Healthcare in America: What's Broken, What Works, and How to Fix It

Why Is Healthcare So Expensive in America?

The United States spends $4.5 trillion per year on healthcare — more per capita than any other country — yet ranks last in health outcomes among wealthy nations. The problem isn't the quality of doctors or hospitals. It's the system that pays for them.

American healthcare costs are driven by three structural failures that no other wealthy democracy tolerates. First, administrative overhead: the United States has over 900 private insurance companies, each with its own billing codes, prior authorization requirements, claims processing systems, and denial protocols. Hospitals employ more billing staff than doctors. An estimated $1.1 trillion per year — roughly one-quarter of all healthcare spending — goes not to patient care but to the bureaucratic machinery of figuring out who pays, how much, and when.

Second, the absence of price negotiation. In every other wealthy country, the government negotiates drug prices, hospital reimbursement rates, and procedure costs on behalf of its citizens. In the United States, pharmaceutical companies, hospital systems, and device manufacturers set their own prices with virtually no check. The result: Americans pay 2-3 times more for the same drugs, the same surgeries, and the same devices as patients in Canada, Germany, or Japan.

Third, insurance complexity itself creates perverse incentives. When your coverage depends on your employer, losing your job means losing your healthcare. Insurers profit by denying claims, not by keeping you healthy. Prior authorization — a system where insurance companies second- guess your doctor's treatment decisions — delays care, increases costs, and sometimes kills people. The system is not accidentally broken. It is working exactly as designed — for the companies that profit from it, not the people who depend on it.

Source: OECD Health Statistics, Commonwealth Fund. See the full healthcare issue page for complete sourcing.

What Would Universal Healthcare Actually Look Like?

Under a single-payer system, every American would have health insurance through one national plan. You keep your doctor. You keep your hospital. The only thing that changes is who pays the bill — and the price they pay.

Single-payer healthcare is not government-run medicine. It is government-financed medicine with private delivery. The distinction matters enormously. In Canada, which has operated a single-payer system since the 1960s, every doctor's office, clinic, and hospital is privately owned. Patients choose their providers freely. The only difference is that instead of hundreds of insurance companies processing claims, one entity handles payment — which is why Canada spends half what the US does per person and covers everyone.

The confusion between single-payer and socialized medicine is deliberate. Insurance industry lobbying groups have spent decades conflating public financing with government control because the distinction — once understood — makes their business model indefensible. The UK has socialized medicine: the government owns the hospitals and employs the doctors. Canada has single-payer: the government pays the bills but owns nothing. The Common Good plan follows the Canadian model, not the British one.

Under universal coverage, your healthcare is no longer tied to your employer. You can change jobs, start a business, take time off to care for a family member, or retire early — without ever worrying about losing your insurance. This isn't just a health policy. It's an economic freedom policy. It's an affordability policy. It's a policy that unshackles workers from jobs they keep only for the benefits.

Read the full policy paper for legislative language and implementation details.

How Does the Common Good Healthcare Plan Work?

The Common Good plan establishes universal coverage through a single federal payer while keeping all healthcare delivery private. No government hospitals. No government doctors. Just one insurance plan that covers everyone.

The plan is built on seven core provisions, each designed to address a specific failure in the current system. Together, they create a healthcare system that costs less, covers more, and eliminates the bureaucratic nightmare that patients and doctors deal with every day.

• Universal Coverage: Every American — regardless of employment, age, or income — is covered from birth. No enrollment periods, no eligibility gaps, no falling through the cracks.
• Private Delivery: All doctors, hospitals, clinics, and healthcare providers remain privately owned and operated. You choose your provider, not the government.
• Comprehensive Benefits: Medical, dental, vision, hearing, mental health, substance abuse treatment, and prescription drugs — all covered under one plan.
• Federal Drug Negotiation: The federal government negotiates prices on all prescription drugs — not just the 10 currently covered under the Inflation Reduction Act — using international reference pricing.
• Elimination of Administrative Waste: One payer, one billing system, one set of rules. Estimated savings: $1.1 trillion per year currently lost to insurance company overhead and hospital billing departments.
• No Premiums, No Deductibles: Primary care visits, preventive services, and essential treatments have no out-of-pocket costs. Modest copays apply only to elective and non-emergency services.
• Three-Year Transition: A phased implementation that expands Medicare eligibility year by year — no sudden disruption, no gap in coverage for anyone currently insured.

For the complete plan with legislative detail, cost projections, and sourcing, see the full healthcare issue page.

Will I Lose My Doctor Under Universal Healthcare?

No. Under the Common Good plan, all doctors and hospitals remain private. You choose your provider. The only change is that instead of your employer or an insurance company paying, a single national plan pays — at negotiated rates that are transparent and fair.

In fact, you would have more choice under single-payer, not less. Right now, your choice of doctor is constrained by your insurance network. If your doctor is "out of network," you either pay vastly inflated rates or you find a new doctor. If you change jobs and your new employer uses a different insurer, you may lose access to the providers you've been seeing for years. Under a single national plan, there are no networks. Every doctor participates. Every hospital accepts the plan. Your choice of provider is limited only by geography and availability — not by which insurance company your employer happened to select.

The "you'll lose your doctor" argument was designed by the insurance industry to protect its business model. It is not supported by the experience of any country that has transitioned to universal coverage. In Canada, patients choose their family doctor freely. In Australia, patients choose between public and private providers. In every peer nation with universal coverage, physician choice is equal to or greater than in the United States.

The irony is that it's the current system — not a single-payer system — that routinely forces Americans to change doctors. Every time an insurer adjusts its network, every time an employer switches carriers, every time a hospital drops a plan, patients lose access to the providers they trust. Universal coverage ends that cycle permanently.

How Much Would Universal Healthcare Cost — And How Do We Pay For It?

The US already spends $4.5 trillion per year on healthcare. A single-payer system would cost less, not more, by eliminating $1.1 trillion in administrative waste and negotiating drug prices. The funding comes from progressive taxation and eliminating private insurance premiums.

This is the question people ask most — and it's the one the current system's defenders least want you to think about clearly. Americans already pay for universal healthcare. They just don't get it. Between insurance premiums, deductibles, copays, out-of- pocket maximums, and taxes that fund Medicare, Medicaid, the VA, CHIP, and the ACA marketplace subsidies, Americans collectively spend more per person on healthcare than citizens of any country that actually provides universal coverage. The question is not "can we afford universal healthcare?" The question is "can we continue to afford the system we have?"

Under the Common Good plan, the funding sources are specific and transparent. Employer health insurance premiums — currently averaging $23,968 per family — are replaced by a payroll contribution that costs employers significantly less. Individual premiums and deductibles are eliminated entirely. Progressive income tax adjustments ensure that 95% of American households pay less for healthcare under the new system than they do today. The top 5% pay more — and still receive comprehensive coverage in return. For the full fiscal framework, see the budget and fiscal responsibility page and the taxation policy.

Sources: KFF Employer Health Benefits Survey, CMS National Health Expenditure Data, CBO estimates. See full issue page for detailed sourcing.

What About Prescription Drug Prices?

Americans pay 2-3x more for the same drugs as people in other countries. The Common Good plan establishes federal negotiation on all drugs — not just the 10 currently covered — and implements international reference pricing so you pay what other countries pay.

The Inflation Reduction Act of 2022 was a historic step: for the first time, Medicare was allowed to negotiate prices on a handful of drugs. But the law covers only 10 drugs initially, expanding slowly over a decade. Meanwhile, the pharmaceutical industry spent $374 million on lobbying in 2022 alone — more than any other industry — to ensure the law remained as narrow as possible. The Common Good plan removes those restrictions entirely. If a drug is sold in the United States, its price is negotiated. Period.

International reference pricing means Americans would pay no more than the median price paid by other wealthy democracies for the same medication. Insulin that costs $300 per vial in the US costs $30 in Canada and $8 in Australia. Under the Common Good plan, the American price falls to the international median. This isn't radical — it's what every other country already does. The pharmaceutical industry's argument that lower prices would destroy innovation is contradicted by the fact that most of these other countries continue to produce world-leading medical research.

For the complete prescription drug pricing framework, see the healthcare issue page and the affordability and cost of living policy.

How Does US Healthcare Compare to Other Countries?

The United States spends more on healthcare than any country in the world — by a wide margin — while achieving worse outcomes on nearly every measure that matters. The data is not ambiguous. Every peer nation covers all its citizens, spends less, and gets better results.

The pattern is unmistakable. The United States pays roughly twice what other wealthy countries pay per person — and gets less for it. American life expectancy is lower. Infant mortality is higher. Maternal mortality is dramatically higher. And 26 million Americans have no coverage at all, a situation that exists in no other wealthy democracy on Earth.

These aren't cherry-picked statistics. They come from the OECD, the World Health Organization, and the Commonwealth Fund — the same sources that every health policy researcher in the world relies on. For a detailed side-by-side comparison of party positions on healthcare, see the Compare Parties page.

What Are the Biggest Myths About Universal Healthcare?

The healthcare industry spends hundreds of millions of dollars every year on lobbying and advertising designed to make Americans afraid of the one reform that would actually save them money. Here are the four most persistent myths — and what the evidence actually shows.

Healthcare Policy: Frequently Asked Questions

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