arguments for universal healthcare essay

Universal Health Care: Arguments For and Against

Introduction, works cited.

The constant debates around the health care system in the United States, recently heated by the president’s health care reforms proposal, is a direct indication that the issue of health care in the United States is a painful subject. On the one hand, there is a support for the health care owned by the private sector, in which the medical treatment should be paid for ensuring higher efficiency, and on the other hand there are supporters of the opinion that health care is a right that should be accessible to everybody. The mutual point of intersection between the two groups is that both of them acknowledge that the current system needs reform (Roberts). Taking the position of the health care as a right accessible to everyone, “Sicko”, a 2007 documentary film by Michael Moore, outlined the effectiveness of such system – universal health care, showing and comparing the implementation of this system in practice in other developed countries such as Canada and France, and accordingly, pointing to the deficiencies of the current, based on insurance, health care in the United States. In that regard, this paper takes the position for universal health care, outlining the supportive arguments, as well as the arguments used by its opposition.

In the majority of universal health care system, the government’s involvement is the main approach in providing health care. In that regard, the sources of government coverage stem from general and dedicated taxation, and social insurance (McDougall, Duckett and Manku). Accordingly, it can be seen that the reliance on universal health care will lead the creation of more government positions.

Such point can be seen through Moore’s film, where the example of France is showing the social services provided by the government. Accordingly, it can be assumed that the necessity for such positions in any country adopting a universal health care system will lead to the creation of more government jobs.

Nevertheless, it should be stated that such positions imply limiting health care providers to the government, rather than that the payment methods will be regulated. In the example of France indicated in the film, the “The state sets the ceiling for health insurance spending, approves a report on health and social security trends and amends benefits and regulation”.

Following the previous argument, it can be said that government regulations will lead to a decrease in the doctors’ payment within a universal health care system. One point of controversy, which is held by the opposition of universal health care, is the possibility of health care quality reduction due to regulation of payments by the government and “enslaving the doctors”.

Looking at the representation of the doctors working in universal health care systems in Moore’s film, the doctors in Britain are paid by the government, and accordingly the system of commission implemented in Britain implies that the doctors are paid more when there are documented improvements in patients’ conditions. In such way, the doctors are interested in providing the best treatment for their patients, and at the same time the patient is sure that the aid he is receiving is not dependable on such factor as the doctors’ income.

Taking a look at other countries with universal health care such as France, where the fees are negotiable with the government, Switzerland, where the government negotiates rates with doctor organizations, and Netherlands, where insurers negotiate rates (McDougall, Duckett and Manku), it can be seen that such approach is definitely will not deprive the doctors of their rights, especially considering that negotiating imply a more flexible approach for the doctors, rather than regulation, where payments are regulated in government programs, as seen in the United States (Organization for Economic Development and Cooperation, The Commonwealth Fund and Henry J. Kaiser Family Foundation).

Finally, the most important argument, which can be considered as the criterion, based on which the health care system should be evaluated is the effectiveness seen through the results. In that regard, one of the arguments used in Moore’s film, in addition to the accessibility of the health care to everyone, is the results of such implementation on the overall health of the population. Taking the example of Great Britain in the film, a report from the AMA (American Medical Association) into the health of 55- to 64-year-olds says Brits are far healthier than Americans. That was only one example of the way the universal health care is more effective.

Taking life expectancy as a measure, the United States is the behind the such countries as Great Britain, United Kingdom, New Zealand, Italy, Canada, Sweden, Austria and France (McDougall, Duckett and Manku). Accordingly, in infant mortality rate as of 1999, the United States is ranked the last among the previously mentioned countries. In fact, the health care in the United States might have positive results in some areas, taking various positions surpassing the position of some of the countries in the list. However, it should be stated that considering the fact that “the U.S. spends far more per capita on health care than any other nation,” (Organization for Economic Development and Cooperation, The Commonwealth Fund and Henry J. Kaiser Family Foundation) it is not the leader in health among other developed countries.

Opposing the universal health care system, the arguments used vary in their effectiveness and accuracy, although some of them can be considered logical. Taking the example of the insurance company, one argument that might used can be seen in the statement that private insurance companies will go out of business. The as arguments is stemming from the fact that the current health system in the United States is largely operated by the private sector, either in provision of medical services or the insurance, where in terms of the latter the percentage of people covered by private health insurance was 67.5 as of 2007 (DeNavas-Walt et al.). Nevertheless, it can be stated that the universal health care system implies the option for private insurance companies, where taking the example of Switzerland the health system comprises of universal coverage, a mandate that everyone buy insurance and a major role for private insurance companies (McManus).

Omitting such factor as less payment for doctors, as previously explained in the example Britain, another important argument is overcrowded hospitals in universal health care systems. Such argument seems reasonable, where the examples of hospitals being overcrowded can be seen in such countries as Japan, Australia and others. In the case of Australia, Australian Medical Association stated that “there are 1500 unnecessary deaths in Australia due to overcrowding in public hospitals” (SHEPHERD). In that regard, such argument has sense, but nevertheless, it cannot be generalized on universal health care systems everywhere, rather than examples of funding issues might have led to such consequences in specific cases. Taking such factor as performance effectiveness, measured based on average length of stay, it can be seen that there are countries with universal health care that are leading with such indicators, which generally can imply that the type of health care system is not influencing such factor. Accordingly, such variables as the number of beds can be resulted from ineffective funding programs, rather than general health deficiencies.

It can be concluded that the universal health system is an option to hold to, specifically measuring such factors as costs and outcomes. Generally speaking, separate examples do not indicate the superiority of the system or its failure, while general trends examined through several developed countries shows the perspectives of such system. Universal health care is a step forward toward confirming the statement that health care is a right that is accessible to everyone.

“The State of Affairs in 16 Countries in Summer 2004”. World Health Organization . Eds. Grosse-Tebbe, Susanne and Josep Figueras. Web.

DeNavas-Walt, Carmen, et al. “Income, Poverty, and Health Insurance Coverage in the United States: 2007”. 2008. Census.gov . U.S. Government Printing Office. Web.

McDougall, Ashley, Paul Duckett, and Manjeet Manku. “International Health Comparisons”. National Audit Office . Web.

McManus, Doyle. “Switzerland’s Example of Universal Healthcare”. 2009. LA Times .Web.

“Sicko”. Dir. Moore, Michael. DVD. 2007.

Organization for Economic Development and Cooperation, The Commonwealth Fund, and Henry J. Kaiser Family Foundation. “Compare International Medical Bills”. 2008. National Public Radio . Web.

Roberts, Joel. “Poll: The Politics of Health Care”. 2007. CBS News . Web.

SHEPHERD, TORY. “Needless Hospital Deaths”. 2008. News Limited . Web.

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Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons

Every citizen of every country in the world should be provided with free and high-quality medical services. Health care is a fundamental need for every human, regardless of age, gender, ethnicity, religion, and socioeconomic status.

Universal health care is the provision of healthcare services by a government to all its citizens (insurancespecialists.com). This means each citizen can access medical services of standard quality. In the United States, about 25% of its citizens are provided with healthcare funded by the government. These citizens mainly comprise the elderly, the armed forces personnel, and the poor (insurancespecialists.com).

Introduction

Thesis statement.

• Universal Healthcare Pros
• Universal Healthcare Cons

Works Cited

In Russia, Canada, and some South American and European countries, the governments provide universal healthcare programs to all citizens. In the United States, the segments of society which do not receive health care services provided by the government usually pay for their health care coverage. This has emerged as a challenge, especially for middle-class citizens. Therefore, the universal health care provision in the United States is debatable: some support it, and some oppose it. This assignment is a discussion of the topic. It starts with a thesis statement, then discusses the advantages of universal health care provision, its disadvantages, and a conclusion, which restates the thesis and the argument behind it.

The government of the United States of America should provide universal health care services to its citizens because health care is a basic necessity to every citizen, regardless of age, gender, ethnicity, religion, and socioeconomic status.

Universal Healthcare Provision Pros

The provision of universal health care services would ensure that doctors and all medical practitioners focus their attention only on treating the patients, unlike in the current system, where doctors and medical practitioners sped a lot of time pursuing issues of health care insurance for their patients, which is sometimes associated with malpractice and violation of medical ethics especially in cases where the patient is unable to adequately pay for his or her health care bills (balancedpolitics.org).

The provision of universal health care services would also make health care service provision in the United States more efficient and effective. In the current system in which each citizen pays for his or her health care, there is a lot of inefficiency, brought about by the bureaucratic nature of the public health care sector (balancedpolitics.org).

Universal health care would also promote preventive health care, which is crucial in reducing deaths as well as illness deterioration. The current health care system in the United States is prohibitive of preventive health care, which makes many citizens to wait until their illness reach critical conditions due to the high costs of going for general medical check-ups. The cost of treating patients with advanced illnesses is not only expensive to the patients and the government but also leads to deaths which are preventable (balancedpolitics.org).

The provision of universal health care services would be a worthy undertaking, especially due to the increased number of uninsured citizens, which currently stands at about 45 million (balancedpolitics.org).

The provision of universal health care services would therefore promote access to health care services to as many citizens as possible, which would reduce suffering and deaths of citizens who cannot cater for their health insurance. As I mentioned in the thesis, health care is a basic necessity to all citizens and therefore providing health care services to all would reduce inequality in the service access.

Universal health care would also come at a time when health care has become seemingly unaffordable for many middle income level citizens and business men in the United States. This has created a nation of inequality, which is unfair because every citizen pays tax, which should be used by the government to provide affordable basic services like health care. It should be mentioned here that the primary role of any government is to protect its citizens, among other things, from illness and disease (Shi and Singh 188).

Lastly not the least, the provision of universal health care in the United States would work for the benefit of the country and especially the doctors because it would create a centralized information centre, with database of all cases of illnesses, diseases and their occurrence and frequency. This would make it easier to diagnose patients, especially to identify any new strain of a disease, which would further help in coming up with adequate medication for such new illness or disease (balancedpolitics.org).

Universal Healthcare Provision Cons

One argument against the provision of universal health care in the United States is that such a policy would require enormous spending in terms of taxes to cater for the services in a universal manner. Since health care does not generate extra revenue, it would mean that the government would either be forced to cut budgetary allocations for other crucial sectors of general public concern like defense and education, or increase the taxes levied on the citizens, thus becoming an extra burden to the same citizens (balancedpolitics.org).

Another argument against the provision of universal health care services is that health care provision is a complex undertaking, involving varying interests, likes and preferences.

The argument that providing universal health care would do away with the bureaucratic inefficiency does not seem to be realistic because centralizing the health care sector would actually increase the bureaucracy, leading to further inefficiencies, especially due to the enormous number of clientele to be served. Furthermore, it would lead to lose of business for the insurance providers as well as the private health care practitioners, majority of whom serve the middle income citizens (balancedpolitics.org).

Arguably, the debate for the provision of universal health care can be seen as addressing a problem which is either not present, or negligible. This is because there are adequate options for each citizen to access health care services. Apart from the government hospitals, the private hospitals funded by non-governmental organizations provide health care to those citizens who are not under any medical cover (balancedpolitics.org).

Universal health care provision would lead to corruption and rent seeking behavior among policy makers. Since the services would be for all, and may sometimes be limited, corruption may set in making the medical practitioners even more corrupt than they are because of increased demand of the services. This may further lead to deterioration of the very health care sector the policy would be aiming at boosting through such a policy.

The provision of universal health care would limit the freedom of the US citizens to choose which health care program is best for them. It is important to underscore that the United States, being a capitalist economy is composed of people of varying financial abilities.

The provision of universal health care would therefore lower the patients’ flexibility in terms of how, when and where to access health care services and why. This is because such a policy would throw many private practitioners out of business, thus forcing virtually all citizens to fit in the governments’ health care program, which may not be good for everyone (Niles 293).

Lastly not the least, the provision of universal health care would be unfair to those citizens who live healthy lifestyles so as to avoid lifestyle diseases like obesity and lung cancer, which are very common in America. Many of the people suffering from obesity suffer due to their negligence or ignorance of health care advice provided by the government and other health care providers. Such a policy would therefore seem to unfairly punish those citizens who practice good health lifestyles, at the expense of the ignorant (Niles 293).

After discussing the pros and cons of universal health care provision in the United States, I restate my thesis that “The government of United States of America should provide universal health care to its citizens because health care is a basic necessity to every citizen, regardless of age, sex, race, religion, and socio economic status”, and argue that even though there are arguments against the provision of universal health care, such arguments, though valid, are not based on the guiding principle of that health care is a basic necessity to all citizens of the United States.

The arguments are also based on capitalistic way of thinking, which is not sensitive to the plight of many citizens who are not able to pay for their insurance health care cover.

The idea of providing universal health care to Americans would therefore save many deaths and unnecessary suffering by many citizens. Equally important to mention is the fact that such a policy may be described as a win win policy both for the rich and the poor or middle class citizens because it would not in any way negatively affect the rich, because as long as they have money, they would still be able to customize their health care through the employment family or personal doctors as the poor and the middle class go for the universal health care services.

Balanced politics. “Should the Government Provide Free Universal Health Care for All Americans?” Balanced politics: universal health . Web. Balanced politics.org. 8 august https://www.balancedpolitics.org/universal_health_care.htm

Insurance specialists. “Growing Support for Universal Health Care”. Insurance information portal. Web. Insurance specialists.com 8 august 2011. https://insurancespecialists.com/

Niles, Nancy. Basics of the U.S. Health Care System . Sudbury, MA: Jones & Bartlett Learning, 2010:293. Print.

Shi, Leiyu and Singh, Douglas. Delivering Health Care in America: A Systems Approach . Sudbury, MA: Jones & Bartlett Learning, 2004:188. Print.

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IvyPanda. (2023, February 18). Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/

"Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." IvyPanda , 18 Feb. 2023, ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

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1. IvyPanda . "Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." February 18, 2023. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

Bibliography

IvyPanda . "Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." February 18, 2023. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

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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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Exploring what works, what doesn’t, and why.

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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The promise and peril of universal health care

David e. bloom.

1 Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA

Alexander Khoury

Ramnath subbaraman.

2 Center for Global Public Health and the Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA

Universal health care (UHC) is garnering growing support throughout the world, a reflection of social and economic progress and of the recognition that population health is both an indicator and an instrument of national development. Substantial human and financial resources will be required to achieve UHC in any of the various ways it has been conceived and defined. Progress toward achieving UHC will be aided by new technologies, a willingness to shift medical tasks from highly trained to appropriately well-trained personnel, a judicious balance between the quantity and quality of health care services, and resource allocation decisions that acknowledge the important role of public health interventions and nonmedical influences on population health.

The September 1978 Alma- Ata Declaration is a landmark event in the history of global health. The declaration raised awareness of “health for all” as a universal human right,whose fulfillment reduces human misery and suffering, advances equality, and safeguards human dignity. It also recognized economic and social development and international security as not only causes, but also consequences, of better health. In addition, it highlighted the power of primary health care and international cooperation to advance the protection and promotion of health in resource-constrained settings.

Building on the achievement of Alma-Ata and gaining further traction from the Millenium Development Goals and the Sustainable Development Goals set by the United Nations, universal health care (UHC) has emerged in recent years as a central imperative of the World Health Organization (WHO), the United Nations and most of its member states, and much of civil society. UHC characterizes national health systems in which all individuals can access quality health services without individual or familial financial hardship. More broadly, UHC covers social systems that provide medical and nonmedical services and infrastructure that are vital to promoting public health.

Although there are numerous articulations of the UHC agenda, the WHO and World Bank offer a relatively simple UHC service-coverage index that is useful for intercountry comparison. This index focuses on four categories of health indicators: reproductive, maternal, and child health; infectious disease control; noncommunicable diseases; and service capacity and access. Comparison of UHC index values for 129 countries reveals that country index scores are positively correlated with income per capita, though there is considerable variation in scores among countries with similar incomes. These variations presumably reflect differentials in income inequality, commitment to public health infrastructure, and the quality and reach of human resources for health. The WHO and World Bank also offer multiple measures of health spending–related financial hardship in assessing UHC, which do not increase monotonically with increasing income, health spending per capita, or coverage of health services. Rather, catastrophic health expenditures tend to be lower in countries that channel health spending through public social security or insurance programs, rather than private insurance schemes.

Bangkok, Thailand. A nurse keeps records of a blood donor at the Thai National Blood Centre on 14 June 2017.

The financial cost of massively expanding access to health care globally is a formidable barrier to achieving UHC. For example, the Disease Control Priorities Network estimates that low- and lower-middle-income countries would, on average, need to raise their respective annual per capita health expenditures by U.S.$53 and U.S.$61 per person to achieve coveragewith the essential UHC package of 218 core interventions, a sizable burden in relation to average expenditure increases in recent years. Wealthy industrial countries are much further along the path to achieving UHC, though they also face challenges involving rising costs of new health care technologies and the growing share of their populations at the older (and more health care–intensive) ages.

Technically and economically efficient approaches to the achievement of UHC may include the use of electronic medical records, telemedicine systems, digital monitors for drug adherence, and clinical decision–support applications; expansion of the quantity and quality of human resources for health at the physician, nurse, and community health worker levels; improvements in inventory systems and supply chains for the delivery of vaccines, drugs, diagnostics, and medical devices; screening for risk factors and early signs of disease; and focusing on the often neglected domains of surgical care, reproductive health, and mental health. Also key will be efforts to ensure universal access to proven public health interventions that address social and environmental determinants of health, such as health education campaigns; access to safe water; regulation of excessive sugar and salt in the food supply; control of tobacco and the unsafe consumption of alcohol; road traffic safety; walkable city designs; expanding enrollment in high-quality primary and secondary schools; and more equitable distributions of income and wealth.

Achieving UHC is an ambitious aspiration and a powerful indicator of human progress. Fortunately, it may be expected to deliver myriad health, economic, and social welfare benefits along the way, helping to mobilize the substantial political and financial resources needed for its continued future expansion.

Universal health care (UHC) characterizes national health systems wherein all individuals can access quality health services without individual or familial financial hard ship. More broadly, UHC covers social systems that provide medical and nonmedical services and infrastructure that are vital to promoting public health.

ThenotionofUHCdates toOtto vonBismarck, who established the world’s first national social health insurance system in Germany in 1883 ( 1 ). More recently, the September 1978 Alma-Ata Declaration raised global awareness of “health for all” as a universal human right and of the power of primary health care to advance its achievement ( 2 ). During the 20th century, many industrialized countries extended UHC to their citizens. Although progress in expanding UHC slowed in the 1980s—mainly because of economic slowdowns, fiscal stress, and structural adjustment programs—achieving UHC in all countries is currently among the central imperatives of the World Health Organization (WHO), the United Nations (UN) and most of its member states, and much of civil society.

As the Alma-AtaDeclaration’s 40th anniversary approaches, we examine the rationale, progress, consequences, and prospects for achieving UHC globally. We first explore the rationale for UHC, the scope of what UHC encompasses, and its operational definitions at the international level. We then report statistics on current measures of UHC attainment, highlighting patterns by country income level. We go on to review evidence on three key premises of UHC: that it promotes longer, healthier lives; that it does so efficiently; and that it confers social, economic, and political benefits above and beyond the utilitarian value of living healthier lives. Finally, we discuss prospects for further expansion of UHC.

We argue that UHC has considerable potential to improve the trajectory of human progress. To achieve UHC, however, governments and the public health community will have to mobilize substantial human, financial, and technological resources and avoid pitfalls in implementation.

Rationale and scope

Four sets of arguments are commonly advanced in support of UHC. The first set appeals to ethics and morality and the notion that safeguarding everyone’s physical and mental health is just, fair, and consistent with principles of right conduct and distributive justice. The second argument, rooted in international law, relates to the acceptance of health as a fundamental human right ( 3 ). The third set of arguments is pragmatic, relating to the observation that healthy populations tend to be more socially cohesive and politically stable. The final set of arguments is economic in nature: UHC corrects health-related market failures, such as those related to the social benefits of disease prevention among individuals, and good health may promote economic well-being not just among healthy individuals but also at the macroeconomic level ( 4 ). These economic arguments are bolstered by evidence that committing resources to health care is associated with a high return on investment, rivaling, or even surpassing, other high-return investments like those in primary and secondary education ( 5 – 8 ).

Although there is a strong rationale for the possible benefits of UHC, there are also numerous challenges to its realization. A central challenge preceding any realization of UHC is defining its scope and boundaries. Although precise definitions of UHC vary widely among sources, the WHO’s definition is a typical formulation of the concept as a system in which “all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care” ( 9 ).

This definition highlights many of the ambiguities involved in conceptualizing UHC. What levels of reduced mortality risk, increases to quality of living, or other thresholds must be crossed before a health service is considered needed or essential? Should financial hardship be defined by the amount of money spent relative to income, the amount of income that households retain after health spending, or some other criteria? Should these criteria shift or remain constant across settings? Given this definition’s emphasis on health services, does UHC also imply a commitment to addressing social and environmental health determinants beyond the traditional purview of health service delivery?

As discussed below, the answer to this last question may have considerable implications for UHC’s effectiveness in improving health outcomes. It is widely accepted that most health outcomes are associated with social and environmental factors, including wealth, income inequality, discrimination, education, occupation, diet, substance use, violence and conflict, air pollution, and water and sanitation access ( 10 , 11 ). Addressing these factors is central to emerging public health agendas such as One Health (which views human, animal, and environmental health holistically) and Planetary Health (which focuses on the economic and social systems that shape human and environmental health). Deficiencies in the availability and quality of medical services are important but, nonetheless, contribute less to premature mortality than these nonmedical determinants ( 11 ). But even though UHC definitions that address nonmedical health determinants have greater potential to improve health outcomes, operationalizing a UHC agenda that addresses these determinants would require wide-ranging interventions in sectors outside of health care, which may be more politically, socially, and technically challenging.

Given the ambiguities in defining UHC, there are several possible approaches to put the concept into practice. These approaches vary according to intended use, such asmaking comparisons across countries, tracking progress over time, or delineating a roadmap for achieving UHC. The WHO and World Bank offer a relatively simple UHC service-coverage index (hereafter, “the WHO– World Bank index”), which is useful for intercountry comparisons. They define this index in terms of 16 indicators, grouped into four categories: reproductive, maternal, newborn, and child health; infectious-disease control; noncommunicable diseases; and service capacity and access ( 9 ).

This relatively small number of indicators allows 129 countries to be included in the UHC service-coverage index. The indicators are meant to serve as a proxy for the overall coverage of the health care system, which should ideally provide many more health services than those represented.

However, although measurement of a handful of tracer conditions and services has often been used as a proxy for overall health system quality, many public health experts have concerns that only indicators that get measured actually get implemented in practice. In addition, the health services included in the index are fairly basic—in terms of the medical conditions covered, skill levels required by health care personnel, and technological capacity required—limiting this metric’s value for comparing high income countries with well-funded health systems. Some of the indicators, such as access to insecticide-treated bed nets for malaria prevention, have minimal relevance in most high-income countries. In addition, these indicators do not comprehensively capture many of the high burden diseases that could be successfully addressed with health services in high income countries, such as treatment for most types of cancer.

The WHO and World Bank also describe multiple approaches for measuring health spending–related financial hardship in assessing UHC. They suggest two thresholds for annual health spending— equal to 10 and 25% of total household expenditures—as alternative metrics for routinely measuring catastrophic health spending, which refers to out-of-pocket expenses exceeding a household’s ability to pay without imposing considerable financial hardship. Two additional metrics aim to more directly assess impoverishment resulting from health expenditures, by measuring the percentage of households whose average daily non health consumption expenditures would have placed its members above the U.S.$1.90 and U.S. $3.20 per capita poverty lines but for the household’s spending on healthcare ( 12 ). Given the very low thresholds for impoverishing health expenditures, these metrics are primarily relevant in low and middle-income countries (LMICs).

More comprehensive UHC priority descriptions exist. For example, the Disease Control Priorities (DCP) Network has compiled 218 distinct cost-effective interventions, which they argue should form a standard of essential services for LMICs because they address a substantial burden of disease. Unlike the indicators in the WHO– World Bank index, more than one-third of the DCP Network’s essential interventions—including tobacco taxes, air pollution reduction, and road safety improvements—focus on broader social or environmental determinants and would require non–health care sector involvement. ( 13 ). A subset of 108 interventions, termed the highest-priority package, avert death or disability while also scoring highly on a financial risk protection index. Comprehensive data are not available on population coverage for many interventions included in the DCP Network’s UHC package, limiting its use in making comparisons among countries. Measurement and inclusion of many of these evidence-based services should be considered in future iterations of the global UHC agenda. coverage increase with rising income levels ( 14 ), it is also likely that the higher country incomes are, at least in part, the result of better health care coverage and health ( 4 ). Disparities in UHC service coverage by income level are even more apparent when looking at groups of countries together: The average service-coverage score for low-income countries is roughly half that of high income countries ( Table 1 ). Sub-Saharan Africa and South Asia feature the lowest index scores, whereas the Latin American and Caribbean and the East Asia and Pacific regions have index scores comparable to those in North America and in Europe and Central Asia.

Population, income, health expenditure, and UHC index score by income group and geographic region . Figures are weighted according to population size. Source: World Bank (2018) ( 15 ), with UHC service-coverage index scores and catastrophic health expenditure data from World Bank (2017) ( 9 ). All data are for 2016, except for the health expenditure data, which are for 2015, and the catastrophic health spending data, which are for 2010.

Also notable are the instances of similar income countries having highly disparate index scores. For example, Nigeria and Vietnam both have per capita GDPs around U.S.$2200, but Vietnam’s UHC index score is 34 points higher than Nigeria’s. This reflects the fact that Vietnam outperforms Nigeria on several indicators, including reported rates of three-dose diphtheriatetanus- pertussis infant vaccination coverage (94 versus 42%), births attended by skilled professionals (94 versus 35%), and households with access to basic sanitation (78 versus 32%). Dissimilar income distributions in the two countries offer a plausible partial explanation for the coverage discrepancies. An estimated 78% of Nigeria’s population lives on less than U.S.$3.20 per day in 2017 dollars, compared with only 32% of Vietnam’s population ( 15 , 16 ). Poverty imposes constraints on accessing health services, particularly in LMICs ( 17 ). Furthermore, less-comprehensive health service coverage reinforces poverty by failing to protect individuals from illnesses that have high treatment costs or that limit their ability to work or learn ( 18 ).

Unlike the association between UHC service coverage and GDP per capita ( Fig. 1 ), protection from catastrophic health expenditures is not clearly correlated with GDP per capita. In aggregate, middle-income countries have higher rates of catastrophic health expenditures than low- and high-income countries ( Table 1 ). However, the variation in catastrophic expenditure rates within these income groups is greater than the variation among them. Furthermore, protection from catastrophic health expenditures does not systematically improve with increasing UHC service-coverage index score or with increasing percentage of GDP spent on health care ( 19 ). Thus, protection from health care–related financial ruin does not directly follow from GDP growth, improved essential health service coverage, or increased total health care spending. Rather, catastrophic health expenditures may be associated with the pathways through which health care spending occurs. Countries in which much of health spending is prepaid through public social security or insurance programs tend to have lower catastrophic health expenditure rates than countries that mostly rely on private insurance schemes ( 19 ).

WHO–World Bank UHC index score versus the natural logarithm of GDP per capita. The plot captures absolute changes in UHC index scores (maximum of 80) relative to percentage changes in GDP per capita. Source: UHC index scores from World Bank (2017) ( 9 ) and GDP per capita from World Bank (2018) ( 15 ). R 2 , coefficient of determination.

Even among countries attaining the maximum UHC index score of 80, there is substantial heterogeneity in health outcomes, health spending, and the proportion of the population protected from catastrophic health spending. Comparing the UHC records of two high-income countries with perfect index scores, the United States and Japan, illustrates these disparities.

The United States is the only high-income country that does not explicitly provide UHC for its citizens, although its relative expenditures on health care—15% of GDP in 2008 and 17% of GDP in 2017—are much higher than those of any other Organisation for Economic Cooperation and Development country ( 20 ). Unlike the United States, Japan expanded health insurance coverage to its entire population in 1961. This change coincided with a massive improvement in the health of Japan’s population, which, by 1983, had the highest life expectancy of any country (and also now, at 84 years) ( 15 ). Japan’s health system has been lauded for its role in promoting a world-leading level of population health and for maintaining relatively low health care costs historically. However, these health expenditures have risen from 8% of GDP in 2008 to 11% in 2017 ( ), and the Japanese health care system must adapt to a continually increasing elder share of the population while constrained by an economy that has performed relatively poorly since the 1990s.

Consequences of expanding UHC

The premise that UHC could lead to longer, healthier lives has a strong underlying rationale. For most indicators in the WHO–World Bank index, achieving high coverage could benefit individuals through reduced disability, increased longevity, improved nutritional status, increased economic productivity, or decreased health-related financial hardship ( Table 2 ).

UHC essential services as defined by the WHO and World Bank and the rationale for their impact on health and social outcomes.

Increased coverage of services can also have a population-level health impact, especially for leading infectious causes of death, such as tuberculosis (TB), HIV/AIDS, and malaria. For these diseases, early treatment of affected individuals can terminate the chain of transmission, thereby reducing disease incidence. For example, over a 7-year time period, HIV-uninfected individuals living in areas with high antiretroviral therapy coverage in Kwa Zulu Natal, South Africa, were 38% less likely to acquire HIV than those in areas with low coverage ( 21 ). Similarly, in China during the 1990s, TB prevalence declined only in provinces where the directly observed therapy short-course (DOTS) strategy—which involves provision of free or subsidized TB testing and treatment—was rolled out with high coverage ( 22 ).

Similarly, expanding vaccine coverage through the UHC agenda—especially for leading causes of child mortality such as Streptococcus pneumoniae, Haemophilus influenzae, and rotavirus—would have a population-level health impact in a highly cost-effective manner. The full societal benefits of disease prevention through vaccination include increased schooling and labor productivity, slowing of the pace at which antimicrobial resistance develops, and reductions in health and economic risk, all magnified by the value of improved health outcomes among non vaccinated community members owing to herd effects ( 23 ).

Regarding the potential impacts of UHC on both health and financial hardship, some compelling evidence is found in the Oregon Health Insurance Experiment ( 24 ). In 2008, the U.S. state of Oregon randomly selected about 30,000 individuals to be eligible to apply for Medicaid from among the roughly 90,000 who had expressed interest in applying to the newly expanded program providing low-cost health coverage for low-income adults. Through comparisons of individuals who were not selected to those who applied and were accepted, researchers found that receiving Medicaid virtually eliminated catastrophic medical spending, reduced medical debt, increased use of preventive medical care, reduced depressive symptoms, and improved subjective perception of overall health status. Measures of physical health—including control of high blood pressure, high cholesterol, and diabetes—did not significantly improve among individuals who received Medicaid; however, the 2-year follow-up time for individuals may have been too short to detect meaningful improvements in these outcome indicators.

Other literature on the impact of increased coverage and density of primary care and hospital based services on health outcomes is generally of weaker quality. Nevertheless, examples from Costa Rica and Cuba suggest a strong association between the universal expansion of public sector primary care services and rapid reductions in child and adult mortality and increases in life expectancy ( 25 , 26 ). In addition, a systematic review highlights the consistency, across a variety of LMIC contexts, of the positive association between large-scale primary care initiatives and lower child mortality ( 27 ). In other LMIC settings, increased hospital access is associated with reduced maternal mortality ( 28 ). In high-income countries, a higher density of primary care providers is associated with lower all-cause mortality ( 29 ).

Beyond improving health, expanding UHC could potentially promote economic well-being, reduce economic inequalities, and bolster social and political stability ( 5 , 30 ). Improving population health could accelerate economic growth by improving labor productivity, school attendance, educational attainment, cognitive function, capital accumulation, and fertility control ( 31 , 32 ). Rigorous microeconomic evidence supports the impact of health improvements on individual or House hold economic circumstances. Interventions with demonstrated effects on education and earnings include iodine supplementation ( 33 ), iron supplementation ( 34 ), deworming ( 35 , 36 ), and malaria eradication campaigns ( 37 ). These benefits may also have an appreciable macroeconomic impact ( 38 ): On average, a 10-year life expectancy gain is associated with up to a 1% increase in annual income per capita growth ( 5 ).

The impact of better health on economic growth may be particularly powerful in LMICs, where children, adolescents, and prime-age adults are the chief beneficiaries of health gains, leading to improvements in productivity across the life course ( 37 ). Ensuring access to basic health care, especially for the prevention and treatment of infectious diseases, may be essential for escaping poverty traps in settings where extreme poverty has historically been persistent ( 39 , 40 ). But benefits of health on economic growth are also manifest in high-income countries, where gains in longevity tend to accrue disproportionately to older adults. The social and economic value resulting from these gains in longevity for older adults may not be well represented in national GDP because the value created is often related to the enabling effect of health on nonmarket activities such as child-rearing, caretaking of other individuals, and community volunteer work ( 41 ).

Expanding UHC also reduces health disparities because poor members of society are less likely to receive adequate health care than wealthier individuals where UHC systems are lacking. Increased access to primary care is associated with reduced wealth- and race-based mortality disparities in both LMICs ( 27 ) and high-income countries ( 29 ). As noted, decreasing health inequality may also reduce income, wealth, and education disparities. As with investments in education, expansion of health care coverage is one of the rare policies that simultaneously promotes equitable distribution of income while also increasing economic growth ( 6 , 42 ). Reducing disparities through improved public health and social welfare systems may help to minimize the risk of political and social instability, though empirical evidence of this association is not especially robust ( 43 ). Through these various pathways, UHC serves important functions that support a healthy, prosperous, and cohesive society.

Although the potential benefits of UHC are numerous, possible pitfalls in implementation could undermine its impact and prevent UHC from fulfilling its promise. Rapid scale-up of UHC without sufficient concern for the quality of implementation could have unintended adverse consequences, as delivery of health services will not be effective in improving health outcomes if the delivered care is not of reasonable quality. Deficiencies in quality of care such as medical errors, spread of infection in health care settings, and poor retention of patients across sequential steps of care (also known as the cascade of care) could undermine the benefits of expanded service coverage. Even though existing UHC frameworks allude to this problem, quality-related indicators can be hard to measure, and achieving high quality of care will be especially challenging with large-scale expansion of coverage ( 44 ).

The recent history of TB care delivery illustrates limitations of focusing on coverage of health services without ensuring that the services offered are of sufficient quality to be effective. In 1991, the World Health Assembly adopted the DOTS strategy, which included comprehensive coverage of free or subsidized TB testing and treatment as a key objective. Over the next two decades, high-burden countries such as India and China achieved high DOTS coverage nationally, leading to reductions in disease prevalence or TB-related mortality ( 22 , 45 ). However, despite high global DOTS coverage, TB incidence is declining slowly (<1.5% per year); the disease remains the leading infectious cause of death, resulting in nearly 1.7 million deaths annually, one-third of which occur in India. Poor quality of care may in part explain these disappointing public health outcomes ( 46 ). For example, in India, considerable numbers of patients are lost across sequential steps of the care cascade; as a result, only about 39% of prevalent TB patients were estimated to have achieved an optimal outcome in the government program in 2013 ( Fig. 2 ) ( 47 ). Similarly, in Rwanda, improved rates of maternal institutional delivery have not translated into reductions in newborn mortality, likely owing to gaps in care quality ( 48 ).

Cascade of care for patients with any form of TB in India in 2013. Patient losses at each stage of care represent shortcomings in quality of care that undermine the effectiveness of TB services, despite a high level of population coverage. Source: Subbaraman et al. ( 47 ).

As these examples suggest, poorly functioning health systems are a central challenge to realizing the benefits of UHC. Health systems in LMICs commonly suffer from a variety of weaknesses, including absenteeism and insufficient training among health care workers, mistreatment of patients by health care workers, corruption, poorly functioning inventory systems and supply chains, electricity cuts and outages, and lack of clean water. These shortcomings in health care delivery often reflect higher-level problems in governance and market failures. Achieving UHC will therefore require innovations in the structure and operation of health systems to ensure that rapid expansion in coverage is not undermined by shortcomings in delivery and quality of care.

With regard to the scope of UHC, it is entirely appropriate for countries to prioritize different health interventions in their UHC agendas to address local needs and constraints. It is also reasonable to expect the number of health services considered essential in each setting to undergo progressive expansion over time to reflect changing resource availability and to address new or emerging health concerns. For example, the WHO–World Bank index—perhaps the most prominent articulation of the UHC agenda— mostly focuses on health service coverage for conditions that have been long-standing global health priorities, such as maternal health, HIV, and TB. The index does not emphasize measurement of service coverage for other conditions that contribute substantially to the global burden of disability or death, such as depression and anxiety (the leading causes of disability globally) and conditions that require basic surgical care (inaccessible to about 5 billion people) ( 49 , 50 ).

In addition, the WHO–World Bank index includes a measure of access to essential medicines but does not cover access to essential diagnostic tests, which are crucial to address population level threats to health, such as antimicrobial resistance ( 51 ). Rising rates of antimicrobial resistance could be a major unintended consequence of UHC if increasing health care coverage does not go hand-in-hand with expanded access to diagnostic tests that facilitate judicious use of antibiotics. As suggested by these examples, if countries adhere to an overly narrow set of UHC priorities, they could miss out on opportunities to address conditions for which there is a dearth of health care providers and institutional capacity in LMICs.

The relatively limited inclusion of measures of nonmedical health determinants in most UHC frameworks represents another, more fundamental, limitation in scope. The WHO–World Bank index focuses on assessing delivery of medical services, with the exception of access to adequate sanitation and insecticide-treated bed nets. The UHC scope thus defined largely avoids the question of ensuring universal access to many public health interventions that could lead to healthier lives—including health education campaigns, in-home piped water supplies, regulation of excessive sugar and salt in the food supply, tobacco control, road traffic safety, construction of walkable cities, high quality primary and secondary education, and equitable distribution of wealth.

Two examples illustrate the limitations of a UHC approach that avoids addressing underlying nonmedical health determinants. In the United States, the dramatic rise in mortality among middle-aged white people in recent years occurred during a time of increasing health insurance coverage in the general population. These “deaths of despair”—largely attributable to mortality from substance use, suicide, and injuries—are thought to be driven by social determinants, such as lack of employment opportunities for blue-collar workers and increasing wealth inequality ( 52 ).

Another example is stunting owing to chronic child undernutrition, which is associated with poor health outcomes, cognitive development, and educational attainment. Most factors that contribute to stunting—poverty, lack of maternal education, poor maternal nutrition, lack of dietary diversity, and lack of sanitation—reflect failures to address nonmedical health determinants ( 53 , 54 ). In India, which accounts for 40% of the world’s stunted children, social inequalities such as gender and caste discrimination drive deficiencies in maternal education and sanitation access, thereby impeding progress in reducing stunting ( 53 , 54 ). As these examples suggest, UHC that narrowly focuses on health service delivery alone is necessary, but insufficient, to bring about wide-ranging health and social benefits. UHC will be implemented within the wider context of the Sustainable Development Goals (SDG) set by the UN, which includes targets related to some of these nonmedical determinants; however, embedding these SDG targets within a UHC-related public health framework could shape the approach and intensity with which these targets are achieved.

The financial cost of massively expanding access to health care globally is a formidable barrier to achieving UHC. The cost of attaining UHC partly hinges on a population’s existing health, which is influenced by factors such as age structure, levels of physical activity, pollution, water and sanita sanitation infrastructure, vaccination coverage, and diet. Using their broad operationalization of UHC described above, the DCP et work estimates that low- and lower-middle-income countries would, on average, need to raise their respective annual per capita health expenditures by U.S.$26 and U.S.$31 per person to achieve coverage with the highest priority package (108 core interventions); achieving coverage with the essential UHC package (218 core interventions) would require an annual spending increase of U.S.$53 and U.S.$61 per person on average ( 13 ).

However, the authors caution that achievement of even the essential UHC package would not be sufficient to reach the SDG target of reducing deaths of individuals less than 70 year sold by 40% by 2030. Achieving the highest-priority and essential UHC package would accomplish around half and two-thirds of this goal, respectively ( 13 ). Presumably, covering the essential health services in the WHO–World Bank index would require lower per capita health expenditure but would be expected to fall even shorter in reaching the SDG targets

As Table 3 shows, the health expenditure growth needed to achieve essential UHC in LMICs by 2030 is comparable to the rate of health spending increases that these countries experienced in recent years. However, these raw estimates of recent growth in health spending could paint an overly optimistic picture. A recent study from the Global Burden of Disease Health Financing Collaborator Network uses data from a similar period (1995–2015) and an ensemble of models that include covariates associated with GDP and health expenditure growth (such as fertility rates and mean years of education) to project health expenditure growth through 2030 ( 55 ). The Network projects that the difference between the number of individuals covered by UHC in the “worst-case” and “best-case” health financing scenarios would be about 871 million people ( 55 ).

Health expenditures needed to attain the highest-priority package (HPP) and essential UHC (EUHC) package by income. Source: Watkins et al. (2017) ( 13 ), with public health expenditure data and average growth (2000–2015) calculated from WHO (2018) ( 15 ).

Given the sizable expenditure increases necessary to achieve UHC, rolling out UHC programsin stages will be necessary. The Lancet Commission on Investing in Health advocates a “progressive universalist” approach to funding these efforts, whereby selected health services are offered broadly and affordably to all citizens by the government, even if this necessitates offeringa smaller package of interventions. The authors argue that this approach is more efficient and equitable than a system that covers more interventions but necessitates higher out-of-pocket expenditures or restricts coverage to fewer individuals ( 56 ).

In light of expected health expenditure increases required to achieve UHC, physicians and public health practitioners may have to radically rethink strategies for health care delivery to simultaneously improve efficiency and health outcomes. For example, lack of trained health care personnel, especially in LMICs, is arguably the most serious hurdle to scaling up UHC ( 57 ). In many countries—such as India, Bangladesh, and Uganda—most health care personnel are informal providers who lack formal medical training ( 58 ). Informal providers are often assumed to deliver low-quality care; however, a recent randomized trial found that intensive training sessions with these providers can improve the quality of care that they deliver to a level that is, in some cases, on par with formal providers ( 59 ). Careful and constructive engagement with these informal providers may therefore be one strategy for bridging the substantial health care workforce gaps that threaten to undermine progress toward UHC in LMICs. Stemming outmigration of physicians from LMICs through bonding schemes (such as conditional scholarships) or enforcement of ethical recruitment policies in high-income countries may also help to reduce health care worker shortages ( 60 ).

Programs to recruit and train community health workers (CHWs) offer another, more widely accepted, strategy for expanding the health care workforce and increasing the coverage and effectiveness of primary health care. Growing evidence suggests that these programs can contribute to improved outcomes in child nutrition, maternal health, HIV, and TB ( 61 ). Moreover, CHW programs could potentially expand the reach of health care provision to the household level. This would be especially beneficial in the context of a rapidly increasing global burden of chronic disease. Primary and secondary prevention of chronic diseases requires early screening for risk factors and lifelong treatment of those risks (e.g., medications for hypertension), and many chronic diseases and risk factors cluster within households ( 62 ). CHWs may also have an important role in tracking newborns at the household level from the first to the last vaccination during infancy. By extending screening, monitoring, and treatment of medical conditions to the household level, CHW programs could have substantial effects on preventing disease, increasing rates of health screening, and improving treatment outcomes, thus improving UHC coverage, efficiency, and impact.

Integrating innovative technologies into health systems—including electronic medical records, clinical decision–support applications, telemedicine, digital medication-adherence technologies, and point-of-care diagnostic tests—could also facilitate UHC by improving the reach, timeliness, efficiency, and quality of clinical care and public health monitoring. These technologies could improve the quality and coverage of longitudinal clinical records, facilitate health care providers’ use of evidence-based clinical care algorithms, extend access to specialized medical knowledge to rural communities, reduce time delays for diagnosis and treatment, and enable real-time monitoring of medication adherence. Artificial intelligence and machine learning have the potential to perform some tasks—such as interpreting x-rays, electrocardiograms, and electroencephalograms— that currently require highly trained and specialized health care workers.

Technological innovations will not obviate the need to dramatically increase the health care workforce in LMICs, but they could still prove to be game changers as the global community tries to rapidly scale up health service delivery to achieve UHC. The ambitious scope of the UHC agendamay provoke physicians and public health experts to reimagine how to deliver health services. New frontline health care personnel (such as CHWs and nonhealth professionals receiving appropriate training) and innovative technologies could help to move care provision into nontraditional spaces, such as homes or workplaces, extending the existing health system’s effective reach.

The bottom line

Four decades after the Alma-Ata Declaration articulated primary care for all as being a most important worldwide social goal, the global community is striving to achieve UHC with renewed interest and ambition. A central motivation of the UHC agenda is the belief that access to health care—with the goals of extending longevity, minimizing disability, and diminishing suffering—is a fundamental human right that advances equality and safeguards human dignity. Achieving UHC would represent one of the most ambitious ventures in the area of human rights, even if UHC were defined narrowly as universal delivery of essential health services. In addition, evidence suggests that well-implemented universal coverage of essential health services could improve welfare more broadly, by reducing economic inequalities, promoting economic well-being, and, perhaps, improving social and political stability.

A broader UHC conception that aims to also address the nonmedical determinants that most strongly shape human health would have even greater implications for society and would require broader social transformations. Addressing cross-cutting social and environmental determinants that contribute to ill health—such as wealth inequality; race, gender, and caste discrimination; air pollution; and lack of water and sanitation facilities—could lead the UHC agenda to intersect more closely with the human rights, One Health, and Planetary Health agendas in the coming decades.

Numerous potential pitfalls could impede UHC expansion or undermine its positive impact on health and well-being. Most challenging, perhaps, is the need to increase health financing rapidly enough to facilitate universal coverage of essential health services among LMIC populations that are simultaneously growing in size and aging. For example, for the world’s less-developed regions, an increase of roughly 1 billion people isprojected from 2018 through 2030, with the percentage aged 60 years or older projected to increase from 10.6 to 14.2%( 63 ). In addition, a UHC agenda that fails to address social determinants of health could limit its impact on health outcomes. Finally, focusing too much on coverage alone, rather than on ensuring the quality of health services, ould undermine UHC effectiveness. Addressing these challenges may require radical transformations in the way that health services are delivered, potentially by expanding the use of frontline health personnel and incorporating innovative technologies into care delivery.

Ultimately, the path to UHC and the interventions prioritized in this process will be unique to each country pursuing universal coverage. Although achieving full UHC is a daunting task, incremental steps toward fulfilling this goal also offer myriad health, economic, and social welfare benefits. cognizing these benefits should help mobilize the resources needed for continued future expansion of UHC.

ACKNOWLEDGMENTS

We are grateful for feedback from K. Prettner, T. Bärnighausen, R. Steinglass, D. Cadarette, R. Glass, M. A. Pate, and two anonymous reviewers.

Research by D.E.B. reported in this manuscript was supported by the National Institute on Aging of the National Institutes of Health under award number P30AG024409. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. D.E.B.’s research on this manuscript was also made possible by a grant fromthe Carnegie Corporation of New York. R.S. acknowledges support from a grant from the Bill and Melinda Gates Foundation via the Arcady Group (OPP1154665) and a Doris Duke Clinical Scientist Development Award. This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ . This license does not apply to figures/photos/artwork or other content included in the article that is credited to a third party; obtain authorization from the rights holder before using such material.

Competing interests

D.E.B. has been in receipt of grants, travel grants, and/or personal fees from Merck, Pfizer, GSK, Sanofi Pasteur, and Sanofi Pasteur–MSD (all related to his research on the value of vaccination) and Gilead Life Sciences (related to his work on the value of treatment for hepatitis C in India). The authors declare no other competing interests.

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• Universal Health Care

The Importance of Universal Health Care in Improving Our Nation’s Response to Pandemics and Health Disparities

• Policy Statements and Advocacy
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• Proposed Policy Statements
• Date: Oct 24 2020
• Policy Number: LB20-06

Key Words: Health Insurance, Health Care, Health Equity

Abstract The COVID pandemic adds a new sense of urgency to establish a universal health care system in the United States. Our current system is inequitable, does not adequately cover vulnerable groups, is cost prohibitive, and lacks the flexibility to respond to periods of economic and health downturns. During economic declines, our employer-supported insurance system results in millions of Americans losing access to care. While the Affordable Care Act significantly increased Americans’ coverage, it remains expensive and is under constant legal threat, making it an unreliable conduit of care. Relying on Medicaid as a safety net is untenable because, although enrollment has increased, states are making significant Medicaid cuts to balance budgets. During the COVID-19 pandemic, countries with universal health care leveraged their systems to mobilize resources and ensure testing and care for their residents. In addition, research shows that expanding health coverage decreases health disparities and supports vulnerable populations’ access to care. This policy statement advocates for universal health care as adopted by the United Nations General Assembly in October 2019. The statement promotes the overall goal of achieving a system that cares for everyone. It refrains from supporting one particular system, as the substantial topic of payment models deserves singular attention and is beyond the present scope.

Relationship to Existing APHA Policy Statements We propose that this statement replace APHA Policy Statement 20007 (Support for a New Campaign for Universal Health Care), which is set to be archived in 2020. The following policy statements support the purpose of this statement by advocating for health reform:

• APHA Policy Statement Statement 200911: Public Health’s Critical Role in Health Reform in the United States
• APHA Policy Statement 201415: Support for Social Determinants of Behavioral Health and Pathways for Integrated and Better Public Health

In addition, this statement is consistent with the following APHA policies that reference public health’s role in disaster response:

• APHA Policy Statement 20198: Public Health Support for Long-Term Responses in High-Impact, Postdisaster Settings
• APHA Policy Statement 6211(PP): The Role of State and Local Health Departments in Planning for Community Health Emergencies
• APHA Policy Statement 9116: Health Professionals and Disaster Preparedness
• APHA Policy Statement 20069: Response to Disasters: Protection of Rescue and Recovery Workers, Volunteers, and Residents Responding to Disasters

Problem Statement Discussions around universal health care in the United States started in the 1910s and have resurfaced periodically.[1] President Franklin D. Roosevelt attempted twice in the 1940s to establish universal health care and failed both times.[1] Eventually, the U.S. Congress passed Medicare and Medicaid in the 1960s. Universal health care more recently gained attention during debates on and eventual passage of the Affordable Care Act (ACA).[2]

To date, the U.S. government remains the largest payer of health care in the United States, covering nearly 90 million Americans through Medicare, Medicaid, TRICARE, and the Children’s Health Insurance Program (CHIP).[3] However, this coverage is not universal, and many Americans were uninsured[4] or underinsured[5] before the COVID-19 pandemic.

The COVID-19 pandemic has exacerbated underlying issues in our current health care system and highlighted the urgent need for universal health care for all Americans.

Health care is inaccessible for many individuals in the United States: For many Americans, accessing health care is cost prohibitive.[6] Coverage under employer-based insurance is vulnerable to fluctuations in the economy. Due to the COVID-19 pandemic, an estimated 10 million Americans may lose their employer-sponsored health insurance by December 2020 as a result of job loss.[7] When uninsured or underinsured people refrain from seeking care secondary to cost issues, this leads to delayed diagnosis and treatment, promotes the spread of COVID-19, and may increase overall health care system costs.

The ACA reformed health care by, for instance, eliminating exclusions for preexisting conditions, requiring coverage of 10 standardized essential health care services, capping out-of-pocket expenses, and significantly increasing the number of insured Americans. However, many benefits remain uncovered, and out-of-pocket costs can vary considerably. For example, an ACA average deductible ($3,064) is twice the rate of a private health plan ($1,478).[4] Those living with a disability or chronic illness are likely to use more health services and pay more. A recent survey conducted during the COVID-19 pandemic revealed that 38.2% of working adults and 59.6% of adults receiving unemployment benefits from the Coronavirus Aid, Relief, and Economic Security (CARES) Act could not afford a $400 expense, highlighting that the COVID-19 pandemic has exacerbated lack of access to health care because of high out-of-pocket expenses.[8] In addition, the ACA did not cover optometry or dental services for adults, thereby inhibiting access to care even among the insured population.[9]

Our current health care system cannot adequately respond to the pandemic and supply the care it demands: As in other economic downturns wherein people lost their employer-based insurance, more people enrolled in Medicaid during the pandemic. States’ efforts to cover their population, such as expanding eligibility, allowing self-attestation of eligibility criteria, and simplifying the application process, also increased Medicaid enrollment numbers.[10] The federal “maintenance of eligibility” requirements further increased the number of people on Medicaid by postponing eligibility redeterminations. While resuming eligibility redeterminations will cause some to lose coverage, many will remain eligible because their incomes continue to fall below Medicaid income thresholds.[10]

An urgent need for coverage during the pandemic exists. Virginia’s enrollment has increased by 20% since March 2020. In Arizona, 78,000 people enrolled in Medicaid and CHIP in 2 months.[11] In New Mexico, where 42% of the population was already enrolled in Medicaid, 10,000 more people signed up in the first 2 weeks of April than expected before the pandemic.[11] Nearly 17 million people who lost their jobs during the pandemic could be eligible for Medicaid by January 2021.[12]

While increasing Medicaid enrollment can cover individuals who otherwise cannot afford care, it further strains state budgets.[11] Medicaid spending represents a significant portion of states’ budgets, making it a prime target for cuts. Ohio announced $210 million in cuts to Medicaid, a significant part of Colorado’s $229 million in spending cuts came from Medicaid, Alaska cut $31 million in Medicaid, and Georgia anticipates 14% reductions overall.[11]

While Congress has authorized a 6.2% increase in federal Medicaid matching, this increase is set to expire at the end of the public health emergency declaration (currently set for October 23, 2020)[13] and is unlikely to sufficiently make up the gap caused by increased spending and decreased revenue.[14] Given the severity and projected longevity of the pandemic’s economic consequences, many people will remain enrolled in Medicaid throughout state and federal funding cuts. This piecemeal funding strategy is unsustainable and will strain Medicaid, making accessibility even more difficult for patients.

Our health care system is inequitable: Racial disparities are embedded in our health care system and lead to worse COVID-19 health outcomes in minority groups. The first federal health care program, the medical division of the Freedmen’s Bureau, was established arguably out of Congress’s desire for newly emancipated slaves to return to working plantations in the midst of a smallpox outbreak in their community rather than out of concern for their well-being.[15] An effort in 1945 to expand the nation’s health care system actually reinforced segregation of hospitals.[15] Moreover, similar to today, health insurance was employer based, making it difficult for Black Americans to obtain.

Although the 1964 Civil Rights Act outlawed segregation of health care facilities receiving federal funding and the 2010 ACA significantly benefited people of color, racial and sexual minority disparities persist today in our health care system. For example, under a distribution formula set by the U.S. Department of Health and Human Services (DHHS), hospitals reimbursed mostly by Medicaid and Medicare received far less federal funding from the March 2020 CARES Act and the Paycheck Protection Program and Health Care Enhancement Act than hospitals mostly reimbursed by private insurance.[16] Hospitals in the bottom 10% based on private insurance revenue received less than half of what hospitals in the top 10% received. Medicare reimburses hospitals, on average, at half the rate of private insurers. Therefore, hospitals that primarily serve low-income patients received a disproportionately smaller share of total federal funding.[16]

Additional barriers for these communities include fewer and more distant testing sites, longer wait times,[17] prohibitive costs, and lack of a usual source of care.[18] Black Americans diagnosed with COVID-19 are more likely than their White counterparts to live in lower-income zip codes, to receive tests in the emergency department or as inpatients, and to be hospitalized and require care in an intensive care unit.[19] Nationally, only 20% of U.S. counties are disproportionately Black, but these counties account for 52% of COVID-19 diagnoses and 58% of deaths.[20] The pre-pandemic racial gaps in health care catalyzed pandemic disparities and will continue to widen them in the future.

Our health care system insufficiently covers vulnerable groups: About 14 million U.S. adults needed long-term care in 2018.[21] Medicare, employer-based insurance, and the ACA do not cover home- and community-based long-term care. Only private long-term care insurance and patchwork systems for Medicaid-eligible recipients cover such assistance. For those paying out of pocket, estimated home care services average $51,480 to $52,624 per year, with adult day services at more than $19,500 per year.[22]

Our current health care system also inadequately supports individuals with mental illness. APHA officially recognized this issue in 2014, stating that we have “lacked an adequate and consistent public health response [to behavioral health disorders] for several reasons” and that the “treatment of mental health and substance use disorders in the United States has been provided in segregated, fragmented, and underfunded care settings.”[23]

The COVID-19 pandemic has brought urgency to the universal health care discussion in the United States. This is an unprecedented time, and the pandemic has exacerbated many of the existing problems in our current patchwork health care system. The COVID-19 pandemic is a watershed moment where we can reconstruct a fractured health insurance system into a system of universal health care.

Evidence-Based Strategies to Address the Problem We advocate for the definition of universal health care outlined in the 2019 resolution adopted by the United Nations General Assembly, which member nations signed on to, including the United States. According to this resolution, “universal health coverage implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative, rehabilitative and palliative essential health services, and essential, safe, affordable, effective and quality medicines and vaccines, while ensuring that the use of these services does not expose the users to financial hardship, with a special emphasis on the poor, vulnerable and marginalized segments of the population.”[24]

Our current system is inaccessible, inflexible, and inequitable, and it insufficiently covers vulnerable populations. Here we present supporting evidence that universal health care can help address these issues.

Universal health care can increase accessibility to care: Evidence supporting universal health care is mostly limited to natural experiments and examples from other countries. Although countries with universal health care systems also struggle in containing the COVID-19 pandemic, their response and mortality outcomes are better owing to their robust universal systems.[25]

While individuals in the United States lost health care coverage during the pandemic, individuals in countries with universal health care were able to maintain access to care.[26–28] Some European and East Asian countries continue to offer comprehensive, continuous care to their citizens during the pandemic.

Taiwan’s single-payer national health insurance covers more than 99% of the country’s population, allowing easy access to care with copayments of $14 for physician visits and $7 for prescriptions. On average, people in Taiwan see their physician 15 times per year.[27] Also, coronavirus tests are provided free of charge, and there are sufficient hospital isolation rooms for confirmed and suspected cases of COVID-19.[28]

Thai epidemiologists credit their universal health care system with controlling the COVID-19 pandemic.[29] They have described how their first patient, a taxi driver, sought medical attention unencumbered by doubts about paying for his care. They benefit from one of the lowest caseloads in the world.[29]

Universal health care is a more cohesive system that can better respond to health care demands during the pandemic and in future routine care: Leveraging its universal health care system, Norway began aggressively tracking and testing known contacts of individuals infected with COVID-19 as early as February 2020. Public health officials identified community spread and quickly shut down areas of contagion. By April 30, Norway had administered 172,586 tests and recorded 7,667 positive cases of COVID-19. Experts attribute Norway’s success, in part, to its universal health care system.[26] Norway’s early comprehensive response and relentless testing and tracing benefited the country’s case counts and mortality outcomes.

Once China released the genetic sequence of COVID-19, Taiwan’s Centers for Disease Control laboratory rapidly developed a test kit and expanded capacity via the national laboratory diagnostic network, engaging 37 laboratories that can perform 3,900 tests per day.[28] Taiwan quickly mobilized approaches for case identification, distribution of face masks, containment, and resource allocation by leveraging its national health insurance database and integrating it with the country’s customs and immigration database daily.[28] Taiwan’s system proved to be flexible in meeting disaster response needs.

Although these countries’ success in containing COVID-19 varied, their universal health care systems allowed comprehensive responses.

Universal health care can help decrease disparities and inequities in health: Several factors point to decreased racial and ethnic disparities under a universal health care model. CHIP’s creation in 1997 covered children in low-income families who did not qualify for Medicaid; this coverage is associated with increased access to care and reduced racial disparities.[30] Similarly, differences in diabetes and cardiovascular disease outcomes by race, ethnicity, and socioeconomic status decline among previously uninsured adults once they become eligible for Medicare coverage.[31] While universal access to medical care can reduce health disparities, it does not eliminate them; health inequity is a much larger systemic issue that society needs to address.

Universal health care better supports the needs of vulnerable groups: The United States can adopt strategies from existing models in other countries with long-term care policies already in place. For example, Germany offers mandatory long-term disability and illness coverage as part of its national social insurance system, operated since 2014 by 131 nonprofit sickness funds. German citizens can receive an array of subsidized long-term care services without age restrictions.[32] In France, citizens 60 years and older receive long-term care support through an income-adjusted universal program.[33]

Universal health care can also decrease health disparities among individuals with mental illness. For instance, the ACA Medicaid expansion helped individuals with mental health concerns by improving access to care and effective mental health treatment.[34]

Opposing Arguments/Evidence Universal health care is more expensive: Government spending on Medicare, Medicaid, and CHIP has been increasing and is projected to grow 6.3% on average annually between 2018 and 2028.[35] In 1968, spending on major health care programs represented 0.7% of the gross domestic product (GDP); in 2018 it represented 5.2% of the GDP, and it is projected to represent 6.8% in 2028.[35] These estimates do not account for universal health care, which, by some estimates, may add $32.6 trillion to the federal budget during the first 10 years and equal 10% of the GDP in 2022.[36]

Counterpoint: Some models of single-payer universal health care systems estimate savings of $450 billion annually.[37] Others estimate $1.8 trillion in savings over a 10-year period.[38] In 2019, 17% of the U.S. GDP was spent on health care; comparable countries with universal health care spent, on average, only 8.8%.[39]

Counterpoint: Health care services in the United States are more expensive than in other economically comparable countries. For example, per capita spending on inpatient and outpatient care (the biggest driver of health care costs in the United States) is more than two times greater even with shorter hospital stays and fewer physician visits.[40] Overall, the United States spends over $5,000 more per person in health costs than countries of similar size and wealth.[40]

Counterpoint: Administrative costs are lower in countries with universal health care. The United States spends four times more per capita on administrative costs than similar countries with universal health care.[41] Nine percent of U.S. health care spending goes toward administrative costs, while other countries average only 3.6%. In addition, the United States has the highest growth rate in administrative costs (5.4%), a rate that is currently double that of other countries.[41]

Universal health care will lead to rationing of medical services, increase wait times, and result in care that is inferior to that currently offered by the U.S. health care system. Opponents of universal health care point to the longer wait times of Medicaid beneficiaries and other countries as a sign of worse care. It has been shown that 9.4% of Medicaid beneficiaries have trouble accessing care due to long wait times, as compared with 4.2% of privately insured patients.[42] Patients in some countries with universal health care, such as Canada and the United Kingdom, experience longer wait times to see their physicians than patients in the United States.[43] In addition, some point to lower cancer death rates in the United States than in countries with universal health care as a sign of a superior system.[44]

Another concern is rationing of medical services due to increased demands from newly insured individuals. Countries with universal health care use methods such as price setting, service restriction, controlled distribution, budgeting, and cost-benefit analysis to ration services.[45]

Counterpoint: The Unites States already rations health care services by excluding patients who are unable to pay for care. This entrenched rationing leads to widening health disparities. It also increases the prevalence of chronic conditions in low-income and minority groups and, in turn, predisposes these groups to disproportionately worse outcomes during the pandemic. Allocation of resources should not be determined by what patients can and cannot afford. This policy statement calls for high-value, evidence-based health care, which will reduce waste and decrease rationing.

Counterpoint: Opponents of universal health care note that Medicaid patients endure longer wait times to obtain care than privately insured patients[42] and that countries with universal health care have longer wait times than the United States.[43] Although the United States enjoys shorter wait times, this does not translate into better health outcomes. For instance, the United States has higher respiratory disease, maternal mortality, and premature death rates and carries a higher disease burden than comparable wealthy countries.[46]

Counterpoint: A review of more than 100 countries’ health care systems suggests that broader coverage increases access to care and improves population health.

Counterpoint: While it is reasonable to assume that eliminating financial barriers to care will lead to a rise in health care utilization because use will increase in groups that previously could not afford care, a review of the implementation of universal health care in 13 capitalist countries revealed no or only small (less than 10%) post-implementation increases in overall health care use.[47] This finding was likely related to some diseases being treated earlier, when less intense utilization was required, as well as a shift in use of care from the wealthy to the poorest.[47]

Alternative Strategies States and the federal government can implement several alternative strategies to increase access to health care. However, these strategies are piecemeal responses, face legal challenges, and offer unreliable assurance for coverage. Importantly, these alternative strategies also do not necessarily or explicitly acknowledge health as a right.

State strategies: The remaining 14 states can adopt the Medicaid expansions in the ACA, and states that previously expanded can open new enrollment periods for their ACA marketplaces to encourage enrollment.[48] While this is a strategy to extend coverage to many of those left behind, frequent legal challenges to the ACA and Medicaid cuts make it an unreliable source of coverage in the future. In addition, although many people gained insurance, access to care remained challenging due to prohibitively priced premiums and direct costs.

Before the pandemic, the New York state legislature began exploring universal single-payer coverage, and the New Mexico legislature started considering a Medicaid buy-in option.[49] These systems would cover only residents of a particular state, and they remain susceptible to fluctuations in Medicaid cuts, state revenues, and business decisions of private contractors in the marketplace.

Federal government strategies: Congress can continue to pass legislation in the vein of the Families First Coronavirus Response Act and the CARES Act. These acts required all private insurers, Medicare, and Medicaid to cover COVID-19 testing, eliminate cost sharing, and set funds to cover testing for uninsured individuals. They fell short in requiring assistance with COVID-19 treatment. A strategy of incremental legislation to address the pandemic is highly susceptible to the political climate, is unreliable, and does not address non-COVID-19 health outcomes. Most importantly, this system perpetuates a fragmented response to the COVID-19 pandemic.

An additional option for the federal government is to cover the full costs of Medicaid expansion in the 14 states yet to expand coverage. If states increased expansion and enforced existing ACA regulations, nearly all Americans could gain health insurance.[50] This alternative is risky, however, due to frequent legal challenges to the ACA. Furthermore, high costs to access care would continue to exist.

Action Steps This statement reaffirms APHA’s support of the right to health through universal health care. Therefore, APHA:

• Urges Congress and the president to recognize universal health care as a right.
• Urges Congress to fund and design and the president to enact and implement a comprehensive universal health care system that is accessible and affordable for all residents; that ensures access to rural populations, people experiencing homelessness, sexual minority groups, those with disabilities, and marginalized populations; that is not dependent on employment, medical or mental health status, immigration status, or income; that emphasizes high-value, evidence-based care; that includes automatic and mandatory enrollment; and that minimizes administrative burden.
• Urges Congress and states to use the COVID-19 pandemic as a catalyst to develop an inclusive and comprehensive health care system that is resilient, equitable, and accessible.
• Urges the DHHS, the Agency for Healthcare Research and Quality, the Institute of Medicine, the National Institutes of Health, academic institutions, researchers, and think tanks to examine equitable access to health care, including provision of mental health care, long-term care, dental care, and vision care.
• Urges Congress, national health care leaders, academic institutions, hospitals, and each person living in the United States to recognize the harms caused by institutionalized racism in our health care system and collaborate to build a system that is equitable and just.
• Urges Congress to mandate the Federal Register Standards for Accessible Medical Diagnostic Equipment to meet the everyday health care physical access challenges of children and adults with disabilities.
• Urges national health care leaders to design a transition and implementation strategy that communicates the impact of a proposed universal health care system on individuals, hospitals, health care companies, health care workers, and communities.
• Urges Congress, the Centers for Disease Control and Prevention, the DHHS, and other public health partners, in light of the COVID-19 pandemic, to recognize the need for and supply adequate funding for a robust public health system. This public health system will prepare for, prevent, and respond to both imminent and long-term threats to public health, as previously supported in APHA Policy Statement 200911.

References 1. Palmer K. A brief history: universal health care efforts in the US. Available at: https://pnhp.org/a-brief-history-universal-health-care-efforts-in-the-us/. Accessed September 30, 2020. 2. Serakos M, Wolfe B. The ACA: impacts on health, access, and employment. Forum Health Econ Policy. 2016;19(2):201–259. 3. Centers for Medicare and Medicaid Services. CMS roadmaps for the traditional fee-for-service program: overview. Available at: https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualityinitiativesgeninfo/downloads/roadmapoverview_oea_1-16.pdf. Accessed September 30, 2020. 4. Goldman AL, McCormick D, Haas JS, Sommers BD. Effects of the ACA’s health insurance marketplaces on the previously uninsured: a quasi-experimental analysis. Health Aff (Millwood). 2018;37(4):591–599. 5. Collins SR, Gunja MZ, Doty MM, Bhupal HK. Americans’ views on health insurance at the end of a turbulent year. Available at: https://www.commonwealthfund.org/publications/issue-briefs/2018/mar/americans-views-health-insurance-end-turbulent-year. Accessed August 28, 2020. 6. Tolbert J, Orgera K, Singer N, Damico A. Key facts about the uninsured population. Available at: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/. Accessed September 12, 2020. 7. Banthin J, Simpson M, Buettgens M, Blumberg LJ, Wang R. Changes in health insurance coverage due to the COVID-19 recession. Available at: https://www.urban.org/research/publication/changes-health-insurance-coverage-due-covid-19-recession. Accessed September 30, 2020. 8. Gaffney AW, Himmelstein DU, McCormick D, Woolhandler S. Health and social precarity among Americans receiving unemployment benefits during the COVID-19 outbreak. J Gen Intern Med. 2020;35(11):3416–3419. 9. Lutfiyya MN, Gross AJ, Soffe B, Lipsky MS. Dental care utilization: examining the associations between health services deficits and not having a dental visit in the past 12 months. BMC Public Health. 2019;19(1):265. 10. Rudowitz R, Hinton, E. Early look at Medicaid spending and enrollment trends amid COVID-19. Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/early-look-at-medicaid-spending-and-enrollment-trends-amid-covid-19/. Accessed August 14, 2020. 11. Roubein R, Goldberg D. States cut Medicaid as millions of jobless workers look to safety net. Available at: https://www.politico.com/news/2020/05/05/states-cut-medicaid-programs-239208. Accessed August 14, 2020. 12. Garfield R, Claxton G, Damico A, Levitt L. Eligibility for ACA health coverage following job loss. Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss/. Accessed August 14, 2020. 13. U.S. Department of Health and Human Services. Renewal of determination that a public health emergency exists. Available at: https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-2Oct2020.aspx. Accessed September 30, 2020. 14. Rudowitz RC, Garfield R. How much fiscal relief can states expect from the temporary increase in the Medicaid FMAP? Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/how-much-fiscal-relief-can-states-expect-from-the-temporary-increase-in-the-medicaid-fmap/. Accessed August 14, 2020. 15. Downs J. Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction. New York, NY: Oxford University Press; 2015. 16. Schwartz K, Damico A. Distribution of CARES Act funding among hospitals. Available at: https://www.kff.org/health-costs/issue-brief/distribution-of-cares-act-funding-among-hospitals/?utm_campaign=KFF-2020-Health-Costs&utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-_NBOAd_787Yk73Ach1gaH-KDgGLsgoe4vPuqKuidkHwExyNBpENTaB_1ofCIpXrzNoNCx8ACiem-YqMKAF8-6Zv7xDXw&_hsmi=2. Accessed August 15, 2020. 17. Rader B, Astley CM, Sy KTL, et al. Geographic access to United States SARS-CoV-2 testing sites highlights healthcare disparities and may bias transmission estimates. J Travel Med. 2020;27(7):taaa076. 18. Artiga S, Garfield R, Orgera K. Communities of color at higher risk for health and economic challenges due to COVID-19. Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/communities-of-color-at-higher-risk-for-health-and-economic-challenges-due-to-covid-19/. Accessed August 14, 2020. 19. Azar K, Shen Z, Romanelli R, et al. Disparities in outcomes among COVID-19 patients in a large health care system in California. Health Aff (Millwood). 2020;39(7):1253–1262. 20. Millett GA, Jones AT, Benkeser D, et al. Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol. 2020;47:37–44. 21. Hado E, Komisar H. Long-term services and supports. Available at: https://www.aarp.org/ppi/info-2017/long-term-services-and-supports.html. Accessed September 1, 2020. 22. GenWorth Financial. Cost of care survey. Available at: https://www.genworth.com/aging-and-you/finances/cost-of-care.html. Accessed September 1, 2020. 23. American Public Health Association. Policy statement 201415: support for social determinants of behavioral health and pathways for integrated and better public health. Available at: https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/28/14/58/support-for-social-determinants-of-behavioral-health. Accessed September 1, 2020. 24. UN General Assembly. Resolution adopted by the General Assembly on 10 October 2019—political declaration of the high-level meeting on universal health coverage. Available at: https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf. Accessed September 30, 2020. 25. Sommers BD, Baicker K, Epstein AM. Mortality and access to care among adults after state Medicaid expansions. N Engl J Med. 2012;367(11):1025–1034. 26. Jones A. I left Norway’s lockdown for the US: the difference is shocking. Available at: https://www.thenation.com/article/world/coronavirus-norway-lockdown/. Accessed September 1, 2020. 27. Maizland L. Comparing six health-care systems in a pandemic. Available at: https://www.cfr.org/backgrounder/comparing-six-health-care-systems-pandemicX. Accessed August 20, 2020. 28. Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. JAMA. 2020;323(14):1341–1342. 29. Gharib M. Universal health care supports Thailand’s coronavirus strategy. Available at: https://www.npr.org/2020/06/28/884458999/universal-health-care-supports-thailands-coronavirus-strategy. Accessed August 30, 2020. 30. Shone LP, Dick AW, Klein JD, Zwanziger J, Szilagyi PG. Reduction in racial and ethnic disparities after enrollment in the State Children’s Health Insurance Program. Pediatrics. 2005;115(6):e697–e705. 31. McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Health of previously uninsured adults after acquiring Medicare coverage. JAMA. 2007;298(24):2886–2894. 32. Rhee JC, Done N, Anderson GF. Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany. Health Policy. 2015;119(10):1319–1329. 33. Doty P, Nadash P, Racco N. Long-term care financing: lessons from France. Milbank Q. 2015;93(2):359–391. 34. Wen H, Druss BG, Cummings JR. Effect of Medicaid expansions on health insurance coverage and access to care among low-income adults with behavioral health conditions. Health Serv Res. 2015;50(6):1787–1809. 35. Congressional Budget Office. Projections of federal spending on major health care programs. Available at: https://www.cbo.gov/system/files/115th-congress-2017-2018/presentation/53887-presentation.pdf. Accessed October 12, 2020. 36. Blahous C. The costs of a national single-payer healthcare system. Available at: https://www.mercatus.org/publications/government-spending/costs-national-single-payer-healthcare-system. Accessed October 10, 2020. 37. Galvani AP, Parpia AS, Foster EM, Singer BH, Fitzpatrick MC. Improving the prognosis of health care in the USA. Lancet. 2020;395(10223):524–533. 38. Friedman G. Funding HR 676: the Expanded and Improved Medicare for All Act. How we can afford a national single-payer health plan. Available at: https://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf. Accessed September 15, 2020. 39. Organisation for Economic Co-operation and Development. Health expenditure and financing. Available at: https://stats.oecd.org/Index.aspx?ThemeTreeId=9. Accessed September 27, 2020. 40. Kurani N, Cox C. What drives health spending in the U.S. compared to other countries? Available at: https://www.healthsystemtracker.org/brief/what-drives-health-spending-in-the-u-s-compared-to-other-countries/. Accessed September 30, 2020. 41. Tollen L, Keating E, Weil A. How administrative spending contributes to excess US health spending. Available at: https://www.healthaffairs.org/do/10.1377/hblog20200218.375060/abs/. Accessed August 30, 2020. 42. U.S. Government Accountability Office. Medicaid: states made multiple program changes, and beneficiaries generally reported access comparable to private insurance. Available at: https://www.gao.gov/assets/650/649788.pdf. Accessed August 30, 2020. 43. How Canada Compares: Results from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa, Ontario, Canada: Canadian Institute for Health Information; 2017. 44. Organisation for Economic Co-operation and Development. Deaths from cancer: total, per 100,000 persons, 2018 or latest available. Available at: https://data.oecd.org/healthstat/deaths-from-cancer.htm. Accessed October 12, 2020. 45. Hoffman B. Health Care for Some: Rights and Rationing in the United States since 1930. Chicago, IL: University of Chicago Press; 2012. 46. Kurani N, McDermott D, Shanosky N. How does the quality of the U.S. healthcare system compare to other countries? Available at: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start. Accessed September 20, 2020. 47. Gaffney A, Woolhandler S, Himmelstein D. The effect of large-scale health coverage expansions in wealthy nations on society-wide healthcare utilization. J Gen Intern Med. 2020;35(8):2406–2417. 48. King JS. COVID-19 and the need for health care reform. N Engl J Med. 2020;382(26):e104. 49. Hughes M. COVID-19 proves that we need universal health care. States are exploring their options. Available at: https://rooseveltinstitute.org/2020/06/25/covid-19-proves-that-we-need-universal-health-care-states-are-exploring-their-options/. Accessed September 1, 2020. 50. Blumenthal D, Fowler EJ, Abrams M, Collins SR. COVID-19—implications for the health care system. N Engl J Med. 2020;383(15):1483–1488.

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7 Strong Arguments For Why America Should Have Universal Healthcare

With COVID-19 still running its course and no end in sight, the integrity of American healthcare has never been more important. Is the current system truly the best the United States can do for its citizens? Or is socialized medicine a better alternative? Here are seven strong arguments for universal healthcare in America.

1. Lower Overall Costs

The costs of universal healthcare are far lower in other Western countries than private coverage in the United States. For example, administrative expenses alone make up 8% of the nation’s total healthcare costs . On the other hand, other developed countries with universal care don’t reach any higher than 3%.

What’s more, many Americans don’t seek the care they need because the cost of one visit can bankrupt them. Compared to other countries, prices for vital medicine, such as insulin, are sky-high in the United States. Universal healthcare guarantees service to everyone, no matter their financial status. When medical care isn’t such a financial strain, citizens can prioritize their health and seek the treatment they need.

2. Greater Hospital-Patient Trust

One disturbing reason American healthcare is so expensive is the trend of surprise billing. A routine surgery or treatment can cost thousands of dollars more than expected due to additional vague charges. You can even face a hefty fee just for sitting in a waiting room. The U.S. government has made some efforts to fix this problem , but private medical facilities have managed to find loopholes in the legislation.

Universal healthcare takes the billing power away from these facilities, creating more trust between hospital and patient: Payment comes in the form of taxes. While nobody likes to pay more taxes, it’s fairer to pay a fixed amount every year than receive a debilitating hospital bill after one visit.

3. Better Quality Care

The quality of treatment under socialized medicine seems to work better for its citizens than America’s privatized system. Infant mortality rates are lower, average life expectancy is higher and fewer people die from medical malpractice, which happens to be the third-leading cause of death in the United States. 

America also has obesity and cardiovascular disease epidemic, which fills up hospitals and leads to many preventable deaths. Comparable countries with universal healthcare have much lower mortality rates. This is because these nations promote more healthy lifestyles , easing the workload on hospitals and opening up space for people who need urgent care. 

4. More Coverage

Americans rely on their insurance companies to pay for their medical bills, but insurance doesn’t cover every injury or sickness. As you might expect, many citizens go bankrupt from hospital expenses. In contrast, universal healthcare covers any medical issue that might happen to a citizen. So patients don’t need to worry about any loopholes or caveats in their insurance coverage.

5. Shorter Wait Times

Perhaps the biggest criticism of universal healthcare is the extended wait times, but Americans already have long waits. COVID-19 patients are filling up waiting rooms and hospital beds. Because of that, many doctors have begun to hold virtual appointments for patients who can’t see them in person. Still, this solution has only put a dent in the problem. 

Patients under a universal system don’t have to wait for their insurance’s approval before seeking the care they need.

6. Greater Mobility

Since Americans often have to pay their own medical bills, they might feel pressured to keep unfulfilling jobs just for the insurance coverage. So in an ironic twist, they’re forced to put work over their health and well-being just so they can afford healthcare.

Universal healthcare allows you to change jobs without losing coverage. The current privatized system doesn’t embody American values of freedom and liberty. Rather, it restricts their life choices and access to care.

7. Coverage for the Uninsured

Insured citizens at least have access to some healthcare coverage, but the uninsured are entirely on their own. A large percentage of the uninsured have little to no disposable income, and they can’t afford the coverage they need.

Some evidence also suggests that uninsured patients wait longer and receive poorer care than more financially stable patients. As a result, the uninsured have an excess mortality rate of 25% , according to the Institute of Medicine. This negligence is unacceptable and largely avoidable. A universal healthcare system provides its people with care regardless of their insurance status.

America needs universal healthcare. The United States’ private healthcare system has too many glaring flaws to justify its existence. Adopting a universal plan would grant more cost-effective coverage to everyone, including the millions of people who currently can’t afford treatment. A more efficient and trustworthy system would help Americans exercise their fundamental rights to life, liberty, and the pursuit of happiness.

Featured image via CDC on Unsplash

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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.

Online Persuasive Essay Alternatives

Martin Luther King Jr. writes persuasively about civil disobedience in Letter from Birmingham Jail :

• http://www.stanford.edu/group/King/frequentdocs/birmingham.pdf
• http://web.cn.edu/kwheeler/documents/Letter_Birmingham_Jail.pdf
• http://www.oak-tree.us/stuff/King-Birmingham.pdf

Michael Levin argues The Case for Torture :

• http://people.brandeis.edu/~teuber/torture.html

Alan Dershowitz argues The Case for Torture Warrants :

• http://blogs.reuters.com/great-debate/2011/09/07/the-case-for-torture-warrants/

Alisa Solomon argues The Case against Torture :

• http://www.villagevoice.com/2001-11-27/news/the-case-against-torture/1

Writing for Success Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

Persuasive Essay Example: Universal Healthcare

Many countries offer universal healthcare however in the United States many pay for medical health insurance. For many years people in the United States have struggled to pay for medical insurance. Traditionally, the cost for everything was low and people were able to afford things such as medical insurance and the cost of living. With the rise on prices such as food and the cost of living many people must struggle to pay for medical insurance, people have debt and people are not enjoying life. With free universal healthcare people will have less medical debt, people can enjoy life and people can save money.  Free Universal Healthcare is better than private health care because people will have less medical debt, there will be healthier happy people, and the U.S. can work with other countries on making a system that works better for future generation.

Universal health care is a better option for everyone because it is less medical debt for people who cannot afford medical insurance. The healthcare costs in the US have been rising at a very fast rate during the last two decades. One of the causes for the rising costs is unpaid medical bills (Donghui, Zurada, and Jian 2014).  Another key concern regarding medical debt is Recovering bad debt has become a serious matter and may even result in hospitals suing patients (Donghui, et al., 2014). Universal healthcare can eliminate many medical debt and people can focus on living stress free without the worry about working just to pay medical debt. With universal healthcare people can focus on staying healthy without the medical debt. 

Moreover, Universal healthcare can lead to a healthier population. According to Zeiff, Kerr, Moore, and Stoner. (2020) The downside of universal healthcare incorporates people to pay first before receiving the care and the plan did not account for something. On the other hand, Universal healthcare may lead to a healthier population and in the future, it can help alleviate the economic cost from a population who is unhealthy. Another key is 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 Zeiff, Kerr, Moore, and Stoner. (2020). People can benefit when having universal healthcare. With universal healthcare and a better understanding people can have a healthier population. With Universal healthcare, the country will have more healthy people, in the future it can help the country with better economy and with more research it can help generations to come.

Again, understanding other countries when using universal healthcare can be beneficial for everyone in the United States. Nayu et. al. (2011) Found that People in Japan have a longer life expectancy at birth in the world. Japan's success in terms of the increased life expectancy of its population is unlikely to have resulted solely from the achievement of good access to health care. Instead, other cultural background factors might be involved (Nayu et. al., 2011).  Continuing to do research and learning from other countries can help better understand what is best for everyone. Because some countries have Universal health care, we can study on what works for them, how can we improve for generations to come and what can we learn from other counties in perspective of their healthcare system.

Lastly, many experts believe that with universal healthcare the United stated will have a healthier population. With Universal Healthcare people will accumulate less debt, save money for any emergency, and we can learn from other countries making a better healthcare for future generations. With universal healthcare we can have a healthier population in which we will have less debt and an open mind to a better future for generations to come. Universal Healthcare should be for everyone because without it, people who cannot afford Insurance will continue to accumulate debt, die from not having insurance and our future generation will collect debt from family members who are unable to pay. Working with other countries to better understand universal healthcare will be beneficial for everyone.

Donghui Shi, Zurada, J., & Jian Guan. (2014). A Neuro-fuzzy Approach to Bad Debt   Recovery in Healthcare. 2014 47th Hawaii International Conference on System Sciences, System Sciences (HICSS), 2014 47th Hawaii International Conference on, System Sciences (HICSS), 2013 46th Hawaii International Conference On, 2888–2897. https://doi-org.lopes.idm.oclc.org/10.1109/HICSS.2014.361

Gabriel Zieff, Zachary Y. Kerr, Justin B. Moore, & Lee Stoner. (2020). Universal Healthcare in the United States of America: A Healthy Debate. Medicina, 56(580), 580. https://doi-org.lopes.idm.oclc.org/10.3390/medicina56110580

Ikeda, N., Saito, E., Kondo, N., Inoue, M., Ikeda, S., Satoh, T., Wada, K., Stickley, A., Katanoda, K., Mizoue, T., Noda, M., Iso, H., Fujino, Y., Sobue, T., Tsugane, S., Naghavi, M., Ezzati, M., & Shibuya, K. (2011). What has made the population of Japan healthy? The Lancet, 378(9796), 1094–1105. https://doi-org.lopes.idm.oclc.org/10.1016/S0140-6736(11)61055-6

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Journal of Health Ethics

Home > JHE > Vol. 13 (2017) > Iss. 1

Right or Duty: A Kantian Argument for Universal Healthcare

Joseph Crisp , Detar Healthcare System, Victoria, TX Follow

Much of the political rhetoric about healthcare in the United States is couched in terms of healthcare as a right or entitlement. Healthcare as a right, like all welfare rights, carries with it the obligation to pay for it. This paper proposes that healthcare be considered, not a right, but rather a duty within the framework of a Kantian approach to ethics. The categorical imperatives of rational beings include the duties of self-preservation and self-development. As a precondition for these duties, health is essentially bound up with the nature and duties of physical, rational beings. The complexity of healthcare ensures that virtually all persons will need the services of others, and the expense of healthcare can exceed the resources even of those who are insured. Therefore, a just society has a moral duty to ensure access to healthcare to all of its members.

Recommended Citation

https://doi.org/10.18785/ojhe.1301.07

Since December 13, 2017

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