Universal Healthcare
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Abstract
The paper outlines many of the considerations for and against universal healthcare in the U.S. It is true that the Affordable Care Act of 2010 moved the U.S. closer to the model of healthcare adopted by literally all of the world’s other advanced democracies. But it fell well short of providing truly universal healthcare. The unfortunate reality is that the U.S. has the only privatized healthcare system in the developed world. Moreover, it is the most expensive and least effective healthcare system in this world. More money is spent, with the worst healthcare outcomes, of any other nation in the relevant part of the world. Partly because of this, some have begun to argue that the U.S. should move to a truly universal healthcare model. The primary argument in favor of doing so is that having adequate healthcare is a basic human right and that the U.S. can certainly afford to provide this for all citizens, especially given the abominable amount of money that it spends on completely superfluous wars across the world.
Universal Healthcare
One of the many interesting issues that arose in the last five years was the current system under the Affordable Care Act versus the idea of universal healthcare. Of course, this debate has been around since the United States opted for a predominantly privatized healthcare system in the 1970s under Nixon. But it is only in the last few years that the issue has assumed a high level of prominence and serious discussion. The term “universal healthcare” means a system in which every American is automatically afforded healthcare insurance. This is in contrast to the current system, in which many cannot afford such insurance. It used to be the case that many employers would assume part of the cost of their employees’ health insurance costs. But employers are increasingly unwilling to do this, especially as compensation packages for employees become less and less generous with every year that passes. This paper will argue that the topic of universal healthcare is crucial since it shows the importance of attaining healthcare to everyone without being pushed to poverty, and it is essential to the well-being of a country as a whole. The thesis of the paper is that it is important to understand the relevant issues here, including the advantages and disadvantages of universal healthcare in multiple countries.
Most of the stock arguments for and against universal healthcare are familiar. Only a brief mention of each relevant consideration is necessary before proceeding to a more detailed discussion. First, and most obviously, most people who do not have healthcare insurance can afford to pay for medical tests or treatments. This means that many people who are sick, or who otherwise are in need of medical treatment, will not get the help that they need without universal healthcare. A corollary of this point is that we do not really know how many people are in need of medical services, since so many are dissuaded from seeking them in the first place. Therefore, universal healthcare may increase the demand for medical services, which could improve a lot of those in healthcare services. As the system stands now, only the wealthy and the relatively wealthy can afford decent healthcare. It bears noting that the U.S. is the only developed nation in the world that does not provide basic healthcare services for all its citizens or residents. In light of this fact, the term “universal healthcare” is misleading. It is not like “universal basic income”, in proposing a radical socialist scheme. Universal healthcare is what most of the people in democracies all over the world take for granted. Only the U.S. refuses to provide this service for its people. Finally, proponents of universal healthcare argue that it would be less expensive, and more effective, than the current American alternative. The U.S. has the most expensive and least effective system of healthcare in the developed world. “No other country spends so much or suffers worse healthcare outcomes—measured in many ways, prominently including infant mortality rates—than the U.S.” (Abiiro & Allegri, 2015; Mitra, 2018).
On the other side of the argument, there are several reasons that opponents of universal healthcare have cited in defense of their position. One of the most often cited is inefficiency. “It is alleged that socialist systems of medicine, for example, that of Canada, are so inefficient that those who need help commonly have to wait for a very long time to receive attention or treatment” (O’Neill et al., 2013). A corollary to this objection is that, under universal healthcare, the quality of service will decline. Another objection is that under a single-payer system, such as most proposed systems of universal healthcare, doctors and other medical professionals play little if any role in setting prices and rates. This would be left to the government, which (it is said) results in less lucrative deals for doctors, who might just give up and try another profession. Even worse than this, if salaries for medical professionals were to drop many would not go to the trouble of spending nearly a decade in school preparing for their profession. “We would then face the prospect of a world without doctors” (McKee et al., 2013).
The first detailed part of the discussion concerns types of universal healthcare systems. We can distinguish socialized medicine, single-payer systems, and private insurance models. “The first of these is when the government retains all healthcare facilities while the healthcare staffs, such as doctors or physicians, are government employees—and this, supporters claim, is the most efficient universal healthcare system” (Cesur et al., 2015). The second model is the single-payer system of healthcare. “Here the government delivers healthcare, at least ideally, to all citizens while the doctor’s offices and healthcare facilities are private businesses, and this method is costlier than socialized medicine” (Fuchs, 2018). “Finally, there is the private insurance method. This is similar to the current system, except that the government regulates these private enterprises, and every citizen is mandated to have some form of insurance plan” (Wendt, 2014).
We turn now to a more detailed discussion of the advantages of universal healthcare systems. The first is that it lowers the cost of treatment and ensures that everyone has access to quality healthcare services. “Moreover, free healthcare lowers the overall healthcare costs for the economy because the government controls prices” (Zieff et al., 2020). And since the government regulates the prices for medical services, the individual costs of accessing quality medical care are reduced. “Finally, administrative costs would be lowered, under universal healthcare, since healthcare facilities deal with just one government agency” (Moreno-Serra & Smith, 2012).
Another set of reasons centers on a reduction in the mortality rate and a reduction of health crises across the country. There are three subpoints here. First, under universal healthcare, all citizens can access primary care physicians and prevent diseases that are bound to become worse with time. “Second, universal healthcare promotes improvement in the health of the population since everyone can receive proper healthcare when they are young, thereby improving the mortality rate” (Rodney & Hill, 2014). “Third, thousands of lives can be saved using these programs since individuals who could not afford proper healthcare now have the chance to access appropriate healthcare” (Moreno-Serra & Smith, 2012).
A final advantage of universal healthcare is that it boosts the country’s economy because when citizens have affordable healthcare, they can lead healthier lives. This will make citizens have productive lives and work hard to improve the economy of a country.
We turn now to more involved consideration of disadvantages of universal healthcare. Such healthcare tends to prioritize chronic ailments which are caused by lifestyle choices. Examples might be lung cancer caused by cigarette smoking, or liver disease caused by alcoholism. “Since taxpayers’ money funds the healthcare system, under universal healthcare, it is disadvantageous to some of them who will not receive medical care when needed” (Knaul et al., 2015). Furthermore, if a system allows for universal healthcare, the number of patients seeking healthcare services will increase. “Consequently, the quality of services will degrade because of the increase in demand for assistance with a decrease in the supply of physicians and doctors hence decreasing the quality of the services” (Kumar et al., 2011).
There are three further points to make about the disadvantages of universal healthcare. “First, when individuals or citizens are given the incentive of proper healthcare, they are more likely to disregard appropriate care of their bodies and lead unhealthy lifestyles since they have access to free healthcare services if they fall sick” (Liu & Buijsen, 2017). Second, universal healthcare takes most government budget allocation since healthcare systems are expensive compared to other budgetary allocations, such as allocation for education. Indeed, the universal healthcare system can take up to 40% of the government’s budget; hence, countries struggling to maintain their budget will find it very difficult. Third, and finally, universal healthcare makes healthcare facilities to be populated and busier. “Therefore, to make an appointment with a healthcare specialist, they have to wait for long periods, such as four weeks, to be attended to, which would be a different case if a free market system was in place” (Johar et al., 2013).
The final part of the paper will argue that the considerations in favor of universal healthcare outweigh those against universal healthcare. Either the arguments against universal healthcare fail, or they are overridden by more important considerations such as those of equality, democracy, and social justice.
The first general argument mentioned was that universal healthcare will inevitably be inefficient since there will not be enough doctors and other medical professionals to fill the demand. Consequently, patients may have to wait for very long periods to be treated. This objection assumes that the resources that the government devotes to healthcare will remain static. Perhaps it is true that, if no more resources were devoted to healthcare than have been made available at present, quality of care and efficiency would decline. But there is no reason that the government could not devote more of its resources to healthcare, in such a way as to prevent both long waiting times and decreased levels of care.
It could be and has been, objected that the government simply cannot afford to provide quality healthcare for all of its citizens, under the model of universal healthcare. This objection is based on confusion. The U.S. has a sovereign currency. It is literally impossible for it to run out of money. It could be countered that simply printing money will cause inflation. This is true, at least in theory. But there are many ways to avoid high inflation even when money is injected into the economy. One such way is to effect price controls. The reason that inflation increases when excess money is put into circulation are that vendors will take notice of the increased ability to spend and raise prices. But the government has the ability to prevent prices from being raised in this way. It did precisely this during World War II when the country was forced to work together to handle the dramatically increased demand for certain products and services.
It is certainly true that if the government were to expend sufficient resources to provide truly first-rate healthcare for every citizen, it would require sacrifice and discipline in other areas of government spending. But the question that must arise, when contemplating this matter, is what is more important than the health of a nation’s people? Is there a single factor that is so important it could outweigh the despicable practice of providing healthcare only to the nation’s wealthy, or relatively wealthy, as is the case under the current system?
A second argument against universal healthcare is that doctors and other healthcare professionals would not be able to set or control prices under such a system since that would be left to the government. As a consequence, it might be the case that most would-be doctors would not make the considerable sacrifice necessary to earn a medical degree, since they would not be rewarded financially as they are under the current system. The problem with this argument is similar to the problem with the preceding argument. There is no necessity in the fact, if it is a fact, that doctors and other healthcare professionals would make less money under a system of universal healthcare. It is up to the government what they should be paid. In theory, there is no reason that their compensation would have to change from current levels. The government can afford to pay doctors and others any amount that it deems appropriate. Again, opponents of universal healthcare like to act as if the government will literally go broke trying to provide healthcare for all Americans; but this is confusing. It is impossible for the American government to go broke since it has a sovereign currency; and especially so, given that other countries (prominently including Japan and China) are willing to subsidize the U.S. budget deficit, in the form of buying treasury bonds, since they have little else to do with the dollars they have accumulated.
Another argument against universal healthcare that we have described is the alleged fact that individuals will not have the incentive to take care of themselves if they are given the gift of free healthcare from the government. This argument is confused and perverse. It is like saying that people have no incentive to avoid starting fires in their homes given that the fire department is committed to putting out such fires without cost to the individuals involved. The argument confuses rights with privileges. With a genuine privilege, individuals might indeed have an incentive to avoid losing the privilege. An example is maintaining a current driving license, which can indeed be forfeited if one is careless enough in one’s driving. But healthcare is not a privilege, it is a human right. Nearly all of the standard agreements and conventions on human rights, such as the Universal Declaration of Human Rights (UDRH), list basic healthcare needs as a basic human right. The U.S. is one of the only countries in the world that has refused to sign this agreement. There are three reasons, one of which is that the UDHR does in fact list healthcare as a basic human right. The second is the provision in the agreement that children have a right not to live in poverty. The U.S. has the highest child poverty level of any developed nation in the world. The third and final reason the U.S. refuses to sign the UDHR is that it also provides for the right of workers to organize to prevent their exploitation at the hands of greedy and unscrupulous companies, corporations, and other employers.
An additional argument against universal healthcare is that too much of the government’s resources would have to be allocated to healthcare, which would leave it unable to pay for the other essential services that are needed and that it provides. There are two responses to this argument. The first is just a repetition of the claim that the government can simply increase its ability to spend money whenever it deems doing so necessary. The second is that the U.S. government has no trouble spending nearly a trillion dollars a year on what is euphemistically called “defense”, or its inflated military budget. Only a tiny fraction of the total amount of money dedicated every year to the U.S. military is needed for actual defense. Most of the money simply enriches military contractors who have agreements with the Pentagon or provides for the seemingly endless series of unnecessary and unjustified wars that the U.S. engages in, most recently in Afghanistan and Iraq. The mention of Iraq is significant. The amount of money that the U.S. has spent on the war in Iraq is estimated to be around two or three trillion dollars. This amount of money could have ended poverty permanently in the U.S., and indeed throughout much of the world. So claims that the U.S. cannot afford to provide healthcare for its citizens are perverse and obtuse. If it can afford to spend $3 trillion fighting an unnecessary war half the way around the world, it can afford to provide all of its citizens with that which they have a basic human right to, including adequate healthcare.
“It can be objected that the proposals here amount to adopting a socialist, rather than a capitalist, economic system” (Wu, Ho & Tien, 2019). This is too large a matter to be dealt with adequately here, but two points can be made. First, there is no sharp line between socialist and capitalist economies. The U.S., government for example, heavily subsidizes many sectors of its economy, including agriculture and aerospace engineering. It also routinely bails out failed companies, including automobile manufacturers and banks, and other financial companies. No one complains about socialism when this is going on. Second, the U.S. was much closer to being a true social democracy in the 1930s and 1940s, when Roosevelt enacted the various New Deal programs. These programs have been abandoned or at least attacked since the 1970s. The reason was not that they were socialistic, but that they resulted in lower profits for wealthy individuals and corporations. This is the only reason that the U.S. has now moved so far away from the embedded liberalism of the New Deal era.
In conclusion, this paper has outlined many of the considerations for and against universal healthcare in the U.S. It is true that the Affordable Care Act of 2010 moved the U.S. closer to the model of healthcare adopted by literally all of the world’s other advanced democracies. But it fell well short of providing truly universal healthcare. The unfortunate reality is that the U.S. has the only privatized healthcare system in the developed world. Moreover, it is the most expensive and least effective healthcare system in this world. More money is spent, with the worst healthcare outcomes, of any other nation in the relevant part of the world. Partly because of this, some have begun to argue that the U.S. should move to a truly universal healthcare model. The primary argument in favor of doing so is that having adequate healthcare is a basic human right and that the U.S. can certainly afford to provide this for all citizens, especially given the abominable amount of money that it spends on completely superfluous wars across the world. The main objections to universal healthcare assume, contrary to the fact, that there is a limited amount of money that the government can spend on healthcare; that it would result in doctors being paid far less; and that it would result in inferior services being provided. The most important reason to reject these contentions is that, as a nation that has a sovereign currency, it is literally impossible for the U.S. to run out of money. There is unlimited money available. The only question is what is necessary for the government to provide. The paper has argued that basic healthcare is a right that all people enjoy simply in virtue of being human. The fact that tens of millions of Americans are denied this basic human right is a travesty. James 5:3-13-15 states, “Is anyone among you suffering? Let him pray. Is anyone cheerful? Let him sing praise. Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the one who is sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven.” As Christians, we must always remember that God is always there whenever we need him. No matter what is going on in the world all we have to do is call onto him.
References
Abiiro, G. & De Allegri, M. (2015). Universal health coverage from multiple perspectives: A synthesis of conceptual literature and global debates. BMC International Health and Human Rights, 15(1), 1-7.
Cesur, R. et al. (2015). The value of socialized medicine: The impact of universal primary healthcare provision on mortality rates in Turkey. Journal of Public Economics, 150, 75-93.
Fuchs, V. (2018). Is single Payer the answer for the US health care system? JAMA, 319(1), 15-16.
Johar, M. et al. (2013). Discrimination in a universal health system: Explaining socioeconomic waiting time gaps. Journal of Health Economics, 32(1), 181-194.
Knaul, F. (2015). Achieving effective universal health coverage and diagonal approaches to care for chronic illnesses. Health Affairs, 34(9), 1514-1522.
Kumar, S., Ghildayal, N., & Shah, R. (2011). Examining quality and efficiency of the US healthcare system. International Journal of Health Care Quality Assurance, 24(5), 366-388.
Liu, Z. & Buijsen, M. (2017). Reaffirming individual responsibility in distributive justice: A case study of the Chinese healthcare system. International Journal of Social Science Studies, 5(4), 14-23.
Mitra, M. (2018). Free universal health care system in the United States. Sociology International Journal, 2(6), 779-785.
O’Neill, K. et al. (2013). Monitoring service delivery for universal health coverage: The service availability and readiness assessment. Bulletin of the World Health Organization, 91(12), 923-931.
McKee, M. et al. (2013). Universal health coverage: A quest for all countries but under threat in some. Value in Health, 16(1), 39-45.
Moreno-Serra, R. & Smith, P. (2012). Does progress towards universal health coverage improve population health? The Lancet, 380(9845), 917-923.
Rodney, A. & Hill, P. (2014). Achieving equity within universal health coverage: A narrative review of progress and resources for measuring success. International Journal for Equity in Health, 13(1), 1-8.
Wendt, C. (2014). Changing healthcare system types. Social Policy & Administration, 48(7), 864-882.
Wu, J., Ho, T. & Tien, Y. (2019). Correlation between the increased hospital volume and decreased overall perioperative mortality in one universal health care system. World Journal of Surgery, 43(9), 2194-2202.
Zieff, G. et al. (2020). Universal healthcare in the United States of America: A healthy debate. Medicine, 56(11), 1-7.
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