Universal healthcare is an extremely controversial socio-political topic in the United States. The term implies a healthcare system that provides broad and extensive coverage to all citizens and residents of the country. With the current market-based healthcare system experiencing many failures and becoming unsustainable in the long term, the debate around potential changes to replace it has intensified. Universal health coverage is a viable alternative for the current system and presents a significant and sustainable opportunity for United States healthcare by reducing costs and addressing critical health issues in the population.
The United States currently maintains a market-based system with healthcare delivery, insurance, and a large part of financing accomplished by private organizations. The most recent Affordable Care Act mandated insurance for everyone, with approximately 89.6% of the U.S. population having an insurance policy. The government provides insurance for certain population groups such as the elderly and veterans through programs like Medicare, Medicaid, and VA, which cover 36.5% of the population (Dorning).
The market-oriented nature of healthcare leads to the high quality of care, access to medical technology, increased health research, and doctor-patient relationships. However, to pay for this, health insurers and providers are forced to raise prices leading to issues with affordability, access, social class equality, and health outcomes for serious conditions. Overall, the US continuously performs significantly lower in health-system performance than other developed countries (Khazan).
Access and affordability are becoming critical issues as even basic visits to the doctor or emergency room can lead to significant billings, especially if an individual lacks insurance. Meanwhile, a serious chronic illness or hospital stay result in debilitating debt, even for those with adequate insurance. The system creates a vicious cycle that also includes manipulations by insurers and providers of medical equipment and drugs as prices increase at exponential levels. Universal healthcare which is heavily regulated by the government is envisioned to be a solution to reducing costs for private citizens and lowering the over increasing prices of healthcare provision.
Supporting Argument I
The primary argument for introducing a version of universal coverage is that it would lower costs and make fundamental health coverage available to anyone without significant economic burden. A single-payer system is structured in a manner that leads to improved resource allocation. The first step is it would consolidate finances, eliminating wasteful spending that drives up costs. Up to one-third of health care cost increases are caused by administrative expenses and insurance overheads, which would be recovered and diverted to meaningful medical services.
A universal system would eliminate the fragmentation of public programs, uniting Medicare and Medicaid into a streamlined and efficient financing system. A universal system also maintains advantages over private facilities as it can lower costs by purchasing supplies and drugs in bulk, predicted by population data to reduce waste (Sen and Lamont 3). This would also give buyers purchasing power, taking away the ability of pharmaceutical companies to severely inflate prices.
A single-payer system would lead to the adoption of long-term, responsible instead of profit-driven strategies. This would align expenditure with public health needs and planned capital investment while avoiding service duplication, questionable utilization, and market turbulence.
Therefore, the appeal of a single-payer system lies in decreased total costs which are driven down by a unified, large-scale healthcare enterprise. Government control of the healthcare sector holds a competitive advantage in aspects such as advertisement, administration, budgeting, and negotiating terms with service providers. While a coronary bypass in the United States costs $73,000, in France the price is less than $23,000 (Frank).
In a single-payer system, a whole population of a country is covered with minimal healthcare needs, while the current hybrid system in the US disproportionately covers most medically demanding populations such as the elderly and disabled. The delivery of care in single-payer systems is significantly lower at the price to the quality ratio which is a critical evaluation criterion for healthcare efficiency.
Supporting Argument II
Competent reform in healthcare of leads to a healthier population and stronger workforce in the long term which can have a myriad of economic benefits for the country and population. It has been empirically proven that individuals without insurance or those underinsured face a significantly higher risk of morbidity and mortality. Many of the issues are due to mismanagement of chronic conditions, lack of preventive care, and poor follow-up to treatments for diseases that require it.
Universal healthcare resolves this issue by ensuring that everyone has continuous access to healthcare services regardless of their pre-existing conditions, socioeconomic status, or any other barriers to entry currently in place. Universal healthcare dramatically impacts population health, leading to a generally healthier society and lower rates of morbidity, as demonstrated by many countries with the system which score better than the US on critical health indicators (Galvani et al. 2).
The impact on population health generates numerous economic benefits for the country in the long term. It results in a healthier workforce, which is more productive, and reduced spending on sick leave by up to 34%. In the US, where a single form of cancer causes annual losses of $15.3 billion, reduced sick leaves and preventive care to lower disease rates, can have profound impacts which would more than recoup federal investment to transition to universal healthcare. (Galvani et al. 2).
Access to healthcare translates to more common screenings, viable medical advice, and a generally healthier approach to life. This impacts individual households as well since families will no longer be tremendously burdened by excessive medical bills, reducing the amount of debt and bankruptcies, which may aid in reducing inequality as well.
Supporting Argument III
Access to and affordability of healthcare is considered to be a fundamental human right, guaranteed by international charters and arguably supported by Constitutional rights. Although there are no direct mentions of healthcare in the Constitution, nor has the Supreme court ever ruled on the issue, many consider access to and provision of health care an integral right. A number of Supreme Court decisions regarding bodily integrity, privacy, family health, and others have been made, when considered altogether seem to demonstrate that the Constitution does indeed provide an affirmative obligation to healthcare providers as some will argue.
Unfortunately, American constitutionalism is based on a discussion of negative liberties, rather than promoting certain rights regarding healthcare. The ongoing court battle around the ACA legislation, which has been largely in favor of the law could set a legal precedent in shifting American culture and jurisprudence in ensuing constitutional protection of government-provided healthcare (Ruger et al. 2561).
The evidence for the failing state of the US healthcare system is overwhelming, so there are very few experts which truly support the status quo and reject change. However, many are wary of the universal healthcare system as it brings its own set of challenges and can be difficult to implement in practice. A leading argument is that the US population size is simply too large, and it would both be really difficult to provide free access to everyone, nor would it be financially sustainable. At prices anywhere in the current range, the government which already spends approximately 7% of the GDP on healthcare (on par with other developed nations in terms of percentage of GDP), would have to excessively increase federal spending, ensuing fiscal issues (“New Perspectives on Global Health”).
This opposing viewpoint can be deflected by offering the example of China, which offers universal healthcare to its 1.3 billion citizens, which significantly exceeds the US population of 325 million, at significantly lower costs. While levels of care understandably vary, the example demonstrates that a single-payer system can work in countries with populations in the hundreds of millions. Meanwhile, while the initial transition will likely require high levels of federal funding, the costs will be off-put eventually in the long term. This will be done through higher tax revenue which is commonly introduced with universal healthcare, lowered healthcare expenses, and economic growth discussed earlier.
Another opposing viewpoint is that universal healthcare will reduce the level of medical care and significantly stifle innovation in the sector. Currently, the market system is encouraging both hospitals, researchers, and technology providers to compete, including in research and development, to provide the latest innovational treatments and optimal patient experience. Many fear, without competition, this would quickly deteriorate as facilities would no longer have any advantages.
To some extent, this may be true, but scholars believe that with proper implementation of universal healthcare, it can be prevented. First, with government oversight, there will be strict and high-level standards that medical facilities will be expected to follow, to ensure that quality of care does not decline (Bloom et al. 6). In terms of technological capacity and innovation, the government can stimulate research. Currently, the National Institute of Health conducts almost half of all medical research in the country, far exceeding any private organizations. The government can expand its funding to its own research while still encouraging private firms to participate similar to a bid system used for military contracts.
Politically, it will be challenging for the US to implement a fully universal single-payer system. The social perspectives, economic foundations, and political ideologies, for the most part, oppose such socialist endeavors and prefer capitalist-based approaches. However, the US can learn from other developed countries such as the UK, Australia, and France which offer a hybrid two-tier program with a significant universal healthcare aspect.
These countries commonly adopt government-provided healthcare for basic medical services and needs. The coverage extends to common illnesses, chronic diseases, vaccinations, emergency services, family planning, and other foundational healthcare that the population may need on a day-to-day basis. Some groups such as the elderly and disabled may be eligible for more extensive coverage.
However, the population then has a choice to purchase insurance from private organizations which would come into play in case of serious illness or surgery where complex medical care is needed (Holder et al.). Funds are distributed according to need, leading to significantly better indicators of population health than the US currently provides, despite proportionally outspending many other countries in this sector.
It is evident the US healthcare sector is experiencing significant issues currently that are unable to be resolved through traditional interventions. Experts and legislators realize the model is unsustainable, leading to the debate of potentially introducing a form of universal health care. Both theoretical and practical evidence demonstrates that a single-payer system holds significant benefits such as lowering excessive costs, improving population health, positively impacting the economy, and providing citizens with a fundamental right of access to healthcare. In its efforts to transition, the US can utilize a hybrid two-tier system that incorporates many elements of universal healthcare.
Bloom, David E., et al. “The Promise and Peril of Universal Health Care.” Science, vol. 361, no. 6404. 2018, pp. 1-8. Web.
Dorning, Jennifer. “The U.S. Health Care System: An International Perspective.” Department for Professional Employees AFL-CIO, 2016. Web.
Frank, Robert H. “Why Single-Payer Health Care Saves Money.” The New York Times. 2017. Web.
Galvani, Alison P., et al. “California Universal Health Care: An Economic Stimulus and Life-Saving Proposal.” Lancet, vol. 390, no. 10106, 2016, pp. 2012-2018. Web.
Holder, Josh, et al. “How Does the US Healthcare System Compare with Other Countries?” The Guardian. 2017. Web.
Khazan, Olga. “What’s Actually Wrong with the U.S. Health System.” The Atlantic. 2017. Web.
“New Perspectives on Global Health Spending for Universal Health Coverage.” World Health Organization, 2017. Web.
Ruger, Jennifer P., et al. “The Elusive Right to Health Care under U.S. Law.” The New England Journal of Medicine, vol. 372, no. 26, 2015, pp. 2558-2563. Web.
Sen, Amartya, and Thomas W. Lamont. “Universal Health Care: The Affordable Dream.” Harvard Public Health Review, vol. 4, 2015, pp. 1-8. Web.