U.S. Health Care: The Free-market Myth (Michael F. Cannon, Fall 2025, National Affairs)
Many critiques of U.S. health care begin with the assumption that, as The Economist put it, the United States is “one of the only developed countries where health care is mostly left to the free market.” Dr. David Blumenthal, a former advisor to President Barack Obama, told the New York Times in 2013 that in the United States, “we like to consider health care a free market.” That assumption gets the situation backward: In truth, among wealthy nations, the United States may have one of the least-free health-care markets.
In a free market, government would control 0% of health spending. Yet the Organization for Economic Cooperation and Development (OECD) reports that in the United States, government controls 84% of health spending. In fact, government controls a larger share of health spending in the United States than in 27 out of 38 OECD-member nations, including the United Kingdom (83%) and Canada (73%), each of which has an explicitly socialized health-care system. When it comes to government control of health spending, the United States is closer to communist Cuba (89%) than the average OECD nation (75%).
Either a nationalized scheme or universal HSAs would yield a less expensive system with better outcomes.