UNIVERSAL HEALTHCARE ISN’T THE ONLY WAY TO CUT COSTS

Bulk buying works — and America already knows how to do it

For many Americans, “universal healthcare” triggers ideological alarms. That reaction didn’t happen by accident. It’s the product of decades of lobbying by industries that profit from the world’s most expensive healthcare system.

But here’s the key point:

You don’t need to start with universal healthcare to slash costs.

You need purchasing power.

Why other countries pay less

Most Western healthcare systems are affordable for a simple economic reason:

they buy drugs, hospital services, and medical labour in massive volumes.

When a buyer represents most of the market:

• * Suppliers can’t afford to walk away

• * Prices fall

• * Long-term contracts replace price gouging

This is why OECD countries pay a fraction of US prices for insulin, cancer drugs, scans, and hospital care — even when using private providers.

A practical place to start: a state-level single buyer

Instead of reinventing dozens of fragmented insurance programs, states could consolidate existing publicly funded populations into a single, not-for-profit purchasing entity.

This would initially cover people already supported by government, including:

• * Medicare and Medicaid recipients

• * ACA-subsidised enrollees

• * Welfare recipients

• * Veterans and government pensioners

• * State government employees

• * Patients facing catastrophic illness and bankruptcy

This isn’t radical expansion.

It’s rational consolidation.

What a single buyer actually does

A state-owned, not-for-profit purchaser would negotiate:

• * Pharmaceutical prices (in- and out-patient)

• * Hospital beds and procedures

• * Doctor and specialist fees

• * Ambulance and emergency services

• * Dental, mental health, physio, and allied care

This mirrors how systems already operate in Australia, the UK, and much of Europe — often using private providers paid at negotiated rates.

What happens over time

As purchasing power grows:

• * Unit costs fall toward OECD norms (often 30–50% lower than current US prices)

• * Medical bankruptcies drop

• * Infant mortality improves

• * Life expectancy rebounds

Coverage can then expand pragmatically:

• * All children

• * All seniors

• * Eventually, anyone who opts in

Public–private hybrids still work

Private insurance doesn’t disappear. It evolves.

Those outside the public system keep employer or private cover, but:

• * Benefit indirectly from lower system-wide costs

• * May receive tax offsets reflecting public savings

• * Can purchase upgrades — private rooms, provider choice, faster access — just as in Australia and the UK

This is not “socialised medicine”. It’s mixed-market healthcare done properly.

Why resistance is fierce

US trade policy has repeatedly sought to weaken foreign drug-price negotiation systems — largely to protect pharmaceutical profits.

Ironically, tariffs and trade retaliation only raise US prices further, making the domestic problem worse.

Drug companies will fight hardest. Their US market delivers windfall margins unimaginable elsewhere. But that pricing model has lost credibility — especially when Americans pay 10× for the same insulin.

The biggest losers, however, would be insurers and HMO operators whose profits depend on complexity, claim denial, and opacity.

Bottom line

America doesn’t need to leap straight to universal healthcare to fix costs.

It needs to:

• * Aggregate buyers

• * Negotiate like the rest of the world

• * Stop confusing market power with socialism

That’s not ideology. That’s economics.