Washington Outspends the World on Healthcare: $2.5 Trillion in Taxpayer Money

With the Nov. 3 midterm elections less than three weeks away, healthcare has become a central Democratic campaign issue. An Associated Press analysis of AdImpact data found that healthcare was the most common issue in Democratic House and Senate ads since Sept. 1.

Democrats have made four claims: that Washington spends more on war than on healthcare, that most Americans lack health insurance, that Trump’s Medicaid changes take coverage away from poor Americans, and that socialized medicine provides better care. All four claims are false, as the spending figures, insurance coverage data, Medicaid provisions and international comparisons below demonstrate.

U.S. national health spending reached $5.3 trillion in 2024, or $15,474 per person, according to CMS data. That spending was equal to 18.0 percent of GDP. The federal government paid for 31 percent of total health spending, and state and local governments paid for 16 percent. Combined, government at all levels paid roughly $2.5 trillion.

That figure is nearly double the entire health budget of China, the world’s second-largest economy. According to China’s National Health Commission, China’s total health spending in 2024 was an estimated 9.09 trillion yuan, about $1.27 trillion in public and private spending combined, with the government paying 24.9 percent. Per person, the OECD’s health division head told the Senate Special Committee on Aging that U.S. government health spending per capita was greater than in all other OECD countries.

That spending funds coverage for more than a third of Americans. The Census Bureau found that 92.0 percent of Americans, 310 million people, had health insurance in 2024. Employer coverage was the most common type at 53.8 percent, followed by Medicare at 19.1 percent and Medicaid at 17.6 percent. Overall, 66.1 percent of Americans had private coverage and 35.5 percent had public coverage. Government coverage is concentrated among low-income Americans. Public coverage rates fall as income rises: Census figures show 77.0 percent of children and 50.7 percent of adults in poverty had public coverage, compared with 6.7 percent and 5.7 percent of those at or above 400 percent of the poverty line.

Trump signed the One Big Beautiful Bill Act into law on July 4, 2025, and Democrats have since described its Medicaid provisions as taking healthcare away from vulnerable Americans. In a May 2025 press release, House Democratic Leader Hakeem Jeffries called the bill “the largest healthcare cut in our country’s history” and said millions would lose Medicaid coverage. A statement from Jeffries and House Democratic leaders said the law takes healthcare and food assistance from millions of people to fund tax cuts for the wealthy. Rep. Bobby Scott, ranking member of the House Education and Workforce Committee, said Republicans would strip healthcare from the Americans most in need.

The law does not kick poor people off Medicaid, and it does not raise the income eligibility threshold, which remains 138 percent of the federal poverty line. It simply requires able-bodied adults to work, study or volunteer 80 hours a month.

The 138 percent limit equals about $21,597 a year for an individual in 2025, and adults who qualified on income before the law still qualify on income. What changes is how often eligibility is checked: beginning Jan. 1, 2027, states must verify the income test every six months instead of once a year.

A frequently repeated claim holds that the United States is the only industrialized nation without socialized medicine. Under socialized medicine, the government owns the hospitals and employs the doctors, as in Britain’s National Health Service. Many industrialized countries do not use that model. Switzerland and the Netherlands achieve universal coverage through a mandate that every individual buy a basic plan from regulated private insurers.

Germany, France and Japan use statutory insurance systems with largely private providers. The United States, meanwhile, operates its own government-run system: the Veterans Health Administration runs 170 medical centers and 1,193 outpatient sites serving more than 9.1 million enrolled veterans. Nor is the United States the only OECD country without universal coverage: the OECD reports that coverage for core services remained below 95 percent in four member countries in 2024.

In many countries with government-run systems, a private medical sector operates alongside the public one because patients cannot get timely public care. Among 29 OECD countries with comparable data, nine had private insurance covering more than half the population in 2024. In Britain, NHS waiting lists grew from 4.24 million in March 2020 to 7.37 million in June 2025, and concern about NHS waiting times was the leading reason consumers gave for buying private insurance.

In Ireland, 2.55 million people, about 46 percent of the population, held private health insurance at the end of 2025. The main reasons Irish policyholders gave in the state regulator’s survey were lack of access to public services and longer waiting lists. In Spain, private coverage rose from 23 percent of the population in 2020 to 26 percent in 2025, nearly 13 million people, driven largely by waiting times in the public system.

In Canada, patients leave the country and pay for treatment themselves, overwhelmingly choosing the United States. Long waits and unavailable treatment were leading reasons for seeking care outside Canada. More recently, the Fraser Institute estimated that 105,529 Canadians received non-emergency medical treatment abroad in 2025.

That is ironic given the Canadian criticism that America lacks socialized medicine: Canadians cross the border to pay for American healthcare because they can obtain treatment sooner or access care unavailable at home.

While liberals believe that pointing out America’s lack of socialized medicine is a dig at Republicans, it actually underscores a strength of the U.S. system, where the average salary is higher and the average tax rate is lower than in Canada, Germany, and all but a few countries in the world.

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