What Canada and the U.K. can teach America about universal healthcare

“Free healthcare is cool,” comedian Shane Gillis recently said on The Joe Rogan Experience. “We should have that.”

“You should treat the entire country like it’s a community,” Rogan replied. “If you had a community, would you want the sickest person to fucking die who could be very valuable if you could take care of them, and do you have the resources to take care of them?”

While support for “free” healthcare in the United States is not new—Harry Truman campaigned on universal health insurance in 1948, and Sen. Bernie Sanders (I–Vt.) has popularized the “Medicare For All” slogan in recent years—the policy has received renewed interest of late. The Democratic Socialists of America have made universal healthcare “at no cost to individuals” a key component of their party’s expensive platform.

But it is not just political hopefuls who like the idea of universal healthcare; academics seem to as well. A recent study by the Yale School of Public Health claims that single-payer universal healthcare would save more than 100,000 lives a year, and would supposedly cost $1 trillion less than the system it would replace. The study, which has not been peer-reviewed yet, appears to come to its conclusions by modeling a scenario that assumes cheaper pharmaceutical prices, less administrative overhead, reduced fraud, and fewer emergency visits.

But we do not need modeling of unrealistic scenarios to see what universal healthcare could do for Americans; we just need to look at countries that have already implemented this system.

In Canada, the closest country to the United States that has universal healthcare, healthcare spending is responsible for 12.7 percent of GDP, several percentage points higher than the average spend of Organization for Economic Cooperation and Development (OECD) countries. Despite this higher spending, the median waiting time between referral from a general practitioner and receiving treatment has hit 28.6 weeks, which is 208 percent longer than the wait Canadian patients would have expected in 1993. From April 1, 2023, to March 31, 2024, almost 15,500 people died waiting for healthcare in Canada, according to data compiled by SecondStreet via a Freedom to Information Act request. In 2025, 9.1 percent of Canadians “expressed unmet needs for healthcare,” compared to the OECD average of 3.4 percent.

In 2020, 62 percent of Canadians who needed specialist care waited at least a month to get it, compared with just 31 percent of patients in the United States. Drawing on results from the Commonwealth Fund’s International Health Survey, the OECD found that in 2023, more than one in 10 Canadians who needed a specialist appointment reported waiting over a year. Among the 10 countries surveyed, the only other country where this proportion of patients reported waiting over a year was the United Kingdom.

When the U.K. established the National Health Service (NHS) after World War II, NHS architect Clement Attlee envisioned a welfare state that provided care for British citizens from “cradle to grave.” Today, like Canada, long waiting lists are a common fixture. Latest figures from the NHS show that 7.3 million people—or around 1 in 10 people in the U.K.—are on NHS waiting lists. Over 105,000 cases involved patients who had been waiting over a year for treatment.

On Tuesday, The Telegraph reported that patients have died after doctors were encouraged to refer fewer people to hospital under the NHS Advice and Guidance (A&G) system introduced earlier this year. The A&G attempts to reduce hospital waiting lists by encouraging doctors to consult a hospital specialist before formally referring a patient. The Health Services Safety Investigations Body recently said that “poorly designed or inadequately monitored pathways have contributed to physical harm, delayed and missed diagnoses, and in some cases to delays in cancer care.” For instance, The Telegraph reported on one patient who was suffering from regular seizures when their doctor made an A&G request. After waiting for weeks, the patient had a seizure and died of cardiac arrest at home.

The NHS performs poorly on almost every available measure compared to other systems. In the year before the COVID-19 pandemic, the U.K. reported an avoidable mortality rate of 71 per 100,000 people—the second-highest avoidable deaths in all of Western Europe (though it did perform better than the United States). For the most common types of cancer, U.K. survival rates rank near the bottom of Europe, often only marginally ahead of the Czech Republic and Slovenia. Among comparable high-income countries, the U.K. has some of the lowest five-year survival rates for breast, cervical, colorectal, and lung cancers. “Cancer exemplifies the problems with the UK’s health system,” according to the King’s Fund. “Early detection, diagnosis and treatment of cancer is critical for improving patient outcomes, yet the UK compares poorly on all.”

The lack of quality care in Britain has had serious ramifications for patients like Carly, a 31-year-old mother of two. She tells Reason that while pregnant with her second child, doctors discovered a “basketball-sized tumor” that needed to be removed through emergency surgery. Yet “for the next four weeks,” she says, “every week it would come up to like the day before, maybe two days before my surgery had been scheduled for, and they would cancel it.” 

After eventually undergoing a successful surgery at 23 weeks pregnant, Carly says her morphine pump repeatedly ran out, despite doctors warning her that unmanaged pain could trigger labor. She was also told that she, not hospital staff, was in charge of staying on top of her medications. “I didn’t shower. I was there for five days, and I didn’t shower. Nobody changed my bedding,” she says. Looking back, Carly says, “I feel like I was let down horrendously,” adding that she “would have happily gone into medical debt in the U.S. to avoid what happened to me in that situation.”

Failures like these are not surprising in universal healthcare systems. “Every time someone advocates a government activity…they say this is going to save lives. Almost never do they provide evidence establishing that,” Michael Cannon, the Cato Institute’s director of health policy studies, tells Reason. “No one ever tallies all of the costs of extracting that money out of the economy…[or] the foregone benefits of whatever the people who earn that money would have spent it on.”

The U.S. healthcare system has plenty of problems. While the promise of “free stuff” may sound tempting, the experience of countries with universal healthcare should make Americans deeply skeptical of the idea that putting the government in charge of the entire system is a panacea.