Cato Institute
Policy Analysis
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No. 613
March 18, 2008
The Grass Is Not Always Greener
A Look at National Health Care Systems Around the World
by Michael Tanner
Executive Summary
centage of GDP and per capita, costs are ris-
Critics of the U.S. health care system fre-
ing almost everywhere, leading to budget
quently point to other countries as models for
deficits, tax increases, and benefit reductions.
reform. They point out that many countries
In countries weighted heavily toward gov-
spend far less on health care than the United
States yet seem to enjoy better health outcomes.
ernment control, people are most likely to
The United States should follow the lead of
face waiting lists, rationing, restrictions on
those countries, the critics say, and adopt a gov-
physician choice, and other obstacles to care.
Countries with more effective national
ernment-run, national health care system.
However, a closer look shows that nearly all
health care systems are successful to the
health care systems worldwide are wrestling with
degree that they incorporate market mech-
problems of rising costs and lack of access to care.
anisms such as competition, cost sharing,
There is no single international model for nation-
market prices, and consumer choice, and
al health care, of course. Countries vary dramati-
eschew centralized government control.
cally in the degree of central control, regulation,
and cost sharing they impose, and in the role of
Although no country with a national health
private insurance. Still, overall trends from nation-
care system is contemplating abandoning uni-
al health care systems around the world suggest
versal coverage, the broad and growing trend is
the following:
to move away from centralized government con-
trol and to introduce more market-oriented fea-
Health insurance does not mean universal
The answer then to America's health care
access to health care. In practice, many coun-
problems lies not in heading down the road to
tries promise universal coverage but ration
national health care but in learning from the
care or have long waiting lists for treatment.
Rising health care costs are not a uniquely
experiences of other countries, which demon-
strate the failure of centralized command and
American phenomenon. Although other
control and the benefits of increasing consumer
countries spend considerably less than the
incentives and choice.
United States on health care, both as a per-
Michael Tanner is director of health and welfare studies at the Cato Institute and coauthor of Healthy
Competition: What's Holding Back Health Care and How to Free It (second edition, 2007).