Kaiser Permanente Has Been Running Socialized Medicine in America for 80 Years.

Nobody Noticed Because It Works.

For eighty years, Kaiser Permanente has quietly operated what critics of universal healthcare claim is impossible: an integrated, nonprofit health system serving 12.5 million Americans with predictable costs, coordinated care, and no surprise bills. If you’ve ever been a Kaiser member, you’ve experienced something closer to European healthcare than traditional American insurance.

The irony is thick: we already have proof that universal healthcare can work on U.S. soil. We just refuse to scale it.

Meanwhile, France delivers cradle-to-grave coverage for $6,100 per person per year (adjusted for purchasing power). The Netherlands does it for $6,800. Germany spends around $8,000. Japan manages comprehensive coverage for $5,300. The United States spends more than $13,000 per person—roughly twice what other wealthy nations pay—and still leaves tens of millions uninsured.

We know exactly what universal healthcare costs. Thirty countries prove it works. The math isn’t complicated.

Here’s what makes Kaiser’s example even more remarkable: they spend around $8,500 per member while operating primarily in California—one of the most expensive, highly regulated states in the country, where real estate costs are astronomical and labor markets are tight. And they do it while paying the same inflated drug prices as everyone else in the broken U.S. market. No national negotiating power. No bulk purchasing advantage beyond their own membership.

If Kaiser can deliver comprehensive care at Germany-level costs while operating with every disadvantage the critics cite, the argument that universal healthcare is unaffordable in America collapses completely.

The problem isn’t that universal healthcare is impossible. The problem is that Congress won’t make the decisions required to deliver it. Either we’re willing to set a budget, negotiate drug prices, and make hard coverage choices—or we’re not. Make the choice and stop pretending the answer doesn’t exist.

Set a Budget and Make It Stick

Instead of debating slogans like “Medicare for All,” let’s start where Europe starts—with a budget. Pick a number. Set a national target and design the system to live within it. That’s not theoretical. It’s what every other developed country already does.

They set the budget, and the system delivers within it. Period.

Right now, we have the opposite: an open-ended system with no cost guardrails, bloated administration, and prices that vary wildly by zip code. A universal plan built around a fixed national health budget would force the system to align prices, payments, and priorities—exactly as other countries do.

Here’s what budget discipline actually means: making hard choices about what gets covered and what doesn’t. Europe does this. The UK won’t cover treatments that cost more than £30,000 per quality-adjusted life year. Germany has age-based treatment protocols. France’s formularies say “no” to drugs with marginal benefits. These aren’t accidents—they’re the decisions that make universal coverage affordable.

America refuses to have this conversation. We pretend unlimited care at any age for any condition is possible, then wonder why costs spiral out of control.

The arithmetic is straightforward. Americans pay around $1,800 per person annually for prescription drugs. Europeans pay about $670. That’s $1,100 in potential savings per person just from drug price negotiation—the single biggest cost lever available.

For 330 million Americans, European drug prices alone would save $360 billion annually. Add that to the $2 trillion we already spend in public dollars through Medicare, Medicaid, ACA subsidies, Veterans Affairs, and employer tax exclusions, and you’re looking at $2.4 trillion to fund universal coverage—enough for roughly $7,200 per person.

To hit $6,500 per person, you need drug negotiation plus operational discipline: economies of scale, administrative simplification, and yes, hard coverage decisions about what treatments make the cut for the universal baseline. Everything else goes to Tier 2 supplemental insurance.

The Two-Tier Framework

The goal isn’t to eliminate private care but to guarantee a baseline for everyone:

Tier 1: Universal Baseline. Publicly funded coverage for all citizens and legal residents—hospital care, primary care, maternity, mental health, essential drugs, and emergencies. No surprise bills. Regional administrators negotiate uniform prices with hospitals and drug companies, just as Medicare does now but for everyone.

Tier 2: Employer or Private Supplemental. Companies or individuals remain free to purchase enhanced coverage: shorter waits, private rooms, alternative therapies, or elective procedures. This is how France, Germany, and Australia combine universality with choice. Employers still compete on benefits, but within a predictable framework where they’re not subsidizing emergency room visits for the uninsured.

Universal doesn’t mean uniform. Everyone gets the same floor, and private initiative builds the ceiling.

Private Companies Can Deliver Under the Right Constraints

The universal tier should be delivered by multiple competing private companies—whether nonprofit or for-profit—all operating under uniform budget constraints and payment rules.

The key isn’t organizational structure—it’s market design.

Set the constraint: deliver comprehensive care for $6,500-7,000 per person per year. Any company that can meet that budget while maintaining quality standards gets to compete for patients. Those that can’t, exit the market.

Meeting that budget means making hard choices. Tighter drug formularies. Age-based treatment protocols. Saying no to expensive interventions with marginal benefits. Exactly what Europe does and America refuses to do.

This flips the current incentive structure. Today’s insurers profit by denying care and gaming billing codes. Under fixed per-capita budgets, companies profit by keeping people healthy and delivering efficient care within the constraint. The business model shifts from billing optimization to outcomes optimization within a hard ceiling.

This is market-based universal coverage—multiple private providers competing to deliver the best care within a fixed budget. No government monopoly. No nationalizing existing systems. Just proper rules that make companies compete on what actually matters: delivering value within the constraint.

The Bottom Line

This isn’t an impossible problem. We know what works. We know what it costs. Europe has operated these systems for fifty years. Kaiser—a private company operating in competitive American markets—has done it here for eight decades at Germany-level costs, even without the advantage of national drug price negotiation.

The idea that universal healthcare is unaffordable in America is simply false.

Here’s what’s actually true: Congress won’t make the decisions required to solve it.

This isn’t a Republican versus Democratic fight—both parties are equally responsible for this mess. Democrats endlessly showboat about supporting universal healthcare while proving to the public that it can’t work by making the ill-thought-out ACA and thereby creating a governmental nuisance for 15 years. Republicans pretend that it only is not working because of illegal immigrants, fraud, and people too lazy to work.

It’s all performance, zero substance.

How about we stop paying Congress until they solve this? Or don’t let anyone run for office again if this isn’t solved in the next two years? The math exists. The models exist. Thirty countries already do this. Either solve it or get out of the way.

Did either party spend the government shutdown debating healthcare reform? Did they use their six-week recess to draft legislation? No. They went home. They’re not even trying.

We’re the richest country in the world. We know exactly what universal healthcare costs because thirty countries already deliver it. Either we’re willing to set a budget, negotiate drug prices, and make hard coverage decisions—or we’re not.

If we’re not willing to pay for it, then say so. Stop pretending we support universal coverage “in principle” while refusing to do anything that would actually make it work.

If we are willing to pay for it, then set the budget and force the system to deliver within it. Let private companies compete to provide the best care package within that constraint. Add national drug price negotiation. Make the coverage decisions Europe made decades ago.

The math works. Kaiser proves the delivery model works. The only question is whether we have the discipline to stop lying about what it takes and the courage to actually do it.