should healthcare be free persuasive essay

Should Healthcare Be Free? Essay on Medical System in America

Introduction, problem statement, why healthcare should be free, why healthcare should be paid, works cited.

The US government has historically taken a keen interest in the health of its citizens. As far back as the beginning of the 1900s, President Theodore Roosevelt declared that “nothing can be more important to a state than its public health: the state’s paramount concern should be the health of its people” (Gallup and Newport 135). Despite these, the United States is classified as the nation with the most expensive, and yet inefficient, health care system among developed nations.

An expensive health care system translates to an increasing proportion of the population being unable to access the much needed medical care. The New York Times reports that according to census survey carried out in the year 2007, an estimated 45.6 million people in the USA were uninsured and hence unlikely to receive comprehensive medical care from hospitals (1). Due to the perceived inefficiencies, there has been agreement that the current health care system is faulty and therefore in need of radical changes to make it better.

Majority of American’s are greatly dissatisfied with the current health care system which is extremely expensive and highly inefficient. While an effective system can be deemed to be one which is efficient, acceptable and at the same time equitable, the current system is lacking in this attributes.

The aim of this paper will be to analyze the effects that free health care system in America would have. This paper will argue that a health care system which guarantees free health care for all Americans is the most effective system and the government should therefore adopt such a system.

Free health care would result in a healthier nation since people would visit the doctors when necessary and follow prescriptions. Research by Wisk et al. indicated that both middle and lower class families were suffering from the high cost of health care (1). Some families opted to avoid going to the doctor when a member of the family is sick due to the high cost of visiting the doctor and the insurance premiums associated with health care.

In the event that they go to the doctor, they do not follow prescriptions strictly so as to reduce cost. Brown reveals that “60 percent of uninsured people skipped taking dosages of their medication or went without it because it cost too much” (6). Such practices are detrimental to a person’s health and they cost more in the long run.

The last few years have been characterized by financial crises and recessions which have negatively affected the financial well being of many Americans. In these economic realities, the cost of health care has continued to rise to levels that are unaffordable to many Americans. This loss of access to health care has led to people being troubled and generally frustrated. A report by Brown indicates that the price for prescription drugs in the US has escalated therefore becoming a financial burden for the citizens (6).

The productivity of this people is thereby greatly decreased as they live in uncertainty as to the assurance of their health and thereby spend more time worrying instead of being engaged in meaningful activities that can lead the country into even greater heights of prosperity. Free health care would lead to a peace of mind and therefore enable people to be more productive.

Since medical care is not free, many people have to make do with curative care since they cannot afford to visit medical facilities for checkups or any other form of preventive medical care. This assertion is corroborated by Colliver who reveals that many people are opting to go without preventative care or screening tests that might prevent more serious health problems due to the expenses (1).

Research shows that approximately 18,000 adults die annually due to lack of timely medical intervention (The New York Times 1). This is mostly as a result of lack of a comprehensive insurance cover which means that the people cannot receive medical attention until the disease has progressed into advanced stages. This is what has made medical care so expensive since “sick patients need more care than relatively healthy ones” (Sutherland, Fisher, and Skinner 1227).

This is an opinion shared by Sebelius who reveals that 85% of medical costs incurred in the country arise from people ailing from chronic conditions (1). She further notes that if screened early, these diseases such as diabetes and obesity can be prevented thus saving the medical cost to be incurred in their treatment. It therefore makes sense to have a health care system that makes it possible for everyone to access preventive care thus curbing these conditions before they are fully blown.

While most people assume that free health care will result in better services as more people will be able to access health care, this is not the case. The increase in people who are eligible for health care will lead to an increase in the patients’ level meaning that one may have to wait for long before receiving care due to shortage of medical personnel or the rationing of care.

A European doctor, Crespo Alphonse, reveals that when health care is free, people start overusing it with negative implications for the entire system (AP). In addition to this, free health care would invariably lead to cost cutting strategies by hospitals.

This would lead to scenario where finding specialized care is hard and the rate of medical mistakes would increase significantly. As a matter of fact, a survey on Switzerland hospitals found that medical errors had jumped by 40% owing to the introduction of mandatory health insurance (AP). While it is true that free health care will increase the number of people visiting the doctor, this may be a positive thing since it will encourage preventive care as opposed to the current emphasis on curative care.

Free health care is a move towards a socialistic system. As it is, the US is a nation that is built on strong capitalistic grounds. This is against the strong capitalistic grounds on which the United States society is build on. While detractors of the private insurance firms are always quick to point out that the firms make billions of dollars from the public, they fail to consider the tax that these firms give back to the federal government (Singer 1).

Free health care would render players in the health industry such as private insurance companies unprofitable. Free health care will bring about a shift from a profit oriented system to a more people oriented system. Without money as a motivation, research efforts will plummet thereby leading to a decrease in the medical advancement as investment in research will not be as extensive (Singer 1).

The Associate Press reveals that doctors may also lack to be as motivated if they are no incentives and thereby the quality of their work may weaken (1). As such, a free health care system would have far reaching consequences for the economy of the nation since the health care industry is a profitable industry for many.

The Healthcare system is one of the most important components of the U.S. social system since full productivity cannot be achieved without good health. This paper has argued that a free health care system would be the most effective system for America. To reinforce this assertion, the paper has articulated the benefits that the country would accrue from free health care.

With free health care, all Americans would be able to access health services when they need it leading to increased quality of life. In addition, many people would make use of preventive healthcare services, therefore reducing the financial burden that the expensive curative services result in.

The paper has taken care to point out that free health care has some demerits, most notably of which is overloading the health services with a high number of patients. Even so, the observably advantages to be reaped from the system far outweigh the perceived risks. As it is, decades of reform on the US health care system have failed to provide any lasting solution to the problem.

Making health care free for all may be the strategy that will provide a solution for the ideal health care system that has thus far remained elusive. From the arguments presented in this paper, it can irrefutably be stated that free health care will result in a better health care system for the country.

Associate Press. (AP). Europe’s free health care has a hefty price tag . 2009. Web.

Brown, Paul. Paying the Price: The High Cost of Prescription Drugs for Uninsured Americans. U.S. PIRG Education Fund, 2006.

Colliver, Victoria. “Jump in middle-income Americans who go without health insurance,” San Francisco Chronicle (SFGate), 2006.

Gallup, Andrew, and Newport Francis. The Gallup Poll: Public Opinion . Gallup Press, 2005. Print.

Sebelius, Kathleen. Health Insurance Reform Will Benefit All Americans . 2009. Web.

Singer, Peter. Why We Must Ration Health Care . 2009. Web.

Sutherland, Jason., Fisher Elliott, and Skinner Jonathan. “Getting Past Denial – The High Cost of Health Care in the United States” . New England Journal of Medicine 361;13, 2009).

The New York Times. The Uninsured . 2009. Web.

Wisk, Lauren. High Cost a Key Factor in Deciding to Forgo Health Care . 2011. Web.

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IvyPanda. (2023, October 29). Should Healthcare Be Free? Essay on Medical System in America. https://ivypanda.com/essays/free-health-care-in-america/

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Bibliography

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Argumentative Essay: Healthcare Should Be Free

Imagine how helpless you would feel if you needed medical attention but could not get it because you were uninsured and could not afford the medical bill. Wouldn’t that make you feel dependent and unsupported because you can't receive the support you are entitled to? The US spends about $12,530 per person’s healthcare. Although the government provides its citizens with healthcare equally, not everyone needs the money for their healthcare, while others need more money than what is already provided to them. I think the American government should collectively spend for all of its citizens and make healthcare free for all Americans.. Healthcare is a human right that we should all be entitled to regardless of our class. It would save thousands of lives every year. Although many people argue that healthcare would increase the debt rate, free healthcare decreases the spending of the US.  Free healthcare should be enforced morally and logistically to all Americans. 

Healthcare should be provided to everyone at no cost because it is a basic human right that all Americans should be entitled to. In the article “Should All Americans Have the Right (Be Entitled) to Health Care?” It says, “The Declaration of Independence states that all men have “unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness,” [42] which necessarily entails having the health care needed to preserve life and pursue happiness.” This shows that healthcare is a right that all Americans should be entitled to. In this sentence, the author explains that the Declaration of Independence states that all men have the right to “Life, Liberty, and Pursuit to Happiness” this shows that healthcare is also considered a right, which falls into life and the pursuit of happiness. 

Healthcare saves thousands of lives which enforces the right to life and pursuit of happiness in the future. Free healthcare could save lives because many people die from illnesses they never got cured because of the cost of healthcare. In the article “Should All Americans Have the Right (Be Entitled) to Health Care?” Says, “According to a study from Harvard researchers, “lack of health insurance is associated with as many as 44,789 deaths per year,” which translates into a 40% increased risk of death among the uninsured.“ This proves that many people die because they were uninsured. This part of the passage shows a 40% increased risk of death among people who cannot get insured due to the lack of medical support given to the uninsured who can also not afford the medical bill. According to the “Centers for Medicare and Medicaid Services,” the number of people under the age of 65 who were uninsured at the time of the interview was 31.2 million people. This shows that many Americans under the age of 65 are uninsured and probably can not afford the medical bill. 

A common argument against this position is that free healthcare for all Americans would increase US debts. In the article “Should America Have Universal Health Care?” It says “From a study funded by the University of Massachusetts at Amherst, under a single-payer system where everyone has a right to healthcare, private and public healthcare spending could be lowered over 10 years by over 1.8 trillion dollars. This would be due to lower prescription and administrative drug costs.” Some people argue that free healthcare for all Americans would increase US debts. However, the text explains that providing free healthcare does not increase the spending of the US. Instead, It lowered the spending by $1.8 trillion because it lowered the price of drugs prescribed to patients. 

In conclusion, healthcare should be free for all Americans. All Americans should be provided free healthcare because it is a basic human right that all Americans should be entitled to. It would also save lives because many people die from illnesses they never got cured of due to the medical support they needed but did not receive and that was because they were uninsured. Logistically and Morally, Healthcare is a fundamental right that all Americans should be entitled to despite their income and what they can afford. This is an issue that requires us to come together and fight for our rights!

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Point Turning Point: the Case for Universal Health Care

An argument that the COVID-19 pandemic might be the turning point for universal health care.

Why the U.S. Needs Universal Health Care

As we all grapple with our new reality, it's difficult to think of anything beyond the basics. How do we keep our families safe? Are we washing our hands enough ? Do we really have to sanitize the doorknobs and surfaces every day? How do we get our cats to stop videobombing our Zoom meetings? Do we have enough toilet paper?

Win McNamee | Getty Images

The more we read the headlines, the more we feel the need to do something, or at least say something. Change is happening – ready or not. Maybe talking about some of these important issues can lead to action that will help us steer out of this skid.

Historically, Americans have found ways to meet their circumstances with intention, moving in mass to make heretofore unimaginable change that has sustained and improved our lives to this day. The Great Depression lead to the creation of the New Deal and Social Security. The Triangle Shirtwaist Factory fire brought about change in labor conditions. The Cuyahoga River fire lead to the founding of the Environmental Protection Agency.

Could the COVID-19 pandemic be the turning point for universal health care? We can't think of a more propitious time. In the first two weeks of April, 5.2 million Americans filed for unemployment. Economists believe that 30% unemployment is possible by fall. For most Americans, our health care is tied to our employment, and because of this, millions of Americans are losing their health care just when they may need it the most. Economists predict that health insurance premiums will likely increase by 40% in the next year due to less payers and more who are in need of care and the eventual collapse of private health care insurance .

Our current circumstances have illustrated the need for universal health care in a way that is obvious and undeniable. Below we have listed the most frequent arguments in opposition followed by an evidence-based rebuttal.

1. Point: "Governments are wasteful and shouldn't be in charge of health care."

Counterpoint: In 2017, the U.S. spent twice as much on health care (17.1% of GDP) as comparable Organization for Economic Co-Operation and Development countries (OECD) (8.8% of GDP), all of whom have universal health care. The country with the second highest expenditure after the U.S. is Switzerland at 12.3%, nearly 5% less. Of all these countries, the U.S. has the highest portion of private insurance. In terms of dollars spent, the average per capita health care spending of OECD countries is $3,558, while in the U.S. it's $10,207 – nearly three times as costly.

Bottom line: Among industrialized countries with comparable levels of economic development, government-provided health care is much more efficient and more economical than the U.S. system of private insurance.

2. Point: "U.S. health care is superior to the care offered by countries with universal health care."

Counterpoint: According to the Commonwealth Health Fund , in the U.S., infant mortality is higher and the life span is shorter than among all comparable economies that provide universal health care. Maternal mortality in the U.S. is 30 per 100,000 births and 6.4 per 100,000 births on average in comparable countries, which is nearly five times worse.

In addition, the U.S. has the highest chronic disease burden (e.g., diabetes, hypertension) and an obesity rate that is two times higher than the OECD average. In part due to these neglected conditions, in comparison to comparable countries, the U.S. (as of 2016) had among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.

The Peterson-Kaiser Health System Tracker , which is a collaborative effort to monitor the quality and cost of U.S. health care, shows that among comparable countries with universal health care, mortality rate is lower across the board on everything from heart attacks to child birth. The U.S. also has higher rates of medical, medication and lab errors relative to similar countries with universal health care.

Bottom line: With our largely privately funded health care system, we are paying more than twice as much as other countries for worse outcomes.

3. Point: "Universal health care would be more expensive."

Counterpoint: The main reason U.S. health care costs are so high is because we don't have universal health care. Unlike other first world countries, the health care system in the U.S. is, to a great extent, run through a group of businesses. Pharmaceutical companies are businesses. Insurance companies are businesses. Hospital conglomerates are businesses. Even doctors' offices are businesses.

Businesses are driven to streamline and to cut costs because their primary goal is to make a profit. If they don't do this, they can't stay in business. It could mean that in the process of "streamlining," they would be tempted to cut costs by cutting care. Under the current system, a share of our health care dollars goes to dividends rather than to pay for care, hospitals are considered a "financial asset" rather than a public service entity and a large portion of their budgets are dedicated to marketing rather than patient care.

Given all these business expenses, it shouldn't be surprising that the business-oriented privately funded health care system we have is more expensive and less effective than a government provided universal system. In addition, for the health care system as a whole, universal health care would mean a massive paperwork reduction. A universal system would eliminate the need to deal with all the different insurance forms and the negotiations over provider limitations. As a result, this would eliminate a large expense for both doctors and hospitals.

The economist Robert Kuttner critiques the system this way: "For-profit chains … claim to increase efficiencies by centralizing administration, cutting waste, buying supplies in bulk at discounted rates, negotiating discounted fees with medical professionals, shifting to less wasteful forms of care and consolidating duplicative facilities." As he points out, "using that logic, the most efficient 'chain' of all is a universal national system."

Evidence to support these points can be found in a recent Yale University study that showed that single-payer Medicare For All would result in a 13% savings in national health-care expenditures. This would save the country $450 billion annually.

Bottom line: Universal health care would be less expensive overall, and an added benefit would be that health care decisions would be put in the hands of doctors rather than insurance companies, which have allegiances to shareholders instead of patient care.

4. Point: "I have to take care of my own family. I can't afford to worry about other people."

Counterpoint: It is in all of our best interests to take care of everyone. Aside from the fact that it is the compassionate and moral thing to do, viruses do not discriminate. When people don't have insurance, they won't go to the doctor unless they're gravely ill. Then, they're more likely to spread illness to you and your family members while they delay getting the care they need.

In addition, when people wait for care or don't get the prophylactic care then need, they end up in the emergency room worse off with more costly complications and requiring more resources than if they had been treated earlier. Taxpayers currently cover this cost. This affects everyone, insured or not. Why not prevent the delay upfront and make it easy for the patient to get treatment early and, as an added bonus, cost everyone less money?

In addition, the health of the economy impacts everyone. Healthy workers are essential to healthy businesses and thus a healthy economy. According to the Harvard School of Public Health , people who are able to maintain their health are more likely to spend their money on goods and services that drive the economy.

Bottom line: The health of others is relevant to the health of our families either through containment of infectious diseases such as COVID-19 or through the stability of the economy. Capitalism works best with a healthy workforce.

5. Point: "Entrepreneurship and innovation is what makes the U.S. a world leader."

Counterpoint: Imagine how many people in the U.S. could start their own businesses or bring their ideas to market if they didn't have to worry about maintaining health care for their families. So many people stay tethered to jobs they hate just so their family has health care. With workers not needing to stay in jobs they don't like in order to secure health insurance, universal healthcare would enable people to acquire jobs where they would be happier and more productive. Workers who wanted to start their own business could more easily do so, allowing them to enter the most creative and innovative part of our economy – small businesses.

In his book, "Everything for Sale," economist Robert Kuttner asserts that it's important to understand that businesses outside of the U.S. don't have to provide health care for their employees, which makes them more competitive. From a business point of view, American companies, released from the burden of paying employee insurance, would be more competitive internationally. They would also be more profitable as they wouldn't have to do all the paperwork and the negotiating involved with being the intermediary between employees and insurance companies.

Bottom line: Unburdening businesses from the responsibility of providing health insurance for their employees would increase competitiveness as well as encourage entrepreneurship and innovation, and allow small businesses room to thrive.

6. Point: "The wait times are too long in countries with universal health care."

Counterpoint: The wait times on average are no longer in countries with universal healthcare than they are in the U.S., according to the Peterson-Kaiser Health System Tracker . In some cases, the wait times are longer in the U.S., with insurance companies using valuable time with their requirements to obtain referrals and approvals for sometimes urgently needed treatments. On average, residents of Germany, France, UK, Australia, and the Netherlands reported shorter wait times relative to the U.S.

Bottom line: Wait times are longer in the U.S. when compared with many countries with a universal health care system.

7. Point: "My insurance is working just fine, so why change anything?"

Counterpoint: A comprehensive study conducted in 2018 found that 62% of bankruptcies are due to medical bills and, of those, 75% were insured at the time. Most people who have insurance are insufficiently covered and are one accident, cancer diagnosis or heart attack away from going bankrupt and losing everything. The U.S. is the only industrialized country in the world whose citizens go bankrupt due to medical bills. And, if you survive a serious illness and don't go bankrupt, you may end up buried in bills and paperwork from your insurance company and medical providers. All of this takes time and energy that would be better spent healing or caring for our loved ones. Besides, we don't need to abolish private health insurance. Some countries like Germany have a two-tiered system that provides basic non-profit care for all but also allows citizens to purchase premium plans through private companies.

Bottom line: Private insurance does not protect against medical bankruptcy, but universal health care does. The residents of countries with universal health care do not go bankrupt due to medical bills.

8. Point: "I don't worry about losing my insurance because if I lose my job, I can just get another one."

Counterpoint: We can't predict what will happen with the economy and whether another job will be available to us. This pandemic has proven that it can all go bad overnight. In addition, if you lose your job, there is less and less guarantee that you will find a new job that provides insurance . Providing insurance, because it is so expensive, has become an increasingly difficult thing for companies to do. Even if you're able to find a company that provides health care when you change jobs, you would be relying on your employer to choose your health plan. This means that the employee assumes that the company has his or her best interests in mind when making that choice, rather than prioritizing the bottom line for the benefit of the business. Even if they're not trying to maximize their profit, many companies have been forced to reduce the quality of the insurance they provide to their workers, simply out of the need to be more competitive or maintain solvency.

Bottom line: There are too many factors beyond our control (e.g., pandemic, disability, economic recession) to ensure anyone's employment and, thus, health care. Universal health care would guarantee basic care. Nobody would have to go without care due to a job loss, there would be greater control over costs and businesses would not have to fold due to the exorbitant and rising cost of providing health insurance to their employees.

9. Point: "Pharmaceutical companies need to charge so much because of research and development."

Counterpoint: It's usually not the pharmaceutical companies developing new drugs. They develop similar drugs that are variations on existing drugs, altered slightly so that they can claim a new patent. Or they buy out smaller companies that developed new drugs, thus minimizing their own R&D costs. Most commonly, they manufacture drugs developed under funding from the National Institutes of Health, and thus, the tax payers are the greatest funder of drug development via NIH grants provided to university labs.

Oddly, this investment in R&D does not appear to extend any discount to the tax payers themselves. In "The Deadly Costs of Insulin, " the author writes that insulin was developed in a university lab in 1936. In 1996, the cost of a vial of insulin was $21. Today, the cost of a vial of insulin could be as much as $500, causing some without insurance to risk their lives by rationing or going without. The cost of manufacturing the drug has not gone up during that time. So, what accounts for the huge increase in price? In " The Truth About Drug Companies ," the author demonstrates that drug companies use the bulk of their profits for advertising, not R&D or manufacturing. A universal health care system would not only not need to advertise, but would also be more effective at negotiating fair drug prices. Essentially, the government as a very large entity could negotiate price much more effectively as one large system with the government as the largest purchaser.

Bottom line: Taxpayers contribute most of the money that goes into drug development. Shouldn't they also reap some of the benefits of their contribution to R&D? Americans should not have to decide between their heart medication and putting food on the table when their tax dollars have paid for the development of many of these medications.

10. Point: "I don't want my taxes to go up."

Counterpoint: Health care costs and deductibles will go down to zero and more than compensate for any increase in taxes, and overall health care needs will be paid for, not just catastrophic health events. According to the New York Times , “…when an American family earns around $43,000, half of the average compensation when including cash wages plus employer payroll tax and premium contributions, 37% of that ends up going to taxes and health care premiums. In high-tax Finland, the same type of family pays 23% of their compensation in labor taxes, which includes taxes they pay to support universal health care. In France, it’s 2%. In the United Kingdom and Canada, it is less than 0% after government benefits.”

Bottom line: With a universal health care system, health care costs and deductibles will be eliminated and compensate for any increase in taxes.

11. Point: "I don't want to have to pay for health care for people making bad choices or to cover their pre-existing conditions."

Counterpoint: Many of the health problems on the pre-existing conditions list are common, genetically influenced and often unavoidable. One estimate indicates that up to 50% – half! – of all (non-elderly) adults have a pre-existing condition. Conditions on the list include anxiety, arthritis, asthma, cancer, depression, heart defect, menstrual irregularities, stroke and even pregnancy. With universal health care, no one would be denied coverage.

It's easy to assume that your health is under your control, until you get into an accident, are diagnosed with cancer or have a child born prematurely. All of a sudden, your own or your child's life may rely on health care that costs thousands or even millions of dollars. The health insurance that you once thought of as "good enough" may no longer suffice, bankruptcy may become unavoidable and you (or your child) will forever have a pre-existing condition. Some people may seem careless with their health, but who's to judge what an avoidable health problem is, vs. one that was beyond their control?

For the sake of argument, let's say that there are some folks in the mix who are engaging in poor health-related behaviors. Do we really want to withhold quality care from everyone because some don't take care of their health in the way we think they should? Extending that supposition, we would withhold public education just because not everyone takes it seriously.

Bottom line: In 2014, protections for pre-existing conditions were put in place under the Affordable Care Act. This protection is under continuous threat as insurance company profits are placed above patient care. Universal health care would ensure that everyone was eligible for care regardless of any conditions they may have.

And, if universal health care is so awful, why has every other first-world nation implemented it? These countries include: Australia, Austria, Bahrain, Belgium, Brunei, Canada, Cyprus, Denmark, Finland, France, Germany, Greece, Hong Kong, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Singapore, Slovenia, South Korea, Spain, Sweden, Switzerland, United Arab Emirates and the U.K.

Changing collective minds can seem impossible. But there is precedent. Once unimaginable large-scale change has happened in our lifetime (e.g. legalization of gay marriage, election of the first black president of the U.S. and the #MeToo movement), and support for universal health care has never been higher (71% in favor, according to a 2019 Hill-HarrisX survey ).

Point: As Chuck Pagano said, "If you don't have your health, you don't have anything."

Counterpoint: If good health is everything, why don't we vote as if our lives depended on it? This pandemic has taught us that it does.

Bottom line: Launching universal health care in the U.S. could be a silver lining in the dark cloud of this pandemic. Rather than pay lip service to what really matters, let's actually do something by putting our votes in service of what we really care about: the long-term physical and economic health of our families, our communities and our country.

Photos: Hospital Heroes

Tags: health insurance , health care , Coronavirus , pandemic , New Normal

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15.10 Persuasive Essay

Learning objective.

• Read an example of the persuasive rhetorical mode.

Universal Health Care Coverage for the United States

The United States is the only modernized Western nation that does not offer publicly funded health care to all its citizens; the costs of health care for the uninsured in the United States are prohibitive, and the practices of insurance companies are often more interested in profit margins than providing health care. These conditions are incompatible with US ideals and standards, and it is time for the US government to provide universal health care coverage for all its citizens. Like education, health care should be considered a fundamental right of all US citizens, not simply a privilege for the upper and middle classes.

One of the most common arguments against providing universal health care coverage (UHC) is that it will cost too much money. In other words, UHC would raise taxes too much. While providing health care for all US citizens would cost a lot of money for every tax-paying citizen, citizens need to examine exactly how much money it would cost, and more important, how much money is “too much” when it comes to opening up health care for all. Those who have health insurance already pay too much money, and those without coverage are charged unfathomable amounts. The cost of publicly funded health care versus the cost of current insurance premiums is unclear. In fact, some Americans, especially those in lower income brackets, could stand to pay less than their current premiums.

However, even if UHC would cost Americans a bit more money each year, we ought to reflect on what type of country we would like to live in, and what types of morals we represent if we are more willing to deny health care to others on the basis of saving a couple hundred dollars per year. In a system that privileges capitalism and rugged individualism, little room remains for compassion and love. It is time that Americans realize the amorality of US hospitals forced to turn away the sick and poor. UHC is a health care system that aligns more closely with the core values that so many Americans espouse and respect, and it is time to realize its potential.

Another common argument against UHC in the United States is that other comparable national health care systems, like that of England, France, or Canada, are bankrupt or rife with problems. UHC opponents claim that sick patients in these countries often wait in long lines or long wait lists for basic health care. Opponents also commonly accuse these systems of being unable to pay for themselves, racking up huge deficits year after year. A fair amount of truth lies in these claims, but Americans must remember to put those problems in context with the problems of the current US system as well. It is true that people often wait to see a doctor in countries with UHC, but we in the United States wait as well, and we often schedule appointments weeks in advance, only to have onerous waits in the doctor’s “waiting rooms.”

Critical and urgent care abroad is always treated urgently, much the same as it is treated in the United States. The main difference there, however, is cost. Even health insurance policy holders are not safe from the costs of health care in the United States. Each day an American acquires a form of cancer, and the only effective treatment might be considered “experimental” by an insurance company and thus is not covered. Without medical coverage, the patient must pay for the treatment out of pocket. But these costs may be so prohibitive that the patient will either opt for a less effective, but covered, treatment; opt for no treatment at all; or attempt to pay the costs of treatment and experience unimaginable financial consequences. Medical bills in these cases can easily rise into the hundreds of thousands of dollars, which is enough to force even wealthy families out of their homes and into perpetual debt. Even though each American could someday face this unfortunate situation, many still choose to take the financial risk. Instead of gambling with health and financial welfare, US citizens should press their representatives to set up UHC, where their coverage will be guaranteed and affordable.

Despite the opponents’ claims against UHC, a universal system will save lives and encourage the health of all Americans. Why has public education been so easily accepted, but not public health care? It is time for Americans to start thinking socially about health in the same ways they think about education and police services: as rights of US citizens.

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Healthcare is a human right – but not in the United States

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The Supreme Court’s ruling on Dobbs v. Jackson in June is just the latest blow to health rights in the United States. National medical associations in the U.S. agree that abortion is essential to reproductive healthcare. So why would abortion not be protected as such? Because the U.S. does not, and never has, protected a right to health.  

Good health is the foundation of a person’s life and liberty. Injury and disease are always disruptive, and sometimes crippling. We might have to stop working, cancel plans, quarantine, hire help, and in cases of long-term disability, build whole new support systems to accommodate a new normal.

The U.S. remains the only high-income nation in the world without universal access to healthcare. However, the U.S. has signed and ratified one of the most widely adopted international treaties that includes the duty to protect the right to life. Under international law, the right to life simply means that humans have a right to live, and that nobody can try to kill another. Healthcare, the United Nations says, is an essential part of that duty. In 2018, the U.N. Committee on Civil and Political Rights said the right to life cannot exist without equal access to affordable healthcare services (including in prisons), mental health services, and notably, access to abortion. The U.N. committee mentioned health more than a dozen times in its statement on the right to life.

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The bottom line is: the U.S. can’t claim to protect life if it fails to protect health. And it has consistently failed on all three of the U.N.’s measures— the latest being access to abortion.

In the U.S., our debates around healthcare, and especially abortion, are hampered by a lack of right to health. Instead, the Supreme Court in 1973 protected access to abortion through the rights to privacy and due process, not health. Privacy is mentioned only twice by the U.N. committee commentary on the right to life.

Since Dobbs, several state legislatures have declared it fair game to criminalize abortion procedures even in cases where pregnancy threatens maternal health or life. Despite ample evidence that restrictive abortion laws lead to spikes in maternal mortality and morbidity—core public health indicators—the Court prior to the Dobb’s decision has defended abortion as merely a matter of privacy, not health or life. We know this is a myth. Abortion is deeply tied to the ability to stay healthy and in some cases, alive.

Regardless, our political parties remain deeply polarized on access to healthcare, including abortion. But lawmakers should know there is historical backing in the U.S. for elevating a right to health. None other than U.S. president Franklin D. Roosevelt, first proposed healthcare as a human right in his State of the Union address in 1944, as part of his ‘Second Bill of Rights.’ His list featured aspirational economic and social guarantees to the American people, like the right to a decent home and, of course, the right to adequate medical care.

Eleanor Roosevelt later took the Second Bill of Rights to the U.N., where it contributed to the right to health being included in the Universal Declaration of Human Rights in 1948. The right to health is now accepted international law, and is part of numerous treaties, none of which the U.S. Senate has seen fit to ratify. The U.S. conservative movement has historically declared itself averse to adopting rights that might expand government function and responsibility. In contrast, state legislatures in red states are keen to expand government responsibility when it comes to abortion. The conservative movement condemns government interference in the delivery of healthcare—except when it comes to reproductive health. The American Medical Association has called abortion bans a “direct attack” on medicine, and a “brazen violation of patients’ rights to evidence-based reproductive health services.”

Excepting access to abortion, U.S. lawmakers have largely left healthcare to the markets, rather than government. True, the government funds programs like Medicaid and Medicare but these programs vary significantly in quality and access by state, falling far short of providing fair, equitable, universal access to good healthcare.

The only two places where the U.S. government accepts some responsibility for the provision of healthcare are 1) in prisons and mental health facilities; and 2) in the military. While healthcare services in the U.S. prison system are notoriously deficient, they nevertheless exist and are recognized as an entitlement, underpinning the right to life. As an example, in 2005 a federal court seized control of the failing healthcare system in California’s Department of Corrections citing preventable deaths. In the military, free healthcare is an entitlement, and the quality of that care is deemed good enough even for the U.S. president.

So why doesn’t everyone in the U.S. have the same rights?

It is an uphill battle in a country that sees health and healthcare as a private matter for markets and individuals to navigate. But if we want to improve public health in the U.S. we need to start legislating healthcare as a right—and recognize that achieving the highest possible standards of public health is a legitimate government function.

photo: Tony Gutierrez / AP Photo

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Universal Healthcare in the United States of America: A Healthy Debate

Gabriel zieff.

1 Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; ude.cnu.liame@rrekz (Z.Y.K.); [email protected] (L.S.)

Zachary Y. Kerr

Justin b. moore.

2 Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; ude.htlaehekaw@eroomsuj

This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio–economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.

1. Introduction

Healthcare is one of the most significant socio–political topics in the United States (U.S.), and citizens currently rank “healthcare” as the most important issue when it comes to voting [ 1 ]. The U.S. has historically utilized a mixed public/private approach to healthcare. In this approach, citizens or businesses can obtain health insurance from private (e.g., Blue Cross Blue Shield, Kaiser Permanente) insurance companies, while individuals may also qualify for public (e.g., Medicaid, Medicare, Veteran’s Affairs), government-subsidized health insurance. In contrast, the vast majority of post-industrial, Westernized nations have used various approaches to provide entirely or largely governmentally subsidized, universal healthcare to all citizens regardless of socio–economic status (SES), employment status, or ability to pay. The World Health Organization defines universal healthcare as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship” [ 2 ]. Importantly, the Obama-era passage of the Affordable Care Act (ACA) sought to move the U.S. closer to universal healthcare by expanding health coverage for millions of Americans (e.g., via Medicaid expansion, launch of health insurance marketplaces for private coverage) including for citizens across income levels, age, race, and ethnicity.

Differing versions of universal healthcare are possible. The United Kingdom’s National Health Services can be considered a fairly traditional version of universal healthcare with few options for, and minimal use of, privatized care [ 3 ]. On the other hand, European countries like Switzerland, the Netherlands, and Germany have utilized a blended system with substantial government and market-based components [ 4 , 5 ]. For example, Germany uses a multi-payer healthcare system in which subsidized health care is widely available for low-income citizens, yet private options—which provide the same quality and level of care as the subsidized option—are also available to higher income individuals. Thus, universal healthcare does not necessarily preclude the role of private providers within the healthcare system, but rather ensures that equity and effectiveness of care at population and individual levels are a reference and expectation for the system as a whole. In line with this, versions of universal healthcare have been implemented by countries with diverse political backgrounds (e.g., not limited to traditionally “socialist/liberal” countries), including some with very high degrees of economic freedom [ 6 , 7 ].

Determining the degree to which a nation’s healthcare is “universal” is complex and is not a “black and white” issue. For example, government backing, public will, and basic financing structure, among many other factors must be extensively considered. While an in-depth analysis of each of these factors is beyond the scope of this commentary, there are clear advantages and disadvantages to purely private, market-based, and governmental, universal approaches to healthcare, as well as for policies that lie somewhere in-between. This opinion piece will highlight arguments for and against universal healthcare in the U.S., followed by the authors’ stance on this issue and concluding remarks.

2. Argument against Universal Healthcare

Though the majority of post-industrial Westernized nations employ a universal healthcare model, few—if any—of these nations are as geographically large, populous, or ethnically/racially diverse as the U.S. Different regions in the U.S. are defined by distinct cultural identities, citizens have unique religious and political values, and the populace spans the socio–economic spectrum. Moreover, heterogenous climates and population densities confer different health needs and challenges across the U.S. [ 8 ]. Thus, critics of universal healthcare in the U.S. argue that implementation would not be as feasible—organizationally or financially—as other developed nations [ 9 ]. There is indeed agreement that realization of universal healthcare in the U.S. would necessitate significant upfront costs [ 10 ]. These costs would include those related to: (i) physical and technological infrastructural changes to the healthcare system, including at the government level (i.e., federal, state, local) as well as the level of the provider (e.g., hospital, out-patient clinic, pharmacy, etc.); (ii) insuring/treating a significant, previously uninsured, and largely unhealthy segment of the population; and (iii) expansion of the range of services provided (e.g., dental, vision, hearing) [ 10 ].

The cost of a universal healthcare system would depend on its structure, benefit levels, and extent of coverage. However, most proposals would entail increased federal taxes, at least for higher earners [ 4 , 11 , 12 ]. One proposal for universal healthcare recently pushed included options such as a 7.5% payroll tax plus a 4% income tax on all Americans, with higher-income citizens subjected to higher taxes [ 13 ]. However, outside projections suggest that these tax proposals would not be sufficient to fund this plan. In terms of the national economic toll, cost estimations of this proposal range from USD 32 to 44 trillion across 10 years, while deficit estimations range from USD 1.1 to 2.1 trillion per year [ 14 ].

Beyond individual and federal costs, other common arguments against universal healthcare include the potential for general system inefficiency, including lengthy wait-times for patients and a hampering of medical entrepreneurship and innovation [ 3 , 12 , 15 , 16 ]. Such critiques are not new, as exemplified by rhetoric surrounding the Clinton Administration’s Health Security Act which was labeled as “government meddling” in medical care that would result in “big government inefficiency” [ 12 , 15 ]. The ACA has been met with similar resistance and bombast (e.g., the “repeal and replace” right-leaning rallying cry) as a result of perceived inefficiency and unwanted government involvement. As an example of lengthy wait times associated with universal coverage, in 2017 Canadians were on waiting lists for an estimated 1,040,791 procedures, and the median wait time for arthroplastic surgery was 20–52 weeks [ 17 ]. Similarly, average waiting time for elective hospital-based care in the United Kingdom is 46 days, while some patients wait over a year (3). Increased wait times in the U.S. would likely occur—at least in the short term—as a result of a steep rise in the number of primary and emergency care visits (due to eliminating the financial barrier to seek care), as well as general wastefulness, inefficiency, and disorganization that is often associated with bureaucratic, government-run agencies.

3. Argument for Universal Healthcare

Universal healthcare in the U.S., which may or may not include private market-based options, offer several noteworthy advantages compared to exclusive systems with inequitable access to quality care including: (i) addressing the growing chronic disease crisis; (ii) mitigating the economic costs associated with said crisis; (iii) reducing the vast health disparities that exist between differing SES segments of the population; and (iv) increasing opportunities for preventive health initiatives [ 18 , 19 , 20 , 21 ]. Perhaps the most striking advantage of a universal healthcare system in the U.S. is the potential to address the epidemic level of non-communicable chronic diseases such as cardiovascular diseases, type II diabetes, and obesity, all of which strain the national economy [ 22 , 23 ]. The economic strain associated with an unhealthy population is particularly evident among low SES individuals. Having a low SES is associated with many unfavorable health determinants, including decreased access to, and quality of health insurance which impact health outcomes and life expectancies [ 24 ]. Thus, the low SES segments of the population are in most need of accessible, quality health insurance, and economic strain results from an unhealthy and uninsured low SES [ 25 , 26 ]. For example, diabetics with low SES have a greater mortality risk than diabetics with higher SES, and the uninsured diabetic population is responsible for 55% more emergency room visits each year than their insured diabetic counterparts [ 27 , 28 ]. Like diabetes, hypertension—the leading risk factor for death worldwide [ 29 ], has a much higher prevalence among low SES populations [ 30 ]. It is estimated that individuals with uncontrolled hypertension have more than USD 2000 greater annual healthcare costs than their normotensive counterparts [ 31 ]. Lastly, the incidence of obesity is also much greater among low SES populations [ 32 ]. The costs of obesity in the U.S., when limited to lost productivity alone, have been projected to equate to USD 66 billion annually [ 33 ]. Accessible, affordable healthcare may enable earlier intervention to prevent—or limit risk associated with—non-communicable chronic diseases, improve the overall public health of the U.S., and decrease the economic strain associated with an unhealthy low-SES.

Preventive Initiatives within A Universal Healthcare Model

Beyond providing insurance coverage for a substantial, uninsured, and largely unhealthy segment of society—and thereby reducing disparities and unequal access to care among all segments of the population—there is great potential for universal healthcare models to embrace value-based care [ 4 , 20 , 34 ]. Value-based care can be thought of as appropriate and affordable care (tackling wastes), and integration of services and systems of care (i.e., hospital, primary, public health), including preventive care that considers the long-term health and economy of a nation [ 34 , 35 ]. In line with this, the ACA has worked in parallel with population-level health programs such as the Healthy People Initiative by targeting modifiable determinants of health including physical activity, obesity, and environmental quality, among others [ 36 ]. Given that a universal healthcare plan would force the government to pay for costly care and treatments related to complications resulting from preventable, non-communicable chronic diseases, the government may be more incentivized to (i) offer primary prevention of chronic disease risk prior to the onset of irreversible complications, and (ii) promote wide-spread preventive efforts across multiple societal domains. It is also worth acknowledging here that the national public health response to the novel Coronavirus-19 virus is a salient and striking contemporary example of a situation in which there continues to be a need to expeditiously coordinate multiple levels of policy, care, and prevention.

Preventive measures lessen costs associated with an uninsured and/or unhealthy population [ 37 ]. For example, investing USD 10 per person annually in community-based programs aimed at combatting physical inactivity, poor nutrition, and smoking in the U.S. could save more than USD 16 billion annually within five years, equating to a return of USD 5.60 for every dollar spent [ 38 ]. Another recent analysis suggests that if 18% more U.S. elementary-school children participated in 25 min of physical activity three times per week, savings attributed to medical costs and productivity would amount to USD 21.9 billion over their lifetime [ 39 ]. Additionally, simple behavioral changes can have major clinical implications. For example, simply brisk walking for 30 min per day (≥15 MET-hours/week) has been associated with a 50% reduction in type II diabetes [ 40 ]. While universal healthcare does not necessarily mean that health policies supporting prevention will be enacted, it may be more likely to promote healthy (i) lifestyle behaviors (e.g., physical activity), (ii) environmental factors (e.g., safe, green spaces in low and middle-income communities), and (iii.) policies (e.g., banning sweetened beverages in public schools) compared to a non-inclusive system [ 34 , 35 , 36 ].

Nordic nations provide an example of inclusive healthcare coupled with multi-layered preventive efforts [ 41 ]. In this model, all citizens are given the same comprehensive healthcare while social determinants of health are targeted. This includes “mobilizing and coordinating a large number of players in society,” which encourages cooperation among “players” including municipal political bodies, voluntary organizations, and educational institutions [ 41 ]. Developmental and infrastructural contributions from multiple segments of society to a healthcare system may also better encourage government accountability compared to a system in which a select group of private insurers and citizens are the only “stakeholders.” Coordinated efforts on various non-insurance-related fronts have focused on obesity, mental health, and physical activity [ 41 ]. Such coordinated efforts within the Nordic model have translated to positive health outcomes. For example, the Healthcare Access and Quality (HAQ) Index provides an overall score of 0–100 (0 being the worst) for healthcare access and quality across 195 countries and reflects rates of 32 preventable causes of death. Nordic nations had an average HAQ score of 95.4, with four of the five nations achieving scores within the top 10 worldwide [ 42 ]. Though far more heterogenous compared to Nordic nations, (e.g., culturally, geographically, racially, etc.), the U.S. had a score of 89 (29th overall) [ 42 ]. To provide further context, other industrialized nations, which are more comparable to the U.S. than Nordic nations, also ranked higher than the U.S. including Germany (92, 19th overall), Canada (94, 14th overall), Switzerland (96, 7th overall), and the Netherlands (96, 3rd overall) [ 42 ].

4. Conclusions

Non-inclusive, inequitable systems limit quality healthcare access to those who can afford it or have employer-sponsored insurance. These policies exacerbate health disparities by failing to prioritize preventive measures at the environmental, policy, and individual level. Low SES segments of the population are particularly vulnerable within a healthcare system that does not prioritize affordable care for all or address important determinants of health. Failing to prioritize comprehensive, affordable health insurance for all members of society and straying further from prevention will harm the health and economy of the U.S. While there are undoubtedly great economic costs associated with universal healthcare in the U.S., we argue that in the long-run, these costs will be worthwhile, and will eventually be offset by a healthier populace whose health is less economically burdensome. Passing of the Obama-era ACA was a positive step forward as evident by the decline in uninsured U.S. citizens (estimated 7–16.4 million) and Medicare’s lower rate of spending following the legislation [ 43 ]. The U.S. must resist the current political efforts to dislodge the inclusive tenets of the Affordable Care Act. Again, this is not to suggest that universal healthcare will be a cure-all, as social determinants of health must also be addressed. However, addressing these determinants will take time and universal healthcare for all U.S. citizens is needed now. Only through universal and inclusive healthcare will we be able to pave an economically sustainable path towards true public health.

Author Contributions

Conceptualization, G.Z., Z.Y.K., J.B.M., and L.S.; writing-original draft preparation, G.Z.; writing-review and editing, Z.Y.K., J.B.M., and L.S.; supervision, L.S. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Home — Essay Samples — Government & Politics — Health Care Reform — Should the Government Provide Free Health Care in America

Should The Government Provide Free Health Care in America

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120+ healthcare argumentative essay topics [+outline], dr. wilson mn.

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If you’re a nursing student, then you know how important it is to choose Great Healthcare argumentative essay topics.

After all, your essay will be graded on both the content of your argument and how well you defend it. That’s why it’s so important to choose topics that you’re passionate about and that you can research thoroughly.

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Strong Healthcare argumentative essay topics

To help you get started, here are some strong Healthcare argumentative essay topics to consider:

• Is there a nurse shortage in the United States? If so, what are the causes, and what can be done to mitigate it?
• What are the benefits and drawbacks of various types of Nurse staffing models?
• What are the implications of the current opioid epidemic on nurses and patients?
• Are there any ethical considerations that should be taken into account when providing care to terminally ill patients?
• What are the most effective ways to prevent or treat healthcare-acquired infections?
• Should nurses be allowed to prescribe medication? If so, under what circumstances?
• How can nurses best advocate for their patients’ rights?
• What is the role of nurses in disaster relief efforts?
• The high cost of healthcare in the United States.
• The debate over whether or not healthcare is a human right.
• The role of the government in providing healthcare.
• The pros and cons of the Affordable Care Act.
• The impact of healthcare on the economy.
• The problem of access to healthcare in rural areas.
• The debate over single-payer healthcare in the United States.
• The pros and cons of private health insurance.
• The rising cost of prescription drugs in the United States.
• The use of medical marijuana in the United States.
• The debates over end-of-life care and assisted suicide in the United States.

As you continue,  thestudycorp.com  has the top and most qualified writers to help with any of your assignments. All you need to do is  place an order  with us.

Controversial Healthcare topics

There is no shortage of controversial healthcare topics to write about. From the high cost of insurance to the debate over medical marijuana, there are plenty of issues to spark an interesting and thought-provoking argumentative essay.

Here are some Controversial healthcare argumentative essay topics to get you started:

1. Is healthcare a right or a privilege?

2. Should the government do more to regulate the healthcare industry?

3. What is the best way to provide quality healthcare for all?

4. Should medical marijuana be legalized?

5. How can we control the rising cost of healthcare?

6. Should cloning be used for medical research?

7. Is it ethical to use stem cells from embryos?

8. How can we improve access to quality healthcare?

9. What are the implications of the Affordable Care Act?

10. What role should pharmaceutical companies play in healthcare?

11. The problems with the current healthcare system in the United States.

12. The need for reform of the healthcare system in the United States.

Great healthcare argumentative essay topics

Healthcare is a controversial and complex issue, and there are many different angles that you can take when writing an argumentative essay on the topic. Here are some great healthcare argumentative essay topics to get you started:

1. Should the government provide free or low-cost healthcare to all citizens?

2. Is private healthcare better than public healthcare?

3. Should there be more regulation of the healthcare industry?

4. Are medical costs too high in the United States?

5. Should all Americans be required to have health insurance?

6. How can the rising cost of healthcare be controlled?

7. What is the best way to provide healthcare to aging Americans?

8. What role should the government play in controlling the cost of prescription drugs?

9. What impact will the Affordable Care Act have on the healthcare system in the United States?

Hot healthcare argumentative essay topics

Healthcare is always a hot-button issue. Whether it’s the Affordable Care Act, single-payer healthcare, or something else entirely, there’s always plenty to debate when it comes to healthcare. Here are some great healthcare argumentative essay topics to help get you started.

1. Is the Affordable Care Act working?

2. Should the government do more to provide healthcare for its citizens?

3. Should there be a single-payer healthcare system in the United States?

4. What are the pros and cons of the Affordable Care Act?

5. What impact has the Affordable Care Act had on healthcare costs in the United States?

6. Is the Affordable Care Act sustainable in the long run?

7. What challenges does the Affordable Care Act face?

8. What are the potential solutions to the problems with the Affordable Care Act?

9. Is single-payer healthcare a good idea?

10. What are the pros and cons of single-payer healthcare?

Argumentative topics related to healthcare

Healthcare is always an ever-evolving issue. It’s one of those topics that everyone has an opinion on and is always eager to discuss . That’s why it makes for such a great topic for an argumentative essay . If you’re looking for some fresh ideas, here are some great healthcare argumentative essay topics to get you started.

1. Is our healthcare system in need of a complete overhaul?

3. Are rising healthcare costs making it difficult for people to access care?

4. Is our current healthcare system sustainable in the long term?

5. Should we be doing more to prevent disease and promote wellness?

6. What role should the private sector play in providing healthcare?

7. What can be done to reduce the number of errors in our healthcare system?

8. How can we make sure that everyone has access to quality healthcare?

9. What can be done to improve communication and collaboration between different parts of the healthcare system?

10. How can we make sure that everyone has access to the care they need when they need it?

Argumentative essay topics about health

There are many different stakeholders in the healthcare debate, and each one has their own interests and perspectives. Here are some great healthcare argumentative essay topics to get you started:

1. Who should pay for healthcare?

2. Is healthcare a right or a privilege?

3. What is the role of the government in healthcare?

4. Should there be limits on what treatments insurance companies must cover?

5. How can we improve access to healthcare?

6. What are the most effective methods of preventing disease?

7. How can we improve the quality of care in our hospitals?

8. What are the best ways to control costs in the healthcare system?

9. How can we ensure that everyone has access to basic care?

10. What are the ethical implications of rationing healthcare?

Medical argumentative essay topics

• Is healthcare a fundamental human right?

2. Should there be limits on medical research using human subjects?

3. Should marijuana be legalized for medicinal purposes?

4. Should the government do more to regulate the use of prescription drugs?

5. Is alternative medicine effective?

6. Are there benefits to using placebos in medical treatment?

7. Should cosmetic surgery be covered by health insurance?

8. Is it ethical to buy organs on the black market?

9. Are there risks associated with taking herbal supplements?

10. Is it morally wrong to end a pregnancy?

11. Should physician-assisted suicide be legal?

12. Is it ethical to test new medical treatments on animals?

13. Should people with terminal illnesses have the right to end their lives?

14. Is it morally wrong to sell organs for transplantation?

15. Are there benefits to using stem cells from embryos in medical research?

16. Is it ethical to use human beings in medical experiments?

17. Should the government do more to fund medical research into cancer treatments?

18. Are there risks associated with genetic engineering of humans?

19. Is it ethical to clones humans for the purpose

Argumentative essays on mental illness

• Should there be more focus on mental health in schools?
• Are our current treatments for mental illness effective?
• Are mental health disorders more common now than they were in the past?
• How does social media impact mental health?
• How does trauma impact mental health?
• What are the most effective treatments for PTSD?
• Is therapy an effective treatment for mental illness?
• What causes mental illness?
• How can we destigmatize mental illness?
• How can we better support those with mental illness?
• Should insurance companies cover mental health treatments?
• What are the most effective treatments for depression?
• Should medication be used to treat mental illness?
• What are the most effective treatments for anxiety disorders?
• What are the most effective treatments for OCD?
• What are the most effective treatments for eating disorders?
• What are the most effective treatments for bipolar disorder?
• How can we better support caregivers of those with mental illness?
• What role does stigma play in mental illness?

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Persuasive Essay Example on Why Healthcare Should Not Be Free

Healthcare is a big issue in the U.S. and it affects many people that live there.  Most people think it should be provided by the government so people don’t have to worry about paying for it.  While everyone is so concerned about their lives no one even considers that healthcare being free would affect way too many lives to even count.  

Healthcare being free would overall just ruin the economy.  In order to even have healthcare there needs to be money to pay for all of the medical machines and tools to determine what is wrong with patients. Studies also show that “The all-payer system relies on an overall healthy population, as a greater prevalence of sick citizens will drain the “sickness fund” at a much faster rate”. Say someone comes in with an injury, the hospital won’t have the proper technology machines to actually tell what is wrong and how they can make it better.   If they can’t tell what is wrong with the patient then why is there even a hospital?  Also without patients paying for their care, which goes into the hospital they won’t be able to pay off the bills to keep the building open.  So basically without the right amount of money and income there will be no healthcare.  

Healthcare has been around since 1750 when it all started with hospitals.  Since then you have always had to pay for the care that you get because the people that help you put in hard work hours in their days just to keep you safe.  All of the healthcare facilities around the U.S. need people to work there.  That hasn’t changed since then.  If the employees are not going to get paid what they need then they would have no reason to be there.  Sure helping people is the point of their job but if they are not making money for their time and labor then they are not going to be able to pay off their own taxes and bills.  People work so that they can pay for what they need to live, including a house, food, water, clothes, etc.  If healthcare was free there would be no way to pay the doctors, nurses, receptionist, etc.  If they are not getting the salary they deserve and need to live then they would probably want to find a new job so they can provide for themselves and if they have families.  What are the healthcare facilities going to do if there is no one working there to help and care for people?  There wouldn’t be any hospitals or urgent cares with not enough  workers.  So at this point free healthcare would be useless to the country and the people in it. 

A lot of people can’t afford health care when they really need it and they would probably be homeless if they had to pay off their medical bills, but that is exactly what jobs are for.  I think I am right that Healthcare should not be free because there are so many employees and doctors that work so they can live. If healthcare is free the doctors and nurses won’t make enough money.  Why should the employees suffer because people can't afford to pay their bills. 

Overall free healthcare sounds nice, but when you think about the outcome and what will happen overtime it gets you thinking.  You can’t rely on the government for everything, sometimes you need to take responsibility and work for what you want.  Free healthcare is just going to make the country worse.  Life is not supposed to be easy and you're not supposed to get everything handed to you, there are going to be challenges and you need to work through those.  Why are we not thinking about others and what would happen to them?  We want to make the U.S. better, not worse, so make it better.

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Every Country Should Have A Free Health Service | Band 9 IELTS Essay Sample

by Manjusha Nambiar · Published June 1, 2020 · Updated August 26, 2021

Every country should have a free-health service, even if this means that the latest medical treatments may not be available through the service because they are too expensive. To what extent do you agree or disagree?

Here is a band 9 IELTS essay on this topic. Need help with IELTS writing? Get your IELTS essays, letters and reports corrected by me.

Band 9 IELTS essay sample

Health is a fundamental right of every human being. Some people argue that every nation should provide at least basic healthcare for free. I agree with this view. By investing in public health, the government can ensure that even the most disadvantaged sections of the society have access to medical care and treatment. 

Although their number can vary from country to country, the truth is that there are poor people in all countries. A free public healthcare system is essential to cater to their healthcare needs. If the government runs hospitals and healthcare centres where it provides free healthcare and health information, everyone will be able to live a healthy life. Since health is wealth investing in public healthcare is a wise decision for any country. Healthy people are more productive and contribute to the development of the country. Also, by providing free healthcare, the government can prevent epidemics from spreading. This is crucial for the normal functioning of any country.

Of course, the government may not be able to provide advanced or specialist healthcare for free. Such treatments are highly expensive and if the government decides to fund them, it can be a huge burden on the public exchequer. Hence, depending on the financial situation of the country, only the poorest people need be given such treatments for free and there is no harm in charging a nominal or affordable free from the rest of the population. Also, it should be remembered that a lot of expensive medical interventions can be avoided if the disease is diagnosed and treated in the initial stages. For example, in the initial stages diabetes is not an expensive disease to treat and basic healthcare is sufficient; however, if it is not diagnosed or treated, it can lead to complications like renal failure, cardiac arrest or stroke which requires expensive surgeries. In other words, by providing basic healthcare for free, the government can prevent many health complications from arising.

To conclude, the biggest wealth of any nation is its people and hence investing in their health by offering them free healthcare is important for any government. Depending on their healthcare budget nations should determine what treatments they can provide for free. In any case, the basic healthcare must be free for all.

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Hi, I'm Manjusha. This is my blog where I give IELTS preparation tips.

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Insulin should be free. yes, free., it wouldn’t be very complicated, and it wouldn’t be nearly as expensive as you think—around $10 billion a year. the impacts would be profound., tagged healthcare insulin.

Charles H. Best and Frederick Banting, co-discoverers of insulin.

Predatory pricing by the insulin cartel has triggered a public health crisis. Diabetics are dying after self-rationing their overpriced insulin. The past decade’s exorbitant price hikes have left patients stranded like oxygen-starved hikers on Mount Everest.

The insulin debacle has become the public face of a much broader crisis. Sharp increases in out-of-pocket costs have left millions of patients unable to afford their medications. A large majority of Americans now rank the high cost of drugs as their top health-care concern, according to a recent Kaiser Family Foundation poll.

And of all the prescription-drug horror stories out there, insulin is the worst. The insulin story illustrates everything that is wrong with the contemporary drug marketplace. Insulin, which is usually produced naturally by the pancreas to process sugar in the blood, was first isolated and used to prevent death from diabetes in the 1920s. Biosynthetic versions of human insulin were invented more than three decades ago and are no longer patented. Yet, the three-firm cartel that controls the insulin market—Eli Lilly, Sanofi, and Novo Nordisk—still does not face competition from low-cost generics, which typically come to market at a small markup above their manufacturing cost (not the 500 percent markups typical of still-patented branded drugs). Why? Those firms have been primary beneficiaries of a well-funded biotechnology industry campaign that convinced the Food and Drug Administration (FDA) to require long and expensive clinical trials for any biosimilars (the industry name for biosynthetic generics), which makes their cost much closer to the brand-name originals.

About a quarter of the nation’s 30 million diabetics require insulin, without which they either die or suffer debilitating health consequences. Democratic Senator Amy Klobuchar highlighted the crisis by bringing a Minnesota constituent, Nicole Smith-Holt, to the 2019 State of the Union address. Smith-Holt’s 26-year-old son Alec, a Type 1 diabetic, died in 2017 from an acute case of ketoacidosis, the acid buildup in the blood that results from inadequate insulin, after being forced off his mother’s insurance plan when he turned 26. The $1,300-a-month he had to pay out-of-pocket for insulin was $200 more than his biweekly paycheck. Klobuchar and her Iowa Republican colleague Charles Grassley have included an accelerated pathway for biosimilars in their proposed legislation that would end the patent games drug companies use to delay generics entering the market.

Later in the year, on the eve of the second Democratic Party debate, Senator Bernie Sanders, who has made Medicare-for-All his signature policy proposal, took a busload of diabetics to Canada to purchase insulin that is one-tenth the United States price. Sanders’s single-payer system would go beyond negotiating lower prices as is done in Canada and other industrialized nations. It would completely eliminate the copays and deductibles that stand in the way of many patients—including some who are well-insured—getting the medications they need.

That our health-care system fails to provide essential medicines to people who face immediate death or injury without them is morally outrageous. The pricing and access policies of profit-seeking drug companies also make that failure quite literally a human rights violation. Those companies—and the government that fails to control them—are flagrantly ignoring the World Health Organization’s constitution, which calls “the highest attainable standard of health a fundamental right of every human being.” The document, which the United States signed in 1946, also says that “understanding health as a human right creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality.”

But flagrant violations of international norms have not convinced Congress to put an end to this human rights abuse. The drug industry’s protectors include virtually every member of the Republican Party, which marches in lockstep with the army of lobbyists deployed by Big Pharma. Last year, the drug industry spent $169.8 million on lobbying, more than any other industry. It’s on track to spend even more this year, having poured $129.4 million into its Washington influence machine through September, according to the Center for Responsive Politics.

Despite their numerous protests, many Democratic Party leaders remain conflicted about how to solve the problem. Too many legislators buy into the industry’s assertions that high prices are necessary to incentivize innovation. Most Democrats also accept drug and insurance industry campaign contributions, making them reluctant to pursue dramatic changes in the status quo. And conflicted members are in key positions for making policy. Since the beginning of 2019, New Jersey Democratic Representative Frank Pallone, chairman of the House Energy and Commerce Committee, raised $130,700 from medical professionals and $66,500 from drug companies, which together represented nearly 13 percent of his total campaign contributions. Democrat Anna Eshoo, who chairs that committee’s health subcommittee and is a vocal defender of her Silicon Valley district’s biotech companies, raised $115,700 from Big Pharma and $106,350 from medical professionals. That is fully 26 percent of her campaign contributions so far this year. Drug and biotechnology companies are concentrated in areas (eastern Pennsylvania/New Jersey, Boston, and San Francisco/Silicon Valley) that are heavily Democratic. Ending the political paralysis engineered by the drug industry and putting the interests of patients first is long overdue. Insulin is the perfect place to start. And the way to do it is not to make insulin merely affordable. No—the way forward begins by making insulin free to every patient. That’s right, free. To all who need it without copays or deductibles, and without having to wait for the passage of a single-payer health-care system, which will be a very heavy lift under even the most favorable conditions. Making insulin free will force Medicare, Medicaid, private insurers, and pharmacy benefit managers to directly confront the insulin drug cartel over their outrageous prices. If the three drug companies refuse to negotiate, there are practical policies for responding to their intransigence that are applicable to every high-priced drug category.

There are plenty of good ideas out there for how to make drugs affordable to taxpayers and private insurers should policymakers force them to assume the full cost of drugs. It can be done without jeopardizing innovation. All policymakers need to remember when designing a new system is that short-term medical necessity, long-term public health, and basic human decency should take precedence over the excessive profits being extracted from the current system by the pharmaceutical cartel. They must never forget that the greatest medical invention in the world is of no use to a patient who can’t afford to pay for it.

W hy start with insulin? Because diabetes has reached epidemic proportions in the United States. Its incidence is expanding at the same rate as our collective waistlines. Nearly 10 percent of Americans today are diabetic, more than double the rate of 1990. Another 12 percent are pre-diabetic and at high risk of developing the disease because they are overweight or obese, which is the number one risk factor for Type 2 diabetes. (Type 1 diabetes, an autoimmune disorder, usually manifests itself in childhood or early adulthood and accounts for just 4 percent of diabetics.) Because our society has failed miserably in its half-hearted efforts to address the obesity epidemic, the United States now ranks third out of 34 Organization for Economic Cooperation and Development countries for diabetes prevalence. Blacks, Hispanics, and the poor suffer disproportionately from the disease.

The epidemic is imposing a staggering cost on the nation’s health-care system: an estimated $237 billion in 2017 for direct care alone. Poorly treated or untreated diabetes also leads to maiming and life-threatening conditions like kidney and heart disease, blindness, nerve pain, and amputations. Collectively, these complications of diabetes account for an estimated one in every $4 spent on health care, according to the American Diabetes Association. Diabetes mellitus, derived from the Greek words for siphon and sweetness, occurs when the pancreas fails to produce sufficient insulin to process blood sugar after eating. Diabetes is hard to manage under the best of circumstances. It requires constant pinpricks to test blood, complicated drug regimens to control fasting glucose levels, close attention to diet, and, for about one in three diagnosed diabetics, regular injections of short- and long-acting insulins to keep blood sugar levels from spiking up or down, either of which can cause acute reactions like ketoacidosis and death. One-quarter of diabetics in the United States do not even know they have the disease and find out only when they wind up in the emergency room from some diabetes-related complication.

But individual health crises increasingly are triggered by “noncompliance,” the failure to take medicines as prescribed. Noncompliance used to be ascribed to patient apathy or an unwillingness to accept unwanted side effects. Today, physicians are just as likely to attribute diabetic noncompliance to the financial toxicity caused by the high price of insulin and other drugs for managing blood sugar. Across all classes of drugs, an estimated 20 percent of prescriptions are never filled, with copay affordability increasingly cited as a major reason for noncompliance.

The average diabetic now spends nearly $5,000 a year on drugs, with insulin of course being the most expensive. The price of long-acting insulin has shot up eightfold since 2000. Eli Lilly’s Humalog, for instance, retailed at $234 per vial in 2015, up from just $35 in 2001. Moreover, prices are far above those paid abroad. Sanofi’s Lantus retailed at $372 a vial in the United States in 2015, more than six times higher than what the same brand costs in Canada ($67), France ($47), or Germany ($61), according to a 2016 survey published in the Journal of the American Medical Association . Patients need anywhere from two to six vials a month.

As noted earlier, many patients deal with financial toxicity by skimping on their meds. A recent Centers for Disease Control and Prevention (CDC) analysis showed 13.2 percent of diabetics did not take their medications as prescribed, with nearly one in four asking their doctors for lower priced medicine. The uninsured were nearly three times more likely to skip or skimp on treatment. A 2018 survey by T1International, a patient advocacy group based in London, found that fully 26 percent of American patients rationed their insulin in the previous year compared to just 6.5 percent of patients in other high-income countries. The result? The hospitalization rate for diabetes complications was 38 percent higher in the United States compared to other industrialized nations.

The ancillary costs caused by skimping on drugs will only grow in the years ahead unless something is done to make diabetes drugs like insulin universally available at no cost to patients. More diabetics like Smith-Holt’s son will die unnecessarily. The pipeline of people heading for costly dialysis because of inadequate diabetes treatment will widen. The nation’s hospital beds will fill with people suffering diabetes-related heart attacks, strokes, blindness, and amputations. Health insurance premiums and taxpayer obligations will rise to pay for it all.

Dealing with high drug prices is only the start in addressing this mushrooming public health disaster. Americans not only pay higher prices for drugs. They require more drugs because, compared to other advanced industrial nations, Americans suffer from a far greater incidence of chronic diseases like diabetes, heart disease, cancer, and arthritis—a shift that in recent years has been directly tied to rising obesity. Americans and Europeans consumed about the same amount of calories per day in 1989, but by 2013, American consumption had jumped nearly 10 percent while European food intake declined slightly. America today has twice Europe’s obesity rate.

Moreover, declining health status in the United States is disproportionately concentrated among poor, minority, and working-class Americans. Epidemiologists have known for decades that there is a direct correlation between a person’s health and their social conditions. The United States is markedly worse than peer nations on what experts call the social determinants of health. We have the most unequal distribution of wealth and income; the least fair tax system; more inadequate housing, especially for the poor; and our food production and food marketing system, especially for low- and moderate-income people, is a hothouse for incubating obesity-related ill health, especially diabetes.

All are major contributors to the sharply deteriorating health status of working-class Americans. To its great shame, the United States has experienced declining longevity for three years running, according to the CDC, a phenomenon not seen in the industrialized world since Russia in the 1990s after the collapse of the Soviet Union.

It’s important to recognize that the debilitating social conditions that are causing declining longevity are not universal. They do not afflict America’s prosperous suburbs and gentrified urban cores. Indeed, life expectancy in those well-to-do enclaves continues to grow and is equal to the healthiest countries in Western Europe. Inequality, including in access to essential medicines, is driving the growing longevity gap between these prosperous areas and the communities inhabited by America’s working class and poor, where the modern-day epidemics of obesity, opioids, and gun violence are causing significant declines in life expectancy.

The relatively well-off middle class needs to recognize that dealing with these socially borne health disparities is in its self-interest. Only by tackling the causes and consequences of chronic disease epidemics like diabetes can we bring our health-care costs within international norms, and lower insurance premiums for everyone. That work begins by making essential drugs like insulin free for patients and low-cost to the system’s public and private payers.

I nsulin, a naturally occurring protein, hasn’t always been expensive. Dr. Frederick Banting, the Canadian awarded the 1923 Nobel Prize for Medicine for its discovery, reportedly said “insulin belongs to the world, not to me.” He gave half his cash award to one of the co-inventors responsible for its purification, who had been denied recognition by the Nobel Assembly. His co-inventors were similarly imbued with the scientific spirit: They turned the patent over to the University of Toronto for the grand sum of one dollar.

The university, in turn, decided to license it for free to any company willing to produce the drug at the exacting purity standards required by diabetics—not an easy task given the volumes needed for treatment. The first insulin used by Banting and colleagues had come from the minced pancreases of hogs and cattle, which they obtained from local slaughterhouses. Animal insulin is essentially the same as human insulin and works as well once impurities are removed. Drug firms getting into the business would follow the same procedure. They built a supply chain for harvested animal pancreases that ran from major slaughterhouses to their purification factories.

While the original patent was free to anyone who wanted to use it, the university added a fateful codicil to the contracts: Private companies could keep any subsequent patents awarded for improvements to the drug. Eli Lilly of Indianapolis quickly accepted the offer and began producing insulin for the American market. The company patented the technologies for processing out the impurities that could lead to severe side effects, from allergic reactions at the injection sites to anaphylactic shock. Just a few other companies followed suit, thus giving birth to the original diabetes cartel. In 1941, a federal grand jury indicted three firms—Lilly, Sharp & Dohme (later part of Merck), and E.J. Squibb (later merged with Bristol Myers)—for insulin price fixing. They pleaded no contest and settled by paying a $5,000 corporate fine and a $1,500 fine for each of their top corporate officers.

While the penalty was relatively minor, it had a sobering effect on the industry that emerged after World War II price controls were lifted. The price of insulin remained relatively low and wasn’t a major concern for diabetics (unless they were uninsured) for over half a century. But the 1980s biotech revolution enabled researchers to begin making synthetic human insulin. They also developed short- and long-acting versions that dramatically improved diabetes care. The days of diabetic dependence on animal insulin were over.

But these new biotech drugs were protected by a new set of patents, and their prices began edging up. In this century, they were affected by broader changes in drug industry pricing strategies. For most of their postwar history, drug manufacturers depended on selling patented medicines to large patient populations. The prices of antibiotics, anti-inflammatories, broad spectrum anti-cancer drugs, and meds to lower blood pressure, cholesterol, and stomach acid all followed similar patterns. Their prices, when introduced, may have seemed high, especially compared to the generics that came to market after the original drugs went off patent. But they usually sold for less than $1,000 a year. Generating sales in the billions of dollars for most drugs depended on reaching tens of millions of patients. With less than 3 percent of the population suffering from diabetes through the end of the 1980s (it’s now three times that level), insulin was never a major revenue generator for an industry whose profits depended on mass-market blockbusters.

As innovation in these mass-market drugs waned—scientists like to say that by the end of the twentieth century, all the low-hanging fruit of the then-80-year-old drug revolution had been picked—academic and industry labs began focusing on rarer and more difficult diseases that affected smaller patient populations. Advances in molecular biology allowed scientists to identify the specific genetic malfunctions that triggered these diseases and to begin developing drugs that targeted those malfunctions.

Government-funded advances in molecular biology also enabled the treatment revolution popularly known as “personalized” medicine. Scientists began dividing broad disease categories into various sub-types. Breast cancer tumors, for instance, became identifiable as ER-positive, PR-positive, HER2-positive, all of the above, or none of the above. Treatment varied accordingly. It was elegant science, but it also meant the patient population for any given drug shrank. That’s why most of the targeted medicines developed over the past two decades have come from small, venture capital-funded biotech firms started by scientists whose original research was funded by the National Institutes of Health (NIH), charitable foundations, patient groups, or some combination of those resources.

Their successes created a new playbook for the big drug companies, which were scrambling for a revenue replacement strategy as their mass-market drugs came off patent. They began buying up successful biotech firms at inflated prices, often just on the cusp of their new drugs gaining FDA approval. To pay for these costly acquisitions from the venture capitalists, as well as maintain their own revenue streams and profit margins, the big firms began charging higher and higher prices to these smaller and smaller patient populations. Today, some of the latest drugs sport million-dollar price tags for the few thousand patients who benefit from their use.

This pricing strategy has nothing to do with the cost of developing those drugs. The premium paid by American consumers generates revenue far beyond what “the companies spend globally on their research and development,” a recent study in the journal Health Affairs found. Dr. Aaron Kesselheim, writing in the Journal of the American Medical Association , attributed the drug industry’s untrammeled pricing power to two market realities: One, they are protected from competition through patenting; and two, unlike in Europe, their prices are not subject to government controls.

As prices soared on new drugs coming to market, a curious thing happened. The prices of existing-but-still-patented drugs began rising right along with them. Unscrupulous operators like former hedge fund manager Martin Shkreli, now in federal prison for security fraud, even began imposing huge price increases on some generic medicines. After acquiring Turing Pharmaceuticals, the sole manufacturer of Daraprim, which is used to treat a rare parasite infection, Shkreli raised its price from $13.50 to $750 a tablet, a 5,000 percent increase.

The three firms that make up the insulin cartel took advantage of this new pricing climate after switching to biotechnology-derived insulin. The FDA approved Eli Lilly’s first synthetic insulin in 1982. Short- and long-acting versions were approved in 1996 and 2000, respectively. Their prices quickly began rising at double-digit annual rates. When new and allegedly improved versions came along, price spikes would follow despite the absence of evidence that they led to better outcomes for diabetics. European and other advanced industrial countries kept insulin price increases in check through government price-setting and more careful assessment of the newer insulins’ actual medical value.

Patient and consumer advocates had hoped that the earliest biotech drugs, synthetic insulin among them, would by now have given way to much cheaper generics, known as biogenerics or biosimilars in the biotech space. After all, when Congress enabled generic competition through the 1984 Drug Price Competition and Patent Term Restoration Act (popularly known at Hatch-Waxman after its two primary sponsors), the price of drugs coming off patent dropped markedly, sometimes by 80 percent or more.

But due to intense industry opposition, Congress did not pass the Biologics Price Competition and Innovation Act until 2009, three years after the European Union approved its first “biosimilar.” It took another decade before the FDA approved rules enabling biosimilar interchangeability at the pharmacy, which is key to substituting generics for brand-name products.

Why did it take so long? Industry and industry-funded scientists argued that biosimilars—a term they created to distinguish them from bio-generics—needed to show they were equally effective and didn’t have greater side effects than their branded predecessors. Traditional generics only had to show they were chemically the same. Under both presidents Obama and Trump, the FDA has supported the industry position. As a result, biosimilar manufacturers have to conduct long and expensive clinical trials before gaining FDA approval. The handful of biosimilars that have entered the United States market are priced near their brand-name rivals, not like true generics that come to market at 20 percent or less of the brand-name price.

The latest two insulins to enter the market are a case study for this regulatory and market failure. Each is considered a “follow on” drug, not a biosimilar. Each was developed, tested, and put on the market by a member of the insulin cartel. Neither is automatically interchangeable at the pharmacy. Each is priced at 50 percent or more of the branded predecessor. None has achieved significant uptake since many doctors and patients are either unaware of their existence or are unwilling to risk the hyped-up possibility of side effects for the scant savings from switching drugs. American patients and their insurers spent $126 billion on biologic drugs in 2018. Just 2 percent went for biosimilars. For insulin, as well as other pricey biotechnology drugs, the hope that biosimilars would provide low-cost competition has been a total bust.

N ow we get to the heart of the matter: how to make insulin free. Let’s start that discussion by asking: What is the impediment to making insulin free? Answer: Our fragmented insurance system, which has neither the monopsonist buying power to challenge the patent-holding drug cartel nor the ability to negotiate prices. As a result, individual insurers create roadblocks to making insulin and other essential medicines and supplies affordable to patients. Nearly all private insurers impose copays on insulin that can reach hundreds of dollars a month. Even recent caps—Colorado imposed a $100 monthly maximum on out-of-pocket expenses; Express Scripts, a leading pharmacy benefit manager, limited its copay to $25 a month for some customers—will still force some low-income, price-sensitive patients to skimp on their drugs.

Medicare, the biggest government health-care program, falls into the same trap. Congress has been gradually shrinking the coverage gap in the Medicare drug benefit, but under new rules enacted for 2019, beneficiaries must still pay 25 percent of the cost of all brand-name medicines, including insulin, until they reach $5,100 in out-of-pocket expenses, when the copay drops to 5 percent. Total out-of-pocket spending by diabetic Medicare beneficiaries quadrupled between 2007 and 2016 to nearly $1 billion.

The path to ending all copays and deductibles, i.e., making insulin free to patients, is bypassing our fragmented insurance system with a common purchasing program that unites all consumers. It’s not even especially complicated. All it would take is for Congress to create and authorize a drug-purchasing pool, similar to a statewide program being implemented in California, that ideally would include everyone: all Medicare and Medicaid beneficiaries; users of other government programs like the Veterans Administration, the Indian Health Service, and subsidized plans on the exchanges; and the majority of Americans—currently somewhere around 175 million people—who have private insurance for health-care coverage.

The pool, which would be run by the federal government, would jointly purchase all forms of insulin from their manufacturers. It would then turn them over to pharmacies and other distributors free of charge. It would also have to add a small payment to cover distribution costs. Physicians would then be free to prescribe the best insulin for their patients, who would pick up their prescriptions at the pharmacy counter for free. Over time, this unified group purchasing system could be expanded to include other high-cost medicines, including the high-priced cancer chemotherapy and other specialty drugs that are prescribed and administered in physician offices and clinics.

The pool authority would still have to buy the insulin, of course. Nothing is free. But by eliminating markups in the distribution chain and lowering the price it paid for insulin, the pool authority would be able to substantially lower the total payments patients and payers shell out, which the Kaiser Family Foundation estimated at $13.3 billion in 2017 for Medicare alone.

To lower its acquisition costs, the pool authority would be empowered to engage in any of a number of tactics to bring down the price that it pays for insulin. They include:

• Direct negotiations with manufacturers;
• Setting benchmark prices based on an index of prices paid by other industrialized nations (the Trump Administration floated this idea last December and House Democrats included it in their bill; the drug industry has been running an expensive advertising and lobbying campaign to bury the idea);
• Setting reference prices based on the lowest-cost alternatives already in the market; and
• Importing the drugs from lower-cost countries.

Having done this, the pool would next need to finance its acquisition costs in order to make the drug free to patients. The pool authority could raise money in one of two ways, or a combination of both: from general tax revenue collected by the government or from a flat fee paid to the government by every public and private insurer.

How much would it cost? Precise numbers are hard to come by since estimates on current insulin usage vary widely. The CDC estimated that about 14 percent of the nation’s 23 million diagnosed diabetics used insulin in 2015—about 3.2 million people. The Kaiser Family Foundation reported that 3.1 million Medicare beneficiaries used insulin in 2016, at a total cost to the program of $13.3 billion. Since average expenditures per patient on insulin totaled about $5,705 per person in 2016, according to the Health Care Cost Institute, total current spending on insulin, including patient out-of-pocket expenses and the price increases the cartel imposed over the past three years, is probably about $17.5 billion a year.

If the pool authority’s acquisition costs were lowered by 40 percent through negotiations or other tactics (to about what the Veterans Administration pays), its total costs—even after relieving patients of their obligations—would drop to $10.5 billion, a $7 billion annual saving.

And getting rid of copays and deductibles, which may sound expensive to the layperson, wouldn’t even cost that much. Medicare patients pay only 7 percent of the total current cost, so going from “affordable” to “free” is a comparatively small lift.

So that’s a very reasonable estimate of the cost here; $10.5 billion. As a point of comparison, the federal government spends $16.5 billion a year on the CHIP children’s insurance program.

This pool approach holds out the possibility of attracting broad-based, even bipartisan support. For progressives, it represents a single-payer approach to one of the health-care system’s most pressing problems and provides immediate relief for patients’ out-of-pocket expenses. For centrists in the Democratic Party, it conforms with their “Medicare for more” approach and embodies their long-standing demand for direct negotiations with drug manufacturers. And for any conservative who is honestly looking for a health-care alternative (and perhaps a path to disentangle him or herself from the Trump cult), it mirrors the catastrophic reinsurance programs they have historically backed to spread the cost and risk of very sick, very expensive patients in employer-based plans.

Really? Get some Republicans to endorse this? In 2017, when the Republican majorities in both chambers of Congress were pursuing legislation to “repeal and replace” the Affordable Care Act, they included a reinsurance program for high-cost patients in employer-based plans. A dozen states, several of them under Republican leadership, have already received Health and Human Service Department (HHS) waivers to implement reinsurance programs as a way of lowering health insurance costs for small employers. Couching a national drug purchasing pool as a reinsurance program could convince at least a few Republicans to give it bipartisan support.

A variation of the pool approach for drugs is being pursued in California. Governor Gavin Newsom earlier this year ordered his health department to move toward common purchasing for expensive drugs used by state employees, retirees within the California Public Employees’ Retirement System (CalPERS), and customers relying on the state’s publicly funded programs, including Medicaid. The executive order also called on the state’s drug purchasing collaborative to open the pool to all private plans, including those for small businesses, the self-insured, and major insurers like Kaiser Permanente. The state’s Department of Health Care Services is moving quickly to meet the new governor’s January 2021 deadline for implementation. “We are reasserting our market leverage over the industry,” one official said. “We’ll be negotiating for 13 million people,” meaning not just the state’s 2.5 million employees and Medicaid beneficiaries.

Will the state succeed in reining in the prices currently being charged by Eli Lilly, Sanofi, and Novo Nordisk? Big purchasers have clout. Look at California’s auto emission standards, currently in the news because of the Trump Administration’s effort to take away the state’s authority to set stricter mileage requirements. Four major auto companies have already agreed to meet those standards no matter what happens. A big state like California will be able to use its purchasing power to drive prices lower by forcing the cartel members to finally compete, not collude, on the prices they set. Imagine what a national pool could do.

The insulin cartel, and the drug industry at large, will fight this approach with every weapon in its well-stocked lobbying arsenal. But the same is true for any reform that reduces their revenue stream or seriously tackles the exploding cost of drugs. Witness their so-far successful campaign against using international prices to set U.S. prices for the most expensive drugs. Unlike that proposal, however, a purchasing pool that eliminated copays and deductibles would be able to generate broad public support, something none of the half-steps currently under consideration in Washington have done.

Indeed, purchasing drugs in common has the potential to unite most health-care constituencies (patients, employer and individual plan purchasers, doctors, hospitals, insurance companies, and government payers). But in order to succeed, they will have to counter the drug industry’s two main talking points, which haven’t changed in the quarter century since legislators began discussing a drug benefit for Medicare.

First, if you drive prices lower for manufacturers, they will refuse to sell. This will lead to rationing and patients being cut off from expensive but necessary drugs. Second, reducing the drug industry’s total take—especially in the United States, their most lucrative market—will dry up investment in the research necessary for new and improved drugs.

There are legislative approaches already introduced in Congress that begin to deal with both issues. House Speaker Nancy Pelosi’s drug plan said if any manufacturer refuses to negotiate prices on some expensive drugs without sufficient competition, the government will impose a 65 percent tax on the gross sales of those drugs. Pelosi’s plan would also impose penalties if a company refuses to offer Medicare’s negotiated price to private insurers.

Though it doesn’t have leadership support, Texas Representative Lloyd Doggett and Ohio Senator Sherrod Brown have offered an even stronger approach. Their bills would authorize the HHS secretary to give generic manufacturers the right to produce any drug that relied on National Institutes of Health-funded research should negotiations fail. The companies would receive “just compensation” based on an audited statement of their investment in R&D or the medical value of the drug.

As far as new research drying up if industry revenues decline, it’s time to give serious consideration to delinking innovation from the drug pricing system. As the original discovery and production of insulin demonstrates, major innovations in medicine do not depend on pouring huge sums of money into the coffers of the pharmaceutical industry. If that were true, we’d have had a cure for cancer or treatments for Alzheimer’s a long time ago. Innovation only occurs when scientists understand the causes of diseases, which have genetic, chemical, environmental, and social roots. Virtually all of the basic science research that identifies those causes takes place in universities and non-profit labs funded by the government or charitable organizations.

Moreover, the application of science to develop therapies that address a disease, once its causes have been determined, has occurred just as often in government, university, or nonprofit labs as it has in industry-funded ones. The tools of applied science are equally accessible to both arenas. A recent study showed that each of the more than 200 drugs approved by the Food and Drug Administration between 2010 and 2016 depended in whole or in part on NIH-funded research. The playing field has tilted toward industry in the past several decades only because government-funded applied science, where government-funded scientific insights are turned into actual new drugs, has been systematically underfunded. NIH budgets, when adjusted for inflation, are almost exactly the same today as they were in 2001, when President George W. Bush took office.

The way to delink innovation from prices is to establish an even playing field for scientific competition. This will enable scientific labs—whether nonprofit or for-profit, university-based or industry-based—to pursue the most promising scientific leads. In July 2019, 15 Democratic senators introduced legislation that would fund the National Academies of Sciences, Engineering, and Medicine (NAS) to conduct a comprehensive study of alternative ways to promote medical innovation. Progressives’ preferred option would establish a prize fund for medical innovation, where the prizes would be based on the medical value of any new drug receiving FDA approval. Legislation embodying that approach, introduced time after time by Senator Bernie Sanders, has gone nowhere. An independent study by a panel of mainstream scientists at NAS could flesh out whether it’s truly feasible and whether there may be other approaches for separating the financing of innovation from the prices people pay for drugs.

An alternative clearly is needed. The pharmaceutical industry’s present model, which leaves the pricing and marketing of drugs to the companies that own their patents, has generated the current crisis. Creating awards for true innovation and divorcing research and development from pricing and marketing—in essence, breaking up the drug cartel’s vertical monopoly—will create a far more robust system for medical innovation. The one we now have incentivizes industry to pour a substantial share of its R&D resources into minor changes whose primary goal is to extend the patent life of medicines (so-called patent evergreening) and thereby their owners’ monopoly pricing power.

T he health impacts would be enormous. The winning argument for making insulin and other essential diabetes drugs and supplies free starts by emphasizing how much it would help reduce the unnecessary health-care costs generated by inadequate treatment. People who don’t have to worry about copays and deductibles are more likely to stay compliant with their drug regimens. Dose-skipping and skimping will disappear. The quarter of diabetics who are undiagnosed, often because they are uninsured and poorly insured, will be more likely to seek treatment knowing their costs will be covered. The long-term expense from treating diabetes-related dialysis, heart attacks, blindness, and amputations will decline.

Free insulin will also free up provider time to focus on the root causes of diabetes. Today, too many physicians and their staffs spend the little time they have for helping patients plugging them into industry-funded charity programs that help defray the cost of their meds and supplies. A far better use of their time would be to help those patients sign up for gym memberships, dietary advice, and cooking classes, which in some cases can reverse obesity-related Type 2 diabetes. (Medicare already pays for this clinically proven program for its enrollees.) If such programs were expanded to reach the nation’s 84 million pre-diabetics, it could dramatically shrink the pipeline of people on the road to full-blown diabetes.

Yes, the political roadblocks to creating a monopsonist drug purchasing authority and redrawing the nation’s medical innovation system are enormous. Industry opposition to both will be fierce, just as it has been to the half-measures that wouldn’t even solve the affordability crisis, such as getting rid of patent evergreening or giving Medicare a limited right to negotiate prices. But think of the political power of the phrase “free insulin.” Yes, we as a society will still be paying for drugs purchased by the purchasing pool. But imagine 7 million diabetes patients simply never, ever having to worry about paying for their insulin again. That’s very politically potent. And unlike Medicare-for-All, it doesn’t require remaking the entire health-care delivery system; just a part of it—the part that has left people in the richest nation on earth dying for lack of essential medicine.

For the past three decades, most Democrats and even a few Republicans—including Donald Trump—have consistently put the drug industry in their rhetorical crosshairs. Yet nothing has been done to limit the pricing power of the industry. New drugs are coming to market at astronomical prices. Once-cheap generics are skyrocketing in cost. Prices are being raised every year on drugs that are still on patent—long after their FDA approval and long after the research on them has ended. The political system’s abject failure over several decades to solve the drug price problem, which the public considers the most critical in health care, is a major contributor to the public cynicism that has brought our democracy to the brink of collapse.

A big win against the drug industry would prove that government can, in fact, work for people, not just special interests. It will also begin the process of achieving something that has frequently been claimed for our health-care system but has never been true—that it is the best on earth. Any nation that denies essential medicines to millions of its people in violation of their basic human rights cannot make that claim. But if we make insulin free to patients—and finally achieve what Dr. Banting reportedly wanted for patients when he and his colleagues turned over the insulin patent for only a dollar—we’ll be taking a giant step on the path to getting there.

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Merrill Goozner a long-time business and economics journalist, is editor emeritus and columnist for Modern Healthcare , a trade journal that he edited from 2012 to 2017.

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