There’s nothing that shows a person knows less about healthcare policy than when they state, “well the rest of the world has it figured out!”
They haven’t.
Every country faces challenges and tradeoffs with healthcare. The differences among other countries can be greater than their differences with the US. On who sells basic insurance, Switzerland looks much closer to the US than to Canada.
Each country has lessons for American reform. So here are some highlights. I place my emphasis on patient choice and physician independence.
Those are important principles. Patients need to be able to choose a doctor, compare prices, pay directly, and buy insurance that fits their needs. Doctors should be able to open a practice and innovate. Insurers should be forced to compete, incentivizing them to innovate in new methods of care financing. Yes, some regulation is going to be necessary, but too much stifles innovation.
Direct payment gives prices a role in directing scarce time, staff, and equipment. This is an important concept, and it’s immoral to take away people’s ability to use their own resources to seek care. Patients have a reason to compare offers, and doctors have a reason to compete for their business. For people who need financial help, there should be mechanisms for them to expand what they can buy and where they can buy it. Universal coverage is a worthwhile goal.
While government run hospitals might be viable in some countries, they are a disaster in the US. There’s a reason most have been privatized, and the few remaining ones are massively inefficient, often serving as mechanisms to channel public funds into special interest groups. They have worse outcomes and weaker management practices, with poor performing employees more often being retained. For this reason, I am critical of systems that rely heavily on government run hospitals.
Singapore. Compulsory medical savings accounts work like supercharged HSAs, alongside universal public catastrophic insurance. Workers and employers contribute to the savings accounts, with government top-ups for eligible groups. Savings pay for most routine care. About 70% of Singaporeans buy additional private coverage. Government owns much of the hospital system and controls how subsidies and medical savings can be used.
The good. Personal savings and direct payment give patients a reason to care about prices. Private doctors and hospitals can compete for patients, and the government’s published private fee benchmarks are recommendations, not mandates. Subsidies also help lower-income patients use private family doctors.
The bad. Government ownership of hospitals is a serious drawback. Officials also decide which expenses qualify for medical savings and what private insurance may cover. Patients and insurers should have more freedom to decide those things themselves. Private hospitals are key for innovation.
Switzerland offers universal basic coverage through competing private insurers. Everybody must buy a standard policy, insurers must accept everybody, and government helps lower-income people pay premiums. If you fail to enroll, the government assigns an insurer. About half have some form of additional hospital coverage, although those policies vary. Doctors can practice independently, and government also helps finance hospitals.
The good. Poor people get help buying the same basic coverage as everyone else, with a choice of insurer. Doctors can also practice outside basic insurance, with patients paying directly. There is room for a private market beyond the standard policy.
The bad. Government defines the basic package and controls payment rules for covered care. Even additional insurance products require regulatory approval. Premium assistance goes to the insurer, leaving patients with less control over how that money is spent.
Germany mostly uses competing insurance funds under government rules. Patients can choose a fund and participating doctors. Many outpatient doctors own their practices. People who meet employment and income rules can replace this coverage with full private insurance. About 8.8 million people, roughly 11% of the population, had that coverage in 2025.
The good. Independent practices give patients somewhere else to go. Doctors can also open wholly private practices, and patients can purchase treatment outside the insurance funds’ contracts. The insurance is portable, meaning people can take it when they change jobs.
The bad. Even privately paid medicine operates within a government fee framework. Government also restricts who can replace compulsory coverage with a private plan. More people should have that choice, and doctors should have more freedom to compete on price.
Chile lets workers direct their mandatory 7% wage contribution to public or private insurance, adding money if they choose a more expensive private plan. About 13% had private insurance for their main coverage in 2024. Many publicly insured patients can also use subsidized vouchers at private practices. Government regulates both types of insurance and runs the public hospital network.
The good. The mandatory contribution can follow a worker into private coverage. It’s their money, so they can spend it as they want. Independent practices and clinics can compete for patients, and private doctors can set or negotiate their fees. Patients have a choice beyond becoming customers of a government facility.
The bad. Private insurance is still subject to extensive rules on benefits and prices. The poorest public category cannot use the vouchers for private doctors. Those patients should have more control over their assistance and a broader choice of doctors.
The Netherlands requires everybody to buy basic coverage from a private insurer. Government defines the benefits and requires insurers to accept everyone. Lower-income households receive help with premiums. Patients generally need a family doctor referral for specialist care. About 81% bought additional coverage in 2026.
The good. Patients choose among private insurers, and independent doctors and clinics can operate outside insurer contracts. Patients can pay directly for care. Like Switzerland, the basic insurance market avoids the distortions caused by one dominant government insurer.
The bad. Insurers must sell the government’s standard package, leaving less room to compete through different coverage. Referral rules restrict specialist access. Billing and price rules also reach parts of the private market, including some care patients purchase themselves.
Australia combines public insurance with a substantial private sector. Government dictates what public insurance will reimburse, while private doctors set what they charge. Patients can pay the difference. About 46% had private hospital coverage in June 2026. States run public hospitals, where public patients generally receive an assigned doctor.
The good. Doctors can run private practices, set prices, and serve patients outside public payment. Private hospitals offer another route into care. Direct payment lets a practice offer something patients value enough to buy.
The bad. Government still owns the public hospital system. Rules on training, credentials, and practice location shape which doctors can receive public payment, while new hospitals need government licenses. Those rules limit how readily new competitors can enter and grow.
France combines public insurance with extensive private practice. Government and negotiated agreements shape covered benefits and fees. Patients choose their doctors, with lower reimbursement for bypassing referral rules. About 97% had additional coverage in 2023, including subsidized coverage for lower-income people.
The good. Doctors can practice entirely outside the national payment agreement and set their own fees. Eligible poor patients can also use participating private doctors with public support. Independent practice survives both inside and outside the main insurance system.
The bad. Public reimbursement strongly rewards staying inside the official fee rules. Government also runs many hospitals and controls entry into hospital services and purchases of major equipment. Independent facilities should have more room to respond to demand.
Norway funds care through taxes and runs most hospitals through government authorities. Most family doctors are self-employed but work under public payment agreements. Patients can choose among public and contracted private centers after referral. About 16% had private insurance for faster treatment at the end of 2025.
The good. A separate private market can operate without public contracts, with patients or insurers paying market prices. Publicly covered patients also have some choice of treatment center and can seek an alternative when treatment deadlines are missed.
The bad. Government owns most hospitals and determines much of the payment available to doctors. Too much care therefore depends on political budgets and purchasing decisions. Oil wealth helps support public spending, which makes Norway an unusual model to export.
Sweden‘s regions collect taxes, set healthcare budgets, and run most hospitals. Patients can choose public or contracted private primary and outpatient care. Most doctors are salaried, including in private organizations. About 8% of Swedes held private insurance for faster care in 2025.
The good. Entirely private care can exist outside regional contracts, paid directly or through private insurance. Patients therefore have an alternative beyond whichever providers the government chooses to fund.
The bad. Government ownership and regional purchasing still dominate the system. A clinic serving publicly covered patients must work within those payment rules, and most patients cannot redirect the public budget to an independent alternative of their choosing.
Denmark‘s tax-funded regions run hospitals and contract with independent family doctors under negotiated fees. Specialist care generally requires a family doctor referral. About 3.2 million people, just over half the population, had additional insurance, often through work.
The good. Private hospitals and specialists can operate outside public contracts, paid by patients or insurers. Eligible public patients can also use a contracted private hospital when the public service misses the relevant 30-day assessment or treatment deadline.
The bad. Government runs most hospital care and decides which private alternatives public money will buy. Referral requirements also put another decision-maker between the patient and specialist. Patients should have more control over both their care and the money paying for it.
The UK relies heavily on tax-funded, government-run hospitals. Many family doctors are independent contractors, and hospital consultants can also practice privately. About 6.5 million people, roughly 9% of the population, had private medical insurance in 2024, much of it through work.
The good. Doctors can open wholly private practices and deal directly with patients or insurers. Private hospitals offer care outside government contracts. In England, eligible public patients can also choose certain private hospitals with the government paying.
The bad. The public system dominates, and it combines government ownership with centrally controlled budgets. Long waits leave patients looking for an exit, and the dominant public system leaves only the wealthy able to afford that. Patients and independent practices should have far more control over how care is purchased and delivered.
Taiwan uses one public insurer to set covered benefits, payment rates, and overall budgets, while private hospitals and clinics deliver much of the care. Patients can choose doctors and generally see specialists directly. A 2019 official count found 71% had some additional commercial coverage, including hospital, cancer, and accident policies.
The good. Much of the care is privately delivered, and patients can choose among practices. They can also buy additional services directly. Lower-income patients receive help with premiums and copays.
The bad. The public insurer controls payment for most covered care. Government also regulates charges in the private market. Owning a practice gives a doctor less freedom when officials still control what that practice can charge, even to a patient paying directly.
Canada‘s provinces pay for core hospital and physician services under federal conditions. Many doctors run independent practices, but public plans set or negotiate payment. Provincial rules often restrict private billing or insurance for services the public plan covers. That makes it harder to build competing ways of paying for and delivering the same care.
The good. Some private alternatives survive. Wholly private doctors in Quebec can set their fees, and Alberta is introducing another route for privately paid surgery. Those recent openings give doctors and patients more room to make their own arrangements.
The bad. Restrictions on private financing shelter the public system from competition. Patients facing long waits have too few domestic alternatives and even those few recent developments mentioned above were hard fought. Using a physician survey, the Fraser Institute estimated that about 106,000 Canadians received nonemergency treatment abroad in 2025. More alternatives should have room to develop at home.
This is great!
Yeah, sure, OK. It is true that there is often a simplistic approach to HC policy debate in the US, in which many folks advocating for Universal Coverage assume that every other country has everything all figured out, while those advocating for the status quo see only the bad in other countries’ care. But. Once we start to have a serious debate then we get to the meat of the matter, which is that every system has a different set of tradeoffs (as the above article outlines fairly well). And the issue is this: DIFFERENT PEOPLE ARE WILLING TO LIVE WITH DIFFERENT TRADEOFFS. We cannot have a serious discussion on HC policy reform without admitting that we do not all agree on where the concessions should be made, and to what end.