of the debate. As Kevin correctly notes, we’ve already got socialized medicine, it’s just that some of us aren’t yet covered. I therefore don’t dismiss arguments that some sort of single payer system might be an improvement over what we have.

[I moved this paragraph down, so that it would be read with the update that follows.] But one major flaw that most of the comparisons with the US and Europe have is they don’t account for the vast difference in population density. (The same is true, incidentally, with the public transportation argument.) We’ve got a little over 30 people per square kilometer, compared to 110 for France, 15.4 for Finland, etc. It’s going to be more expensive as a portion of GDP to provide equivalent health care regardless of the system.

Update (1519): A commenter on Kevin’s post, where I introduced a much shorter version of my population density argument, notes that many countries with a lower population density than ours have a higher life expectancy–which really doesn’t have anything to do with anything–and that my math was off by an order of magnitude on Finland (I had written 154 rather than the actual 15.4) which rather undercuts my argument.

So, a little more research appears to be in order, and it’s not looking good for my theory: Brian Weatherson provides OECD stats for dollars spent per capita on health care adjusted for purchasing power parity. While there is some variation among the most modern of the OECD countries in that amount, there doesn’t seem to be any obvious correlation between that variation and population density (from this Canadian government list). Now, of course, I can’t account for variability in provision of expensive services here, but it’s baffling to me that Australia and Iceland, who are off the charts with population densities of 2.5 and 2.7 residents per square kilometer, don’t seem to spend more per capita than The Netherlands and Belgium, who are on the other end of the range at 390.3 and 336.1 (the figures are $2224, 2559, 2310, and 2114, respectively).

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.


  1. James,

    In fairness, I have not read Kevin’s post. I would venture a guess though, that the reason Healthcare is not a higher – a MUCH HIGHER – percentage of GDP in other “socialized medicine” countries is because of the fact that government has stripped so much money out of healthcare that Doctors and nurses are leaving for better paying jobs in the US. Canadian doctors and nurses make much less than in the US, and they work longer hours for that money.

    Additionally, you’ll find all the latest medical magic here. You’re lucky to get a lot of it at even the better hospitals in Canada.

    Case in point: MRI’s. In the US, I believe the average wait for a potentially life-saving MRI is a couple days to a week. In Canada, it’s 17 weeks!! Why? Because they are so understaffed that there’s nobody to do them, and so underfunded that, even if the staff was there, there’d be a lack of MRI machines.

    If Canada, for example, had the quality of Healthcare that we have here (and I am speaking as a Canadian) it would be a much larger percentage of the GDP – a MUCH larger %.

  2. William says:

    I think that a single payer system is a good idea . . . but as for the whole “density” arguement, it seems to me that Finland, Iceland, and Australia might have a low population density when you look at the size of their country and divide it by the number of people who live there . . . but when you look at where people actually live, they are pretty dense countries.

    For example, in Iceland, which has more glaciers than all of Europe, there are about 288,000 people, of which about 112,500 live in Reykjavík and about 180,000 live in Greater Reykjavík. Obviously when you average in the glaciers and Greater Reykjavik, there are low overall population densities . . . but in the areas where most folks live, there is a much higher population density.

    Australia, with its vast interior desert seems like it might have similar characteristics. I’m not sure about Finland. But maybe population density needs a more nuanced look.

  3. James Joyner says:


    Interesting. And, yeah, that makes sense. It certainly seems quite reasonable to me that it would be more expensive to provide medical care to, say, all the people of North Dakota than to, say, all the people of Washington DC, even though the populations are comparable, since fewer hospitals, etc. would be needed. But the simple calculations don’t show that; maybe a more rigorous operationalization would help.