Sen. Bernie Sanders addresses a town hall at Simpson College in Indianola, Iowa, February 1, 2020. (Mike Segar/Reuters)

Never mind those Communist regimes, David, Senator Sanders might have had a hard time of it with his health problems in Ireland, where patients who are hospitalized with heart attacks are, according to recent data, more likely to die than they are in the United States.

Ireland has established, in theory, a national health-care system, having passed a big law with big fanfare, and it has a 40-percent income tax and a 23-percent VAT to help pay for it. On paper, Ireland has more hospital beds per person than does the United States.


And yet it just had a bitter election, resulting in a strong showing by the radical Sinn Féin, that was fought out largely on issues related to its failing health-care system: long waiting lists and a lack of treatment capacity that has left more than 10,000 admitted hospital patients without beds.

In 2011, the Irish government promised — see if this sounds familiar — a “democratic revolution,” one that would deliver, among other things, “universal health service, which guarantees access based on need, not income.”

As with our grievously misnamed Affordable Care Act, these big promises did not work out as promised.


Of particular concern to oldsters such as Senator Sanders: More than half of the elderly people who go to Irish hospitals are kept waiting nine hours or more before being admitted.

The U.S. health-care system is, in many ways, a mess — not for wealthy and well-connected people such as Bernie Sanders, but for many people. But do not put it past our “reformers” to make it worse, as other “reformers” have done elsewhere.


Health care presents a series of complexly interrelated problems that do not break down along neat, ideologically satisfying lines. Most European countries do not have British/Canadian-style monopoly systems, and many of them get good results from a variety of different systems — but the British and the Canadians report that they are mostly satisfied with their monopoly systems, though by no means universally so: The British NHS currently enjoys an approval rating of only 53 percent, which is only 7 points higher than President Trump’s.

(Canadians are more satisfied with their system, which has approval ratings above 80 percent.)


The so-called Affordable Care Act failed in part because it was an attempt to replicate the virtues of the Swiss health-care system in the very non-Swiss U.S. context. It was enacted under a Democratic president with Democratic control of both houses of Congress. Question: Do you think that with a new Democratic president and Democratic control of both houses of Congress, U.S. reform efforts would likely end up looking more like Switzerland’s intelligently managed (and, libertarians note, highly interventionist) system or more like Ireland’s incoherent package of half measures and incompletely executed schemes?

Something to noodle on.