US health care is the best in the world – single-payer removes advantage.

Yet over a million people travel to the US every year for their medical care, including heads of state, the wealthy and elite, who presumably could have received care in their home country or anywhere else in the world. The numbers cited above do not even include the millions who are cared for by the international satellite campuses of the Mayo Clinic, Cornell, Harvard and Johns Hopkins systems, to name just a few, that have been established to bring American health care to the rest of the world.

Around 100,000 Canadians, whose nationalized health system is rated above the United States, are likely to cross the border each year for medical care. These medical tourists recognize that, on the whole, health care in the US is the best in the world.

Leading the Way

The United States leads the world as a juggernaut of medical research and innovation. More Americans have received the Nobel Prize in medicine than Europe, Canada, Japan and Australia combined, which together have double the aggregate population of the US. Half of the top 10 diagnostic or therapeutic innovations in the past 50 years have come in whole or in part from the US, along with 75% of the top 30.

When it comes to pharmaceuticals, half of the top 30 blockbusters have come from the United States alone. The advanced medical milieu that Americans enjoy has led to the world’s best cancer survival rates, a life expectancy for those over 80 that is actually greater than anywhere else, and lower mortality rates for heart attacks and strokes than in comparable countries.

There are many reasons that have been put forth to explain this dominance, but the most basic and powerful is very likely money. The free-market health care economy of the US, along with lower regulatory and tax burdens, strongly incentivizes corporations to focus their business in America.

At a fundamental level, greater financial compensation also provides individuals and their families the potential for a better quality of life, while greater autonomy spurs innovation. This is why the United States is routinely listed as one of the best countries in the world to practice medicine. One-quarter of all doctors in America are foreign-trained. Licensure is a daunting process that nearly always requires “starting over” for the immigrant physician. These physicians are often fully licensed and practicing in their home country, but must now sit for the US Medical Licensing Examination (USMLE) and spend years redoing all of residency and fellowship.

Despite this challenge, estimates suggest that over $2 billion is lost annually from physicians leaving sub-Saharan Africa alone to set up shop in the US. This so-called brain drain is rampant in India, Mexico and Central America and is not limited to physicians. In 2014, about 14,000 nurses left the Philippines, while only 5,000 graduated nursing school. The United States represents 5% of the world’s population, accounts for around 5% of the world’s disease burden, but employs 20% of the global health workforce.

The UK and Canada

Contrast this environment with the nationalized health systems of the United Kingdom and Canada, which each year rank higher than the US. When resources are controlled by a single-payer system, the waiting time for care invariably lengthens.

In 2019, the National Health Service (NHS) in England reported that one-quarter of all cancer patients did not start treatment on time despite an urgent referral from their physician. Even before the COVID-19 pandemic, wait times for medically necessary treatments in Canada averaged three months, which the treating physicians documented as one month longer than clinically reasonable.

Universal health care also leads to an increased tax burden. The tax-to-GDP ratio in the United States is 26%, which is among the lowest of 34 advanced nations. In Canada, that number sits at 32%, in the UK at 34% and in France at 45%. Some estimate that a single-payer conversion in America would potentially increase taxes by up to 20%.

For those with the means to pay, there is a booming secondary private insurance industry in most socialized health care economies, which has essentially created a two-tier system of “haves” and everyone else. Self-pay for health care in the UK rises annually by 10%, leading to a 50% increase over the last half decade, and this excludes cosmetics or costs paid by the NHS. One result is that nearly all general practices are private now in the UK, contracting their services out to the government while providing direct-pay services for the affluent.