Rep. Pramila Jayapal introduced a sweeping Medicare for All (MFA) bill on Wednesday ( H.R. 1384 ), and the national debate on healthcare is bound to intensify through the 2020 election. Voters rank healthcare costs as their second most important priority , just after the economy. The political fate of MFA will likely depend on one key question: Will it reduce healthcare costs while preserving the freedom to choose health providers?

If properly structured, MFA can do that: cut costs while improving choice.

Medicare for All has come a long way since Sen. Bernie Sanders launched his 2016 presidential campaign on that theme, while fellow Democrats ran from the label. Sanders also faced the wrath of mainstream pundits like Paul Krugman, who described Sanders' healthcare plan as "smoke and mirrors." Now, every major Democratic Party candidate endorses the label, (though they will certainly differ on the details) and Sanders could well become president in 2021 on the basis of his clear and persistent MFA advocacy.

No doubt the debate will become heated, even shrill. We are talking about serious money, and the largest single sector of the American economy. Healthcare outlays in the United States account for nearly 18% of the country's gross domestic product. Profits are soaring in the private healthcare and pharmaceutical industries, both of which will fight fiercely against MFA. President Donald Trump has weighed in , declaring that Democrats are "radical socialists who want to model America's economy after Venezuela."

While former President Barack Obama spoke out in favor of a single-payer plan , he avoided the battle back in 2009 with the Affordable Care Act. And by making health insurance available to millions more Americans, the Affordable Care Act allowed private industry to raise prices given the increase in demand. The result is that Obamacare expanded overall coverage, and provided hugely popular guaranteed coverage for pre-existing conditions, while avoiding any decisive steps on cost containment.

MFA picks up at that point. Real cost containment will be the critical issue that either makes or breaks each MFA proposal.

Americans currently pay around $10,000 per person per year in health outlays, compared with roughly half that amount in other high-income countries such as Canada, Japan, the Netherlands, or Sweden. The reasons have been debated and studied in detail. Do Americans use more and better healthcare and therefore also pay more? Alas, no. Americans use roughly the same or less healthcare, but pay far more for health services including drugs, hospital stays, and medical procedures such as an MRI.

The Canada comparison

comparison of healthcare costs between the US and 10 other high-income countries allows a detailed comparison of the US and Canada, the most relevant peer country. According to the comparative data, the US spends 17.8% of GDP compared with Canada's 10.3%, amounting to $9,403 per person in the US compared with Canada's $4,641.

All Canadians are covered by the healthcare system, while 10% of Americans lack public or private insurance coverage. Total pharmaceutical spending per person per year averages a whopping $1,443 in the US, compared with $613 in Canada.

For example, the cholesterol drug Crestor is $86 per month in the US, and $32 in Canada; the arthritis drug Humira is $2,505 in the US, compared with $1,164 in Canada. Yet despite the much higher health spending per person, life expectancy in the US is 78.8 years, while in Canada it is 81.7 years.

The article reaches the following conclusion: "The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries."