IESET.
Hypotheses·healthcare·single_payer_cost_outcome_comparison

Universal single-payer healthcare systems (NHS, Canadian Medicare) produce lower per-capita healthcare expenditure with equal or better life-expectancy outcomes than the US multi-payer system.

SUPPORTED SUBSETengine/runs/single_payer_cost_outcome_comparison

supported_subset — cost test PASSES (USA per-capita PPP $10957 vs GBR/CAN mean $5663, ratio 1.93x > 1.5); single-payer matched-or-beat USA on 4/5 tested outcomes (LE/IMR/U5/UHC/OOP). BUT canonical health-system outcomes basket has 4 documented data gaps: O6_amenable_mortality, O7_hale, O8_5yr_cancer, O9_waiting_times. The spec's own disclosure flagged amenable mortality + HALE as preferred outcomes; NHS waiting times and 5-yr cancer survival (USA outperforms) NOT in test. v1 SUPPORTED was indicator-gamed. Max tier: supported_subset.

confidence cueThe result is useful, but not decisive. Treat it as a clue, not a settled conclusion.

policy briefNeeds review

In ordinary language

Does the healthcare rule being tested improve access, cost, or outcomes for patients, or does it mainly shift pressure around the system?

plain answer

The data clearly moved in the predicted direction. cost test PASSES (USA per-capita PPP $10957 vs GBR/CAN mean $5663, ratio 1.93x > 1.5); single-payer matched-or-beat USA on 4/5 tested outcomes (LE/IMR/U5/UHC/OOP).

why it matters

This matters because healthcare claims should change belief only when they survive a pre-declared empirical test.

how the test works

It compares 3 country or place units from 1971 to 2023, using a multi metric checklist design.

what was measured
What changed
  • Single payer indicator
What we checked
  • Health expenditure per capita usd
  • Life expectancy at birth
  • Amenable mortality per 100k
what this does not prove

A single test is not the whole truth. It narrows the claim under a specific sample, time period, and method. Strong policy conclusions need the pattern to survive nearby tests, alternative data, and serious objections.

verification

7 input datasets, 0 unresolved missing series, provenance status: partial provenance.

Results

engine/runs/single_payer_cost_outcome_comparison
1007550250197119972023GBRCANUSA
illustrative sketch · run pending
No coefficients yet. When the model fires, this chart will show health_expenditure_per_capita_usd across 3 sampled countries over 1971–2023.
The shapes above are stylised — none of the lines are real data.
Placeholder for single_payer_cost_outcome_comparison. Published chart will be generated from engine/runs/single_payer_cost_outcome_comparison/chart_data.json.

Who has skin in the game — schools predicting on this

10 schools list this hypothesis as a test of their position. The chips below are school-level scoreboard outcomes, not a second hypothesis verdict.

hypothesis verdict vs scoreboard outcome

The banner verdict judges this hypothesis as written. The scoreboard asks whether each school's polarity-corrected prediction was right. Raw status is not a school win: SUPPORTED supports schools that needed SUPPORTED, but refutes schools that needed REFUTED.

Degrowth / Ecological Macroeconomicswins if SUPPORTEDschool supportedDemocratic Socialism (Bernsteinian revisionism + modern)wins if SUPPORTEDschool supportedEco-Socialism / Red-Greenwins if SUPPORTEDschool supportedMarket Socialism (Lange-Lerner tradition)wins if SUPPORTEDschool supportedMarxian Political Economywins if SUPPORTEDschool supportedMarxism-Leninism (central-planning implementation)wins if SUPPORTEDschool supportedModern Monetary Theorywins if SUPPORTEDschool supportedNew Keynesian (mainstream synthesis)wins if SUPPORTEDschool supportedPost-Keynesianwins if SUPPORTEDschool supportedSocial Democraticwins if SUPPORTEDschool supported

Pre-registration

pre-registered
first-spec commit bae09ab · 2026-04-29T22:09:42Z

Universal single-payer healthcare systems (NHS, Canadian Medicare) produce lower per-capita healthcare expenditure with equal or better life-expectancy outcomes than the US multi-payer system.

Falsification criterion — what would disprove this

set before the run · honoured after

This hypothesis is considered falsified if:

PRIMARY (dispositive multi-metric checklist over GBR, CAN, USA, 2010-2023 mean): M1 (cost): USA per-capita health expenditure exceeds the (GBR, CAN) mean by more than 50% (ratio > 1.50). PPP-USD basis (constructed as SH.XPD.CHEX.GD.ZS / 100 * NY.GDP.PCAP.PP.KD). Outcome block (need >= 2 of 3): M2 life-expectancy at birth: single-payer mean ties-or-exceeds USA. M3 infant-mortality per 1,000: single-payer mean ties-or-beats USA (lower better). M4 under-5 mortality per 1,000: single-payer mean ties-or-beats USA (lower better). SUPPORTED if M1 holds AND outcome block passes. REFUTED if neither M1 nor the outcome block holds. PARTIAL if exactly one of {M1, outcome block} holds. INFORMATIVE: country-by-country values reported in diagnostics so within-system heterogeneity (NHS waiting times, CAN access constraints) is visible even when the aggregate verdict goes one way. METHOD_VALID: requires SH.XPD.CHEX.GD.ZS, NY.GDP.PCAP.PP.KD, SP.DYN.LE00.IN, SP.DYN.IMRT.IN, and SH.DYN.MORT vintages on disk for all three countries over the comparison window. Data gap → INCONCLUSIVE.

formal test & threshold
test:      gbr_can_vs_usa_cost_outcome_multi_metric_2010_2023
threshold: PRIMARY: cost_ratio_USA_over_singlepayer > 1.50 AND n_outcome_metrics_favouring_singlepayer >= 2 (of 3).

Method

Template
multi_metric_checklist
Sample
3 countries · 1971 – 2023
Evidence type
associational

Three-country comparison GBR/CAN/USA, 2010-2023 mean (the modern Medicare/NHS architectural end-state; the spec's 1971-2023 window is informational, the dispositive comparison is on the recent decade where all five series overlap cleanly). Metric bundle: M1 cost — USA per-capita PPP spend / single-payer mean > 1.50 M2 outcome — life expectancy at birth (higher better) M3 outcome — infant mortality per 1k (lower better) M4 outcome — under-5 mortality per 1k (lower better) Verdict map: SUPPORTED if M1 AND >=2/3 outcome metrics favour single-payer; partial if exactly one pillar holds; refuted otherwise. Caveat: aggregates obscure within-system heterogeneity (NHS waiting times, CAN access constraints); country-level values are surfaced in diagnostics.json.

Data

VariableSourceTransform
health_expenditure_per_capita_usd
outcome
world_bank_wdi:SH.XPD.CHEX.PC.CDtier 2
log
life_expectancy_at_birth
outcome
world_bank_wdi:SP.DYN.LE00.INtier 2
level
amenable_mortality_per_100k
outcome
oecd:OECD.ELS.HDtier 2
log
single_payer_indicator
treatment
constructed:indicator = 1 for GBR (NHS) and CAN (Medicare); 0 for USA multi-payer.tier 5
indicator
log_gdp_per_capita_ppp
control
world_bank_wdi:NY.GDP.PCAP.PP.KDtier 2
log
log_population
control
world_bank_wdi:SP.POP.TOTLtier 2
log

● ready  · ● pending  · ● reconstruct-needed

Detailed result card

Single-payer cost-outcome comparison — v2 honesty correction

Verdict: supported_subset — cost test PASSES (USA per-capita PPP $10957 vs GBR/CAN mean $5663, ratio 1.93x > 1.5); single-payer matched-or-beat USA on 4/5 tested outcomes (LE/IMR/U5/UHC/OOP). BUT canonical health-system outcomes basket has 4 documented data gaps: O6_amenable_mortality, O7_hale, O8_5yr_cancer, O9_waiting_times. The spec's own disclosure flagged amenable mortality + HALE as preferred outcomes; NHS waiting times and 5-yr cancer survival (USA outperforms) NOT in test. v1 SUPPORTED was indicator-gamed. Max tier: supported_subset.

Why v2 differs from v1

v1 graded SUPPORTED on cost (USA 1.94x GBR/CAN) + 3 simple mortality outcomes. The spec's own disclosure flagged amenable mortality vs LE — exactly the indicator-gaming concern.

Canonical health-system outcomes basket (OECD HAG, WHO HSP) includes: amenable mortality, HALE, waiting times (NHS lags USA), 5-yr cancer survival (USA leads NHS), out-of-pocket equity. v1 omitted 4 canonical dimensions.

Canonical basket

| Dim | Status | |---|---| | C1_cost_per_capita | ✓ | | O1_le | ✓ | | O2_imr | ✓ | | O3_u5 | ✓ | | O4_uhc | ✓ | | O5_oop | ✓ | | O6_amenable_mortality | ✗ data gap | | O7_hale | ✗ data gap | | O8_5yr_cancer | ✗ data gap | | O9_waiting_times | ✗ data gap |

Numbers

  • USA per-capita PPP: $10957
  • SP mean: $5663
  • Cost ratio: 1.93x
  • Outcomes tested: 5; won: 4

Archives

v1 at ARCHIVED_v1/.

Notes

Stub seeded from a democratic-socialist school prediction comparing NHS, Canadian Medicare, and US multi-payer. Needs human review on whether life-expectancy is the right outcome (vs amenable mortality).

Authored framework. Read the transparency note.