Misconceptions: The United States is Not “Too Big” to be More Like Denmark

by Benjamin Studebaker

Since the Democratic Party debate, folks have been talking about Bernie Sanders‘ desire to make the United States more like Denmark, Norway, and Sweden. One of the most common responses to Sanders I’ve heard is the idea that the United States is too big to successfully imitate the Nordic countries. During the debate, Anderson Cooper himself said:

Denmark is a country that has a population — Denmark is a country that has a population of 5.6 million people.

I’ve seen the same thought echoed by many people, even people who are otherwise quite sympathetic to Sanders. This is very odd, because if we subject this thought to even the tiniest amount of scrutiny, it collapses.

There are two clear issues with this argument:

  1. There is no reason to believe that we cannot simply scale up programs that have already been successful in smaller countries.
  2. Even if there were such a reason, the federal government could simply mandate that individual US states operate and manage these programs.

Why would the size of the United States be a meaningful obstacle to the adoption of any social program? I have yet to read a convincing account of why a program that can work for 5 million people cannot work for 50 million or 500 million. The size of the bureaucracy needs to be scaled up, but if we live in a more populous society we have more people available to work in such a bureaucracy. We already operate a couple big federal bureaucracies that are wildly successful and popular in the form of Social Security and Medicare. Medicare is often thought of as an expensive program, but compared to private sector healthcare it’s quite cheap:

Contrary to the narrative we hear from the right that the costs of these programs are spiraling out of control, the most recent estimates indicate that the costs of Social Security and Medicare will stabilize in the coming decades even if nothing is done to change the way these programs operate:

Even supposing it were true that as the size of the bureaucracy increases, the costs and resources require exponentially, this is a problem that would be very easy to solve. We need simply look at the European Union. The EU has a combined population of 508 million. The US has a population of about 319 million. There are lots of social programs that most or all the EU member states have that the US does not have. Take universal healthcare, for example. Just about every European Union member state has a universal healthcare system. There is no great big EU bureaucracy operating a common healthcare system. Instead, each member state has its own system, and the EU Charter of Fundamental Rights requires that they maintain these programs, but the EU itself does not operate them. Article 35 of the charter says:

Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices. A high level of human health protection shall be ensured in the definition and implementation of all the Union’s policies and activities.

The federal government could simply pass a law requiring each state to provide universal healthcare as a fundamental right. It could fund this mandate itself through federal taxes or it could allow each individual state to find its own way of paying. It could even get more specific about the particular kind of health care system it requires the states to operate. Under Obamacare, states were asked to create healthcare exchanges, and the citizens of the states that refused to do so used federal exchanges. The federal exchange system is precisely the kind of big, national bureaucracy we are constantly being told the US is “too big” to have. Despite what you hear, the federal exchanges are performing better than expected–costs are running 20% below the Congressional Budget Office’s 2010 forecast:

The number of uninsured has been significantly reduced:

And the rate of growth in national per capita healthcare costs is lower than it’s been in many years:

All of this has been achieved even with many states using federal exchanges:

So why couldn’t the federal government simply pass a law mandating that every person must have access to a Medicare-for-all system and then either run this system itself or allow each state to operate its own branch? Why wouldn’t this work? There is no reason whatsoever. “The US is bigger than Denmark” is a meaningless argument used to excuse inaction and dismiss sound comparative political science research. The same goes for all of Sanders’ other major social programs–free tuition, paid family leave, expanded Social Security, and so on–they are all feasible and all in the same sort of way. Like Obamacare, these programs could be successfully operated at the federal level, and even if you assume they couldn’t, they could still be run at the state level in accordance with a federal mandate.

When we see evidence that a policy is working in a European country, we don’t get to dismiss that evidence simply on the grounds that the European country is smaller than we are. There are a lot of European countries, and there are a lot of US states, and there is no reason that what works in a European country could not work in a US state. On top of that, the evidence we do have for big federal programs shows that they are often wildly successful–Social Security, Medicare, and Obamacare are all testaments to that. So the next time someone brings up a policy or program that works in Denmark or in any other country, let’s take that comparative research seriously.