The debate over health care in the United States has been a hot-button issue for years.

From private-pay to Medicare/Medicaid to the Affordable Care Act (ObamaCare) and now to "Medicare for All," lawmakers have argued over how, who, and how much Americans should pay for their health care.

U.S. Rep. Mark Pocan, D-Madison, has been routinely tweeting out his support for the proposed Medicare for All Act, including this tweet from April 30, 2019:

"The United States is the ONLY industrialized country without universal healthcare. The #MedicareforAll Act ensures that every person living in the U.S. has access to healthcare and comprehensive benefits. Today's hearing is a historic step towards making it happen."

We decided to focus on the first part of the tweet. Is the United States the only industrialized country without universal health care?

Let’s take a look.

What is the Medicare for All Act?

In April 2019, U.S. Sen. Bernie Sanders, I-Vermont, unveiled an updated "Medicare for All" bill. Sanders’ plan would create a government-run system that would provide health care coverage to all Americans.

According to an analysis by PolitiFact National, Medicare for All would replace private insurance, as well as Medicaid and Medicare. The Affordable Care Act would go away. A government-run health insurance program would replace them all. The veterans health system would stay in place, as would Indian Health Services.

The new Medicare for All bill largely mirrors an earlier one, but this version fully covers long-term care. PolitiFact National has created a guide to Medicare for All that answers many questions about the program.



The United States vs. other countries

In June 2015, our colleagues at PolitiFact National checked a very similar claim from U.S. Sen. Bernie Sanders, a Democratic presidential candidate:

"We are the only major country on Earth that doesn't guarantee health care to all people as a right."

At that time, a spokesman said Sanders was referring to nations that make up the Organization for Economic Cooperation and Development, a group of 36 countries that includes Australia, Austria, Canada, Denmark, Finland, France, Germany, Japan, the United Kingdom, the United States and 26 more.

The group does not include China and Russia, which the OECD classifies as "emerging economies."

In its analysis, PolitiFact National cited a 2014 OECD report that found only two member countries lacked universal health care coverage:

Mexico had passed a law in 2004 with the goal of getting to universal coverage, but at the time of the fact-check had not yet reached it. As of 2013, coverage had reached about 87% of the population.

However, by 2018, Mexico had implemented a public health care system known as Instituto Mexicano de Seguro Social , which provides universal health care to Mexican families and foreign residents enrolled in the system.

The other country on the OECD’s lack of universal health care list: The United States.

(A footnote: Sanders framed his claim around major countries with a guaranteed right to health care, speaking as though every advanced economy had it. In reality, some do and some don’t. As such, Sanders’ claim was rated Half True.)

In that respect, Pocan’s claim is more straightforward -- he spoke of universal coverage.

Emails to Pocan’s office seeking more information on his claim went unanswered. That said, Pocan spoke of industrialized nations, so the OECD is a good starting point.

Other sources

An April 26, 2018 article in The Economist noted:

"Despite the passage of the Affordable Care Act in 2010, America remains an outlier in health care provision. It has some of the best hospitals in the world, but it is also the only large rich country without universal health coverage. And health care costs can be financially ruinous."

In a May 14, 2017 opinion piece in The Conversation, Timothy Callaghan, an assistant professor at Texas A&M University Health Science Center, cited multiple reasons for why the U.S. is unlikely to adopt such as system:

"Its culture is unusually individualistic, favoring personal over government responsibility; lobbyists are particularly active, spending billions to ensure that private insurers maintain their status in the health system; and our institutions are designed in a manner that limits major social policy changes from happening."

Global Research, an independent research and media organization based in Montreal, Canada, in a July 9, 2017, paper titled "America the Only Developed Country Without Universal Healthcare" said nations providing universal coverage offer one of three forms:

1. Government provided single-payer;

2. Two-tier providing basic care, along with secondary coverage offering more services based on the ability to pay; and

3. Mandate insurance from an employer or individually purchased, supplementing national coverage.

Its report classified countries in this manner, and noted that when you move beyond the OECD -- to less industrialized nations -- there are dozens with universal health care. Among them: Belarus, North Korea, Mongolia, Romania, Tajikistan and Uruguay.

Our ruling

Pocan said "the United States is the ONLY industrialized country without universal health care."

Our research, including an earlier fact-check done by PolitiFact National, made clear this is the case. Indeed, there are numerous non-industrialized countries that also offer universal health care.

We rate the claim True.