Why settle for one government payer when you could have 39 private ones that are legally forbidden to profit on basic coverage?
That is the Swiss deal: everyone must buy the same basic coverage, insurers compete to sell it, and none of them may profit on it.1, 2 It costs about a third less per person than American healthcare, and the Swiss die from treatable causes at about a third of our rate.3, 4, 5 People on welfare pay no premiums or deductibles: the state covers both.6 The Netherlands built its own version of the same model in 20067 and now sits in the top two of the Commonwealth Fund’s rankings of 10 wealthy countries.8The numbers
The Swiss get more mountain per dollar
Switzerland is not cheap; it has the second-highest health spending per person in the OECD, which we deal with below. It is simply far cheaper than the United States, which spent an estimated $14,885 per person in 2024 against Switzerland’s $9,963.3 Americans pay more for less: the same analysis puts U.S. administrative costs above $1,000 per person, about five times the average of other wealthy countries.3
| Measure | Switzerland | Netherlands | United States |
|---|---|---|---|
| Health spending per person | $9,96320243 | $8,436OECD 2025 note9 | $14,88520243 |
| Deaths from treatable causesper 100,000; deaths timely care should prevent | 34OECD 2025 note4 | 49OECD 2025 note9 | 95OECD 2025 note5 |
| Life expectancy at birthshaped by much more than health care | 84.3 yrsOECD, 2023 data4 | 81.9 yrsOECD 2025 note9 | 79.0 yrs2024, a U.S. record high10 |
| People without coverage | Under 1%“More than 99 percent” covered11 | Mandatoryfor everyone who lives or works there12 | 7.9%26.7 million people, 202513 |
| Low-income residents | Subsidizedabout 30% get help; no premiums or deductibles for people on welfare6, 14 | Subsidizedincome-based healthcare allowance; children under 18 pay no premium15, 16 | 1.4 millionuninsured people stuck in the Medicaid coverage gap17 |
| Commonwealth Fund ranking among 10 wealthy countriesMirror, Mirror 2024 | 2nd on outcomes8th overall18 | 2nd overall7th on outcomes18 | 10th on bothlast overall and on outcomes18 |
Status: on time. It’s Switzerland.
Helping the poor
Built for the people with the least
A common single-payer argument is that private insurance leaves the poor behind. Switzerland shows it doesn’t have to. Premiums are the same for rich and poor, so the government helps pay them for people who can’t, and pays the insurer directly.19
To be precise: Switzerland is not free for every low earner. Premiums and deductibles are fully covered only for people on social assistance, more than 270,000 people by Swissinfo’s count20; other low earners get partial or full premium subsidies but still pay deductibles and 10% coinsurance.6, 21 This proposal would go further than Switzerland does.
No gaps to fall through
Swiss coverage follows the person, not the job. America has a gap with no Swiss equivalent: an estimated 1.4 million uninsured people in the 10 states that haven’t expanded Medicaid qualify for neither Medicaid nor marketplace tax credits.17 And it is getting wider. CBO expects the 2025 budget law to add 10 million uninsured people by 2034, and more than 14 million counting the expired marketplace credits.22
One study of Swiss subsidies also found that paying premiums directly to insurers, rather than giving recipients the same amount in cash, reduced their financial distress.23
Where Switzerland still falls short
Subsidized households still spend about 12% of disposable income on premiums, by Swissinfo’s estimate24, and 29% of households earning up to CHF 4,000 a month report regular trouble paying.25 Swiss voters rejected a hard 10% cap in 2024 (55.5% against)26; the counter-proposal now forces cantons to put in a minimum amount for subsidies.27 The proposal would fix this from the first step with a federal floor that no state could skimp on.
For America’s poorest families, Krankenversicherungsgesetz for All looks a lot like Medicare for All: no premium, no deductible.The difference is that 180 million other people pick their new plan from competing insurers, and can stay with the company that insures them now.
How it works
The Krankenversicherungsgesetz, as a Swiss Army knife
Swiss voters adopted the law in 1994 and it took full effect in 1996.28 It is not a government insurer and it is not a free market. It is a set of tools that make private insurance behave like a public utility. The Netherlands built its own version in 2006 on the same core: every resident buys a standard package from a private insurer, and a risk-equalization fund evens out the costs.12 The main difference is money: about half of Dutch funding comes from an income-based contribution collected through employers, with flat premiums, the deductible and a government grant for children covering the rest.29 Dutch insurers must accept every applicant, and people can switch every year.30, 31 Open each tool.
Everyone is covered the big blade
One package, set by law the small blade
The benefits in basic insurance are defined in the law and are identical at every insurer.32 Insurers compete on price and service, not on fine print. In the standard plan, insurers must also contract with every provider34; restricted-network plans exist, but only for people who choose one in exchange for a lower premium.7
No profit on the basics the toothpick
Insurers are not allowed to make a profit on basic insurance; under the supervision law they are non-profit entities that may at most build reserves.1, 2 Profit is allowed on optional supplemental plans (private rooms, extras), which run under ordinary insurance law.2 Many insurers run a non-profit branch for basic cover and a for-profit branch for extras.35 In 2024, 39 insurers offered basic insurance.1
Same price for the same person the scissors
For a given plan, insurers may vary premiums only by region and by three age groups: children, young adults and adults. Health status does not count.32 (Premiums also differ between insurers and with the deductible you choose.)
Risk equalization the saw
Because insurers can’t charge sick people more, a central fund moves money from insurers with healthy customers to insurers with sick ones, adjusted for age, gender, prior hospital stays and past prescription drug use.36 This reduces the reward for cherry-picking.
Some skin in the game, with a ceiling the screwdriver
Adults choose a yearly deductible between CHF 300 and CHF 2,500, then pay 10% coinsurance up to CHF 700 a year. The worst case is CHF 1,000 with the low deductible or CHF 3,200 with the high one.21
Subsidies for those who need them the magnifying glass
Cantons pay premium subsidies directly to insurers. About 30% of residents now receive them, and the canton of Vaud caps premiums at 10% of household income.14 For people on social assistance, the state pays the premiums and the deductibles.6 More on how it protects the poor.
Regulated prices the file
Doctors bill from a national tariff; the old TARMED schedule is being replaced by TARDOC from 2026, with flat rates for some outpatient care.37 Drug prices on the reimbursement list are reviewed every three years37 and set partly by comparing prices in other countries.38 This is a big, unglamorous reason Switzerland pays less than America.
The cantons chip in the can opener
Cantons pay at least 55% of inpatient hospital costs. Voters approved the EFAS reform in November 2024 so cantons and insurers will share outpatient and inpatient costs the same way from 2028, with long-term care added from 2032.39
Medicare for All
How it compares to Medicare for All
Swiss chocolate comes in squares for a reason: you don’t have to eat it all at once.
- What Bernie’s bill doesSenator Sanders reintroduced the Medicare for All Act (S. 1506) on April 29, 2025.41 It enrolls everyone in one federal plan, phased in by age.42 It bars private insurers and employers from offering coverage that duplicates the new program.43Under KVG for All: everyone gets the same standard basic package, but it is sold by many competing insurers through the exchanges that already exist, instead of one federal plan replacing them.32, 41
- Who has to move53.5% of Americans had employer coverage in 2025, roughly 180 million people.13 Most of them like it: in 2019 KFF polling, 76% of the public viewed employer coverage favorably and 86% of people on employer plans rated theirs excellent or good.44Under KVG for All: today’s plans do change, but you choose the new one. Employers can keep their plans during the transition or move their money to individual plans through ICHRAs (Individual Coverage HRAs), which let an employer give workers tax-free money to buy their own plan instead of a company plan.45 By the end, everyone owns a standard basic policy and can buy it from the same insurer they have now. When the Netherlands merged its public and private insurance in 2006, roughly four in five people stayed with their insurer.46
- Up to $3 trillion a yearFor the single-payer designs it studied, CBO put the added federal cost at $1.5 to $3 trillion in 2030 alone; ten-year estimates of various versions run to about $32.6 trillion (Mercatus) and $34 trillion (Urban Institute).47 The Mercatus study of the 2017 version of Bernie’s bill found that doubling every dollar of projected federal individual and corporate income tax would not cover it.48 In fairness, much of that replaces premiums people pay now, and CBO found total national spending could land anywhere from $700 billion lower to $300 billion higher.47Under KVG for All: premiums stay the main source of money, as in Switzerland, with government subsidies for those who need them14, 49. Those subsidies still cost money, and nobody has scored this proposal yet, but it doesn’t require replacing all private premiums with federal taxes.
- Getting it through CongressEvery earlier version of the bill since 2019 died in committee, and the 2025 version hasn’t left committee either.50, 51, 52, 53 Even Vermont, Bernie’s home state, passed a single-payer law in 2011 and then abandoned it in 2014, because it would have needed an 11.5% payroll tax on businesses and an income tax of up to 9.5%.54 Legislators never even debated the financing plan.55Under KVG for All: it builds on laws already passed, like the ACA exchanges, the mandate still on the books and the ICHRA rule45, 56, so it can move in smaller bills. It still needs Congress, but not one all-or-nothing vote.
- Shutting down an industryEconomists at PERI, in a study broadly favorable to Medicare for All, estimated about 1.8 million jobs would become redundant: roughly 800,000 at insurers and about a million in billing and administration at hospitals and doctors’ offices.57, 58 Supporters at EPI argue new demand for care workers would offset those losses over time59, but it would still mean displacing well over a million workers.Under KVG for All: insurers keep operating, non-profit in the basic tier and for-profit in extras, as Swiss insurers do.35 A standard package and one price schedule would still cut some billing work, but there is no shutdown.
- The hospital mathPrivate plans paid hospitals 254% of what Medicare would have paid in 2022.60 With private insurance gone, the government’s rate becomes nearly every hospital’s only revenue, and CBO warned that demand for care could outrun the supply of doctors and hospitals.47Under KVG for All: prices come down too, under one regional schedule that every insurer pays, the way Maryland has set one hospital price for all insurers since 1977.61 Hospitals still deal with several competing buyers, not one.
- The polling cliffIn KFF’s September 2026 poll, 66% supported a national health plan.62 Tell people it eliminates private insurance and support drops to 52%.63Under KVG for All: private insurance stays, which removes the specific trade-off that costs Medicare for All support. More than half of Medicare beneficiaries already choose private plans inside a public framework.64
Medicare for All needs trillions in new federal spending, a Congress that has never moved it out of committee, and making an estimated 1.8 million insurance and billing jobs redundant. Then it asks 180 million people to give up a plan most of them like.Krankenversicherungsgesetz for All changes their plans too, but they pick the new one, and their insurer can stick around, just wearing a non-profit costume.
The queue
Waiting: the weak spot in Canada and the UK
Canada’s single-payer system is the closest large working model of Medicare for All. In 2025, its patients waited a median 28.6 weeks from a family doctor’s referral to treatment, the second-longest wait the Fraser Institute has recorded, with an estimated 1.4 million procedures in the queue.65
Median weeks from GP referral to treatment, 2025.66
Compare specialist access directly. In a Commonwealth Fund international survey cited by the Fraser Institute, 46% of Canadians said they waited two months or more for a specialist appointment. In the Netherlands it was 15.1%, and in Switzerland 13.2%.67 At the far end of the queue, 11% of Britons and 9% of Canadians waited a year or more, against 1% of the Dutch.68 The Netherlands also ranked first of 10 countries on access to care.69
Waited 2 months or more for a specialist
Commonwealth Fund survey.67 UK not reported on this measure in our sources.
Britain’s NHS, which owns the hospitals as well as paying for them, is having a harder decade still:
Direct democracy
The Swiss were offered single-payer. Twice. They said Nein.
The Swiss vote on everything, including this. In 2014 voters rejected replacing their 61 private insurers with a single public one by 62%.76 In 2007 a similar plan lost with 71% against.77 The 2014 vote was the left’s third failed attempt in ten years.78
A fair footnote for single-payer fans: in 2014, the French-speaking cantons of Geneva, Vaud, Neuchâtel and Jura voted oui. The German-speaking cantons outvoted them.79, 80 The Swiss call this language split the Röstigraben, the “hash-brown ditch.”
The conversion blueprint
From Obamacare to Krankenversicherungsgesetz in four years
A renovation, not a demolition. The foundation is already poured.
Here is the inconvenient part for both parties: America has already built half of the Swiss machine. The Affordable Care Act shares Switzerland’s individual mandate and competing private insurers; the big differences are that Switzerland regulates prices and benefits more tightly and its coverage is not employer-based.81 Medicare for All would demolish that machinery and start over. Krankenversicherungsgesetz for All finishes it.
It has been done quickly before. The Swiss adopted their law by referendum in 1994 and had it fully in force by 1996.28 The Netherlands folded its public and private insurance into one regulated-competition system in 2006.82 Four years is also exactly how long Bernie’s own bill gives itself to put everyone on one federal plan.42 We just don’t have to tear anything down first.
The poorest go first. The enhanced ACA credits expired at the end of 2025, marketplace enrollment fell 13%, and subsidized enrollees who kept their plan saw premium payments rise 114% on average.83 So step one starts with them.
This is a blueprint, not bill text. The specific numbers, like free coverage below 150% of the poverty line, are starting points for Congress to set, and nobody has scored them yet.
Parts already in the American garage
- Exchanges where private insurers sell standardized plans
- An individual mandate, still on the books with its penalty set to $0 since 201956
- ICHRAs, which since 2020 let employers fund individual coverage tax-free45
- One hospital price for every insurer, which Maryland has set since 1977.61 It still does for private insurers and Medicaid; from 2028, Washington sets the state’s Medicare rates instead.84
- Private plans inside Medicare, already chosen by 54% of eligible beneficiaries64
Free coverage for the poor, capped premiums for everyone else
Anyone below 150% of the poverty line gets the basic plan with no premium and no deductible, in every state, ending the Medicaid coverage gap. Switzerland already does this for people on social assistance.6 Above that, premiums are capped as a share of income: the expired enhanced credits used 8.5%85, Vaud uses 10%.14 Write it into federal law with a floor no state can undercut. New Mexico has already shown a state can top it up: it was the only one to fully replace the expired federal credits.86
One basic package, one menu of deductibles
Turn the ACA’s essential benefits into one national basic plan, identical at every insurer. Replace the metal tiers with a short list of deductibles and a hard yearly out-of-pocket cap, modeled on Switzerland’s CHF 1,000–3,200 range21, and scaled down by income so the cap never bites the poor. Basic plans must contract with any willing provider.34
Revive the mandate with automatic enrollment
Anyone uninsured at tax time is enrolled in the cheapest basic plan in their region, paid for by the subsidy they already qualify for. Below the free-coverage line, that costs nothing, so nobody is charged for being poor. Above it, people owe their income-capped share of the premium, collected through their taxes, and that money buys them coverage. Switzerland is stricter: the canton assigns an insurer and adds a premium surcharge for signing up late.33 The mandate is still U.S. law; it just needs a working enforcement mechanism.56
Make the basic tier non-profit
Insurers keep their brands and their jobs. Basic coverage must be sold through non-profit subsidiaries whose surpluses stay in the insurance pool; supplemental plans stay for-profit, as in Switzerland.2, 35 Strengthen ACA risk adjustment toward the Swiss formula, which uses prior hospital stays and drug use36, so insurers can’t profit by avoiding poor and sick people.
Fold Medicaid into the same exchange
Medicaid enrollees move into fully subsidized basic plans on the same exchange as everyone else. When their income rises, their subsidy shrinks gradually and they keep the same plan and the same doctor, instead of falling off a cliff. Current seniors keep Medicare; new retirees may keep the exchange plan they already have, following the path Avik Roy sketched for moving public programs onto reformed exchanges.87
Let employer coverage walk to the exchange
Nobody is forced off a plan on day one, but nobody keeps today’s plan forever either. Employers can switch to ICHRAs right away45; over the transition the tax break for job-based insurance becomes a portable credit for the worker’s own basic plan. Employer money still flows, but the policy belongs to the person, and it no longer ends when the job does.
Regional all-payer price schedules, on a glide path
States or regions set one price schedule that every basic plan pays. Maryland shows it can work: since 1977 it has set one hospital price that private insurers, Medicaid and Medicare all pay.61 Starting in 2028, Medicare’s rates there will be set in Washington instead, but Maryland will keep setting one price for private insurers and Medicaid, which is all this step needs.84 Private plans pay hospitals 254% of Medicare rates today60, so step prices down over several years to give hospitals, especially rural and safety-net ones, time to adjust. Reference drug prices against other rich countries and review them every three years, as Switzerland does.37, 38
Side by side
Why this is the easier road
This table compares one thing only: how hard it is to get from today’s system to the new one.
| Hurdle | Medicare for All (S. 1506) | KVG for All |
|---|---|---|
| Who has to change plans | Everyone with private coverage: private and employer plans can’t duplicate the program43, and 53.5% of Americans have employer coverage13 | Everyone ends up on a standard basic plan, from an insurer they choose, which can be their current one. Job-based coverage shifts as the tax break becomes portable; employers can already move their money to individual plans through ICHRAs, allowed since 202045 |
| What happens to today’s machinery | The bill sunsets the ACA exchanges41; a new national program is built in their place | Keeps the exchanges and the mandate already on the books56, and uses one-price-for-all-insurers rate setting of the kind Maryland has run since 197761 |
| New money Congress must raise | $1.5–3 trillion in added federal spending in 2030 alone47; doubling federal income taxes wouldn’t cover it, by one estimate48 | Premiums stay the main funding, with government help for those who need it, as in Switzerland49, where about 30% get subsidies14 |
| The insurance industry | About 1.8 million insurance and billing jobs made redundant, by supporters’ own estimate57 | Insurers stay in business: non-profit for basic cover, for-profit for extras, as Swiss insurers already run it35 |
| Shock to hospital budgets | Private plans now pay 254% of Medicare rates60; CBO warned demand could outrun supply under single-payer47 | Prices step down gradually under one regional schedule, the way Maryland has set one hospital price for all insurers since 197761 |
| Track record in legislatures | Earlier versions since 2019 died in committee50, 51, 52; Vermont passed single-payer, then dropped it over an 11.5% payroll tax54 | Swiss voters approved it in 199428; the Netherlands enacted its version in 200682 |
| Precedent for switching an existing system | Taiwan merged 10+ public insurance schemes, covering 59% of people, into one in 199588; South Korea merged about 350 non-profit insurance societies into one in 200089, 90. Neither had a commercial insurance market like America’s to replace | The Netherlands converted a mixed system, over 60% in public sickness funds and the rest privately insured, into one system of competing private insurers82; the insurers kept operating, and roughly four in five people stayed with theirs in the first year46 |
| Public support once the trade-offs are explained | Drops to 52% when people hear private insurance would be eliminated62 | Keeps private plans, which Americans already choose inside Medicare: 54% of eligible beneficiaries picked Medicare Advantage in 202564 |
Objections
Fair questions, honest answers
“Switzerland is the second most expensive system on Earth.”
True within the OECD, and Switzerland is also one of the most expensive countries on Earth: Swiss health-sector prices run about 62% above the OECD average.91 The relevant comparison for Americans is America, and Switzerland spends $4,922 less per person.3 The Netherlands runs a close cousin of the Swiss system, with mandatory private insurance7, and ranked second overall in the Commonwealth Fund’s 2024 rankings18; the two top-ranked countries also had the lowest spending as a share of GDP.8
“Taiwan is single-payer and has short waits.”
Correct, and Taiwan is the best argument single-payer has. Waits are short and coverage is near universal.73 But Taiwanese average about 16 doctor visits a year, far above the OECD norm74, many consultations last under five minutes75, and the system has run repeated deficits on comparatively low spending.92 Doctors and nurses complain of a rigid global budget and chronic shortages93, and a former insurance chief describes an exodus from critical-care specialties.94 Taiwan also had a smaller job: in 1995 it merged public insurance schemes covering 59% of people and enrolled the 41% who had nothing.74, 88 America would be moving 180 million people off private plans they already have.
“The UK ranked in the top three in that same report.”
It did, alongside Australia and the Netherlands.8 The UK came first on administrative efficiency69 while posting the worst hospital waits in the survey.68 Australia isn’t pure single-payer either: 45.6% of Australians also buy private hospital insurance.95 And the Netherlands runs a close cousin of the Swiss model.82
“Single-payer would cut administrative waste.”
Partly fair. Switzerland ranked last of 10 on administrative efficiency, below the United States.69 But Swiss administration is only about 5% of premiums, so even a perfect single fund would cut premiums only slightly.96 America’s problem is mainly prices, not usage.3 That is why the proposal regulates prices.
“Flat premiums are regressive. This hurts the poor.”
Flat premiums with income-based subsidies are how Switzerland does it: about 30% of residents get help14, and welfare recipients pay no premiums or deductibles.6 But other low earners still pay deductibles, and subsidized households spend about 12% of disposable income on premiums.24 That’s why this proposal would go further than Switzerland, with free coverage below 150% of the poverty line and a federal floor. See the full section.
“Deductibles make poor people skip care.”
That’s why the proposal sets no deductible for low-income people, as Switzerland does for social assistance recipients.6 For everyone else the worst case is capped; in Switzerland it is CHF 3,200 a year at most.21
“Insurers will cherry-pick healthy customers.”
A real risk. An OECD/WHO review of the Swiss system found insurers competed largely through risk selection97, which is why Switzerland has since strengthened its risk-equalization formula.36 The proposal starts with the stronger formula, plus a non-profit basic tier that reduces the reason to game it.
“Swiss premiums keep shooting up.”
They have. The average Swiss premium went from CHF 128 a month in 1996 to CHF 393 in 2026, a rise of about 207%98, or roughly 3.8% a year, driven mainly by people using more care, an aging population and new drugs.99, 100 That has outpaced wages24, and it is a real weakness.
But total costs are rising everywhere, at similar speeds. Before COVID, Swiss health spending grew about 2.8% a year101; Canada’s grew 3.9% a year from 2011 to 2019.102 In 2024, Swiss spending rose 4.1%103, Canada’s an expected 5.7%102 and the UK’s 7.8%.104 Dutch premiums rose about 10% a year from 2023 to 2025.105 American family premiums are up 53% since 2015.106 The difference is who feels it: the Swiss see it on a premium bill, while Canadians and Britons see it in taxes and waiting lists. That’s why the proposal caps premiums as a share of income, so rising costs land on subsidies rather than on family budgets.
“Every other rich country is single-payer.”
Not quite. It’s a mix. One common classification counts 12 rich democracies with single-payer or national health service systems and 7 that cover everyone through competing insurance funds.107 The multi-payer group includes the two largest rich economies after the U.S.:
- Germany: 94 separate non-profit sickness funds as of 2025108
- Japan: more than 3,000 insurers, split between employer-based and residence-based plans109
- France: several statutory funds, plus 96% of people buy private complementary insurance on top110
- Israel: four competing non-profit health plans111
- Belgium, Austria, the Netherlands and Switzerland107
Even PNHP, the leading single-payer physicians’ group, describes Germany and France as “multi-payer.”112
And many single-payer countries still rely on private insurance: about half of Australians and 46% of the Irish buy private cover, mostly for faster access or more choice of doctor,113, 114, 115 and 27 million Canadians, about two-thirds of the population, carry supplemental private insurance, largely for drugs and dental care.116
“You’re not really keeping your plan.”
Fair. Your insurer can stay the same, but the basic plan becomes one standard package, so the coverage itself changes. The difference from Medicare for All isn’t speed, since both take about four years. It’s choice: you pick among competing insurers every year, extras stay available as supplemental plans, and the policy belongs to you rather than your employer. The Netherlands went through exactly this in 2006 when it merged public and private insurance: the companies kept operating, the new basic package was almost identical to the old public coverage, and roughly four in five people stayed with their insurer in the first year.46, 117 Switzerland had even less to move: when its mandate took effect in 1996, nearly everyone was already insured.118
“Medicare is popular. Just expand it.”
In 2025, 54% of eligible Medicare beneficiaries chose a private Medicare Advantage plan over the government plan.64 More than half of Medicare beneficiaries already pick private plans inside a public framework, which is the Swiss idea.
“Obamacare already tried this and it isn’t working.”
The ACA shares the mandate and the exchanges but skipped the parts that make Switzerland work: non-profit basic coverage, contracts with every provider, regulated prices.34, 81 Single-payer advocates make this point themselves. The proposal adds those parts back.
The fine print
The Swiss would insist we be precise
Every plan has holes. This is a Swiss plan, so ours are Emmental-sized and clearly labeled below.
Switzerland has real problems
It is still the second most expensive system in the OECD per person.3 Average premiums are set to rise 5% in 2027, to CHF 412 a month, after increases of 8.7%, 6.0% and 4.4% in the three previous years; the average adult premium hits CHF 487.60.100, 119 About 22% of spending comes straight out of pocket91, and 29% of households earning up to CHF 4,000 a month report regular trouble paying premiums even after subsidies.25
The Commonwealth Fund ranked Switzerland 8th of 10 overall and last on administrative efficiency, below the United States.69
How that compares with Canada and the UK
Per person, Switzerland outspends both, partly because it is a richer country. Measured as a share of the economy, the gap mostly closes: in 2024 Switzerland spent 11.8% of GDP on health, Canada 11.3%, the UK 11.1%, the Netherlands 10.0% and the United States 17.2%.4, 120 Spending is also growing at similar speeds in all of them (see the premiums question).
Where the single-payer countries clearly do better is paperwork, and the UK on out-of-pocket costs. On administrative efficiency the UK ranked 1st and Canada 5th, against Switzerland’s 10th.121 Public or compulsory schemes cover 82% of health spending in the UK, against 70% in Canada and 68% in Switzerland.122, 123, 124 Canadians pay less directly out of pocket than the Swiss (about 14% of spending versus 22%), but lean heavily on private insurance for drugs and dental care.91, 116, 125 Switzerland does better on health outcomes, ranking 2nd of 10, ahead of both18, and its specialist waits are far shorter than Canada’s (see above).
The single-payer side has a case
Supporters make several strong arguments, and some of them hold up well against the Swiss model:
- Less paperwork. One payer means one set of rules and bills. The UK ranks 1st on administrative efficiency; Switzerland, with dozens of insurers, ranks last.121
- No bills at the point of care. Fewer than 2% of UK households face catastrophic health spending, among the lowest rates in the OECD.126 Swiss deductibles still hit low earners.24
- Nobody has to enroll. Coverage comes with residency, so nobody falls behind on premiums.25
- Possible total savings. CBO found some single-payer designs could lower total national health spending, depending on how much providers are paid.47
Critics like Dr. Claudia Chaufan argue the Swiss system is a model to reject11, and single-payer doctors call the Dutch version a cautionary tale.82 We take their best points seriously in the objections above.
Our answer is mostly about the path, not the destination: getting there from the American starting point.
And a warning for the free-marketeers
A big reason Switzerland is cheaper than America is that it regulates prices, not that it deregulated anything.37, 38 The Krankenversicherungsgesetz is a compromise: private insurers, public rules. Swiss voters chose it in 1994 and have refused to trade it for single-payer twice since.76, 77