Policy Insight · 2026 Edition

Why Does the USA Not Have
Free Healthcare?

While Canada, the UK, France, Germany, and dozens of other nations provide universal healthcare to their citizens, America spends more on health per person than anyone — yet leaves millions behind. The full answer involves wars, weapons, billionaires, lobbyists, and a political system built to resist change.

🇨🇦 Canada 🇬🇧 UK 🇩🇪 Germany 🇫🇷 France 🇨🇳 China 🇷🇺 Russia 🇺🇸 NOT USA ❌

$14,885 USA Healthcare
Cost Per Person (2024)

$895B US Military Budget
FY2025

36% Americans Who Skipped
Medical Care Due to Cost

"The United States spends roughly twice as much per person on healthcare as Europe, yet 36% of US adults reported skipping needed medical care because of cost — compared to just 3.6% in the EU." — KFF / North American Community Hub, 2025

The question seems almost absurd: the world's wealthiest nation — a country that can afford to spend nearly $900 billion a year on its military, give $21.7 billion in weapons to a foreign ally in two years, fund wars across multiple continents, and watch its billionaires accumulate more wealth than entire nations — cannot find a way to ensure that its citizens don't go bankrupt visiting a doctor.

The answer is not a mystery. It is not about economic inability. It is a deliberate result of who has power, who benefits from the current system, and who has spent decades ensuring nothing changes. This article examines every significant factor — with data.

Part 01

The Brutal Reality:
America Pays the Most, Gets the Least

According to OECD 2024 data and KFF analysis, the United States spends $14,885 per person on healthcare — nearly double Switzerland, the second-highest spender at $9,963, and more than double the average among comparable wealthy nations ($7,371). Despite this staggering expenditure, American health outcomes lag behind virtually every peer nation.

💸 Healthcare Spending Per Capita — USA vs. The World (2024)

🇺🇸

USA

$14,885

🇨🇭

Switzerland

$9,963

🇩🇪

Germany

~$8,011

🇨🇦

Canada

~$7,400

🇫🇷

France

~$6,800

🇬🇧

United Kingdom

~$5,900

Source: OECD Health Statistics 2024 · Peterson-KFF Health System Tracker

✅ Countries WITH Universal Healthcare

• Life expectancy 2–4 years higher than USA
• Only 3.6% of EU adults skip care due to cost
• Maternal mortality rates far lower
• No medical bankruptcy exists as a concept
• Coverage tied to residency — not employment

❌ USA — No Universal Coverage

• Lowest life expectancy among rich nations
• 36% of Americans skip care due to cost
• 18.6 maternal deaths per 100,000 births
• Medical debt = #1 cause of personal bankruptcy
• Coverage tied to employment — lose job, lose insurance

Part 02

The War Machine:
$895 Billion for Defense, Not Healthcare

The United States' FY2025 military budget stood at $895.2 billion — approved through the National Defense Authorization Act. The FY2026 request climbed further to $961.6 billion, including $292.2 billion for the Navy, $301.1 billion for the Air Force, and $197.4 billion for the Army. To put this in perspective: the US spends more on defense than the next nine countries combined.

"There's a correlation between expanding militarism and worsening health outcomes: when a country's spending on their military increases, their spending on public health decreases. The US ranks last in healthcare among nine high-income countries — but simultaneously spends more on the Pentagon than those nine countries spend on their militaries combined." — Institute for Policy Studies / War Prevention Initiative, 2025

Canada, the UK, France, and Germany can afford universal healthcare in part because they do not carry the financial burden of being the world's self-appointed military superpower. NATO allies spend roughly 2% of GDP on defense. The US spends over 3.5%. That difference — compounded over decades — represents trillions of dollars redirected away from social programs including healthcare, education, and housing.

Expenditure	Amount	Context
US Military Budget (FY2025) Pentagon + Veterans + Nuclear	$895.2 Billion	More than next 9 nations combined
Military Aid to Israel (Oct 2023–Sept 2025) Brown University Costs of War Project	$21.7 Billion	Does not include future commitments
US Military Operations in Yemen/Iran Region Supporting Israeli operations, Oct 2023–2025	$9.65–$12B	Total post-Oct 7 spending: $31–34B
Annual Aid to Israel (MOU commitment) Through 2028	$3.8 Billion/yr	Guaranteed regardless of conditions
Aid to Egypt (Annual) Post-Camp David peace treaty, since 1979	~$1.3 Billion/yr	Mostly military assistance
Aid to Ukraine (FY2023 alone) Pew Research Center	$16.6 Billion	Largest single-year country recipient
Total US Foreign Aid (FY2025 projected) Congressional Budget Office	$58.4 Billion	Across all international programs
Cost to Cover All Uninsured Americans Estimated single-payer expansion cost	~$32–36B/yr	Less than one year of Israel + Yemen war spending

Part 03

The Foreign Aid Question:
Billions Abroad, Bankruptcy at Home

Since the October 7, 2023 Hamas attacks on Israel, the United States has provided at least $21.7 billion in direct military aid to Israel — a figure that does not include tens of billions in committed future weapons sales. According to Brown University's Costs of War Project, when combined with US military operations in Yemen and the broader region in support of Israeli operations, the total two-year bill reaches $31–$34 billion.

Israel has been the largest cumulative recipient of US foreign aid since its founding, receiving over $300 billion (inflation-adjusted) in total economic and military assistance. The current MOU commits $3.8 billion per year through 2028. Egypt receives approximately $1.3 billion annually — primarily military — as part of the 1979 Camp David peace arrangement.

"In the two years since October 7, 2023, the US government has spent $21.7 billion on military aid to Israel. This figure does not include the tens of billions in arms sales committed for weapons that will be delivered in future years." — William D. Hartung, Quincy Institute / Brown University Costs of War Project, 2025

The irony is stark. The estimated additional annual cost to provide healthcare coverage to all uninsured Americans sits at roughly $32–36 billion. The United States spent more than that in just two years of post-October 7 war-related expenditure. Meanwhile, approximately 9.2% of Americans remained uninsured as of 2023, and over a third of those with insurance still skipped care due to cost.

Part 04

The Real Reasons America
Has No Universal Healthcare

1

💊 The Profit Motive

Pharmaceutical & Insurance Industry Lobbying

The American healthcare system is among the most profitable industries on earth — and those profits depend entirely on the absence of universal coverage. The pharmaceutical and health insurance industries collectively spend hundreds of millions of dollars per year lobbying Congress to ensure that a single-payer or government-run system never passes. Insulin spending alone tripled from $8 billion to $22.3 billion between 2012 and 2022 — not because more people needed insulin, but because prices were allowed to rise unchecked. Meanwhile, the US spends $925 per person on administrative costs — nearly four times the comparable country average of $245. That $680 per-person administrative excess flows directly into the pockets of private insurers. Any move toward universal coverage would eliminate this revenue stream entirely, which is why the industry fights it at every level of government.

Insulin: $8B → $22.3B (2012–2022) $925/person admin costs (USA) vs $245 globally Healthcare = Most Powerful DC Lobby Private insurer profits depend on status quo

2

💰 Oligarchic Influence

Billionaire Influence & the Capture of Democracy

A universal healthcare system would raise taxes — primarily on the wealthiest Americans — to fund coverage for all. This is precisely why America's billionaire class has consistently bankrolled political opposition to any such reform. After the Supreme Court's 2010 Citizens United ruling, corporations and the ultra-wealthy can spend unlimited amounts on political campaigns through SuperPACs. Healthcare, pharmaceutical, and insurance executives use this mechanism to fund politicians who oppose Medicare for All or any form of universal coverage. The result is a Congress that, on healthcare, represents its donors more than its voters. Polling consistently shows that 60–70% of Americans support some form of universal healthcare — yet it never advances past congressional committees. The correlation between campaign financing from health industry donors and votes against healthcare reform is well-documented by academic researchers. In a country where a dozen billionaires hold more wealth than the bottom 50% of Americans combined, the political system reflects wealth — not popular will.

Citizens United (2010): Unlimited Corporate Political Spending 60–70% of Americans support universal healthcare Congress receives millions from health industry donors 12 billionaires > bottom 50% of US wealth

3

🪖 The War Economy

The Military-Industrial Complex & Budget Priorities

President Eisenhower warned Americans in 1961 about the "military-industrial complex" — the dangerous alliance between defense contractors, the Pentagon, and Congress. In 2025, the FY2025 National Defense Authorization Act approved $895.2 billion for defense. Defense contractors like Lockheed Martin, Raytheon, and Boeing spend enormous sums lobbying for continued or increased military budgets, creating jobs in key congressional districts — making cuts politically toxic. The US spends more on defense than the next nine countries combined — Russia, China, UK, India, Germany, Saudi Arabia, France, South Korea, and Japan. Canada, France, Germany, and the UK can afford universal healthcare partly because they are not absorbing the global cost of projecting military power across every ocean. Every dollar allocated to the F-35 program, carrier battle groups, or foreign military bases is a dollar not available for domestic healthcare, education, or infrastructure.

$895B Military Budget FY2025 US spends more than next 9 nations combined Defense contractors lobby to protect contracts NATO allies spend ~2% GDP — USA spends ~3.5%

4

🌍 Foreign Entanglements

Wars, Foreign Aid & the Cost of Global Policing

The wars in Afghanistan and Iraq — launched after 9/11 and costing an estimated $8 trillion in total according to Brown University's Costs of War Project — diverted trillions from domestic investment over two decades. Ongoing military commitments in Syria, Somalia, and Niger, naval operations in the Red Sea, and the cost of maintaining 750+ foreign military bases across 80+ countries represent a permanent drain on the federal budget. Since October 2023, the US has spent $31–34 billion on Israeli military support and related operations — enough to fund near-universal coverage of America's uninsured population for an entire year. Annual military aid to Egypt ($1.3B) and Ukraine ($16.6B in FY2023 alone) adds further to a foreign policy spending bill that routinely dwarfs proposed domestic healthcare expansions. The political will to fund foreign wars has consistently exceeded the political will to fund American lives.

Iraq + Afghanistan: ~$8 Trillion total 750+ US military bases in 80+ countries $31–34B post-Oct 7 Middle East spending $16.6B to Ukraine in FY2023 alone

5

🏛️ Political Culture

The "Socialism" Fear & Cold War Ideology

Throughout the Cold War, any proposal for government-provided healthcare was labeled "socialism" or "communism" by political opponents — a rhetorical strategy that proved devastatingly effective in American political culture. This framing was not accidental; it was a deliberate campaign funded in part by the American Medical Association, which launched a major propaganda effort in the 1960s against Medicare — the same Medicare that tens of millions of Americans now depend on and overwhelmingly support. The irony is that the US government already runs several successful universal healthcare systems: Medicare (for seniors), Medicaid (for low-income Americans), the VA (for veterans), and TRICARE (for military personnel). These programs prove that the government is capable of delivering healthcare efficiently. The barrier is not competence — it is ideology deployed in service of profit.

AMA lobbied against Medicare in the 1960s Medicare, Medicaid, VA, TRICARE = US already does it "Socialism" framing = Cold War political weapon Medicare enjoys ~85% public approval

6

📋 System Design

A System Built for Complexity — Not Care

The US healthcare system is not just expensive — it is structurally wasteful in ways that benefit intermediaries rather than patients. The US spends $925 per person on administrative costs alone — nearly four times the international average of $245. This administrative overhead includes running thousands of separate insurance plans, each with different networks, prior authorization rules, copays, deductibles, and billing codes. A universal single-payer system would eliminate the vast majority of this waste — saving hundreds of billions annually that could be redirected to actual care. But the insurance industry's business model depends on this complexity. Prior authorization systems delay or deny care. Network restrictions push patients to out-of-network providers at higher cost. Drug companies charge Americans 3–5x the prices paid in Canada or Germany for identical medications. All of this is legal. All of this is profitable. And all of it is protected by the same lobby that funds American politicians.

$925/person admin costs — 4x international average Drugs cost 3–5x more in USA than Canada/Germany Single-payer would save hundreds of billions Prior authorization = profitable delay of care

7

⚖️ Structural Inequality

Race, Class & Who "Deserves" Healthcare

A persistent and uncomfortable factor in America's resistance to universal healthcare is the role of race and class. Political opponents of universal programs have historically used coded racial language — invoking the specter of "welfare" and "government handouts" — to build opposition among white working-class voters who might otherwise benefit from the programs. This strategy — dating back to at least the New Deal era — has been well-documented by political historians. The reality is that the uninsured in America are disproportionately Black, Hispanic, and low-income. The refusal to cover these populations is not a budgetary decision — it is a political one. Countries like Canada and the UK made a societal decision that healthcare is a right, not a privilege. The US political system has repeatedly rejected this premise — not because it is economically impossible, but because powerful interests have successfully framed it as a cultural and racial threat to the majority.

Uninsured disproportionately Black, Hispanic, low-income Healthcare as "right" rejected by US political mainstream Racial framing used to divide voters against own interests

The Fundamental Paradox

The United States already spends more public money per capita on healthcare than Canada or the UK spends on their entire universal systems — yet still leaves tens of millions uninsured. Americans are not paying less for a system without universal coverage. They are paying more — far more — while getting less. The money exists. The organizational capacity exists. What does not exist is a political system free from the influence of the industries that profit from the status quo.

Part 05

Frequently Asked Questions

Could the USA actually afford universal healthcare?

Yes. The US already spends more public money per person on healthcare than countries with universal systems. Eliminating administrative waste alone ($680 per person above the international average) would save over $200 billion annually. A shift to a single-payer system — eliminating private insurer overhead — is estimated by multiple economists to save $300–600 billion per year, which would more than cover the cost of universal coverage.

Why does the US spend so much on Israel and not on healthcare?

It is a question of political will, not financial capacity. The US has committed to $3.8 billion per year to Israel through 2028 — and spent $21.7 billion in military aid in just two years since October 2023. These decisions are made by Congress and reflect donor priorities, foreign policy commitments, and geopolitical strategy — not a budgetary constraint that prevents healthcare spending. Both could theoretically coexist; the question is what the political system chooses to prioritize.

Does Russia and China actually have free healthcare?

Both countries have constitutionally guaranteed universal healthcare systems, though the quality and accessibility vary enormously by region. China's system covers nearly 1.4 billion people through a tiered insurance model, while Russia inherited the Soviet Semashko system providing free basic care. Neither system is perfect — waiting times and quality gaps are significant — but both represent a foundational commitment that every citizen is entitled to some level of care without financial ruin, which is absent in the United States.

What do most Americans actually want?

Polling consistently shows that 60–70% of Americans support some form of universal or government-provided healthcare. Support for Medicare for All — depending on how it is described — typically ranges from 50–60%. The disconnect between public desire and political reality is a direct consequence of campaign finance systems that allow wealthy industries to influence legislators beyond what public opinion can counter.

Has the US ever come close to universal healthcare?

Yes — multiple times. Franklin Roosevelt considered including health insurance in the Social Security Act (1935) but dropped it under industry pressure. Harry Truman proposed national health insurance in 1945 and 1949 — both efforts were killed by AMA lobbying campaigns. Lyndon Johnson succeeded in passing Medicare and Medicaid in 1965 — a partial breakthrough. Bill Clinton's 1993 healthcare reform effort was famously defeated by a $300 million insurance industry campaign. Barack Obama's ACA (2010) expanded coverage but explicitly excluded the public option under lobbying pressure. Bernie Sanders' Medicare for All bills never reached Senate floor votes.

The Bottom Line

America does not lack universal healthcare because it cannot afford it. It lacks universal healthcare because a convergence of powerful forces — pharmaceutical corporations, private insurance companies, defense contractors, billionaire donors, foreign policy commitments, and a political system built to serve wealth over voters — has successfully prevented it for over a century.

The United States spends roughly twice as much per person on healthcare as Europe, yet patients in many European countries experience fewer cost barriers, more consistent access, and better population-level outcomes. The difference, as KFF and the OECD consistently document, is not medical talent or technology — it is how the system is financed, who controls prices, and who holds political power.

Canada built universal healthcare because Canadians decided healthcare was a right. The UK built the NHS because a post-war government decided that soldiers who had sacrificed everything deserved care when they returned. France, Germany, and dozens of other nations did the same. The United States has made a different choice — repeatedly, consistently, over decades. That choice is not inevitable. It is a policy decision — and policy decisions can change. But only when the political will to serve people outweighs the financial will to profit from their suffering.

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