“To Ourselves and Our Posterity”: An Argument for the Implementation of Universal Healthcare in the United States
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The American healthcare system has been the subject of constant scrutiny in recent years, with many American people adopting an increasingly progressive perspective on their entitlement to a safe and healthy life. In the modern landscape (in which for-profit coverage reigns supreme), it would be a demanding task to find a healthcare consumer without at least one reservation regarding the current system. Such reservations could pertain to anything from the steadily mounting prices of health services, to the inherently impersonal nature of profit-motivated healthcare facilities. Regardless of many Americans’ contempt for the way things are, there’s a prevailing resignation to the current system that deters innovation and allows for the perpetuation of an institution fraught with injustice.
In my own experience, there have always been reasons to forego medical care; the foremost of which being the accompanying expenses. In the face of any impending bills for treatment, my mother has always affected a trusted maxim: “You’re lucky that your parents have good jobs and insurance.” And though I’m certain she means it as a gracious reassurance of our fortune and security, the saying has never left me any more at ease. For me, there was always this friction between the act of relishing our access to privatized health, and the act of shamefully contemplating the opposite eventuality. (“Ah yes! The powers for whom you labor have seen fit to grant us the luxury of corporeal maintenance! Please labor on in expression of our collective gratitude! VS. “You have my undying gratitude for securing the resources to provide for our welfare, but would each higher-than-average temperature or drunken fall from a roof have been financially survivable if you hadn’t?”) This conflict has informed my entire life’s approach to personal health. Each and every enduring ache has become a cost-to-benefit analysis between caring for myself and incurring the expenses of doing so. In spite of the inherently isolating nature of this line of thought, I can’t stand to believe that I live under these feelings alone. As calls for progressive policy reform continue to gain legitimacy and recognition in the public eye, it would seem that hordes of this nation’s underserved denizens are all coming to the same harrowing conclusion: By the American standard, to be afflicted is to be expensive, and to be expensive is to be no more than a liability. This truth — disguised as the symptom of a magnanimous, open-ended system of self-government — is perhaps one of the greatest agents of lasting injustice that this world has ever witnessed.
The above statement is founded on an expansive body of research concerning health-related institutions, both foreign and domestic. This investigation’s intention is to illustrate that the timely removal of American healthcare’s profit motive is the first logical step in discontinuing the damaging conflation of vital signs and dollar signs. It will do so by exploring the implications of a prospective Universal Healthcare model, with particular emphasis on four key elements:
1. Interrogation of the idea that it is a government’s responsibility to attend to the welfare of those that it stands to serve.
2. Surveying the effects of UHC implementation in practicing nations abroad. (Economic Expenditure, National Enthusiasm, Infant Mortality Rates, etc.)
3. Examination of the potential costs of UHC implementation versus the steadily rising National Health Expenditure under the current system
4. Observing the benefits UHC offers in connection to longstanding health-related issues like substance misuse/addiction and chronic illness.
Each element will play a constructive role in exposing the economic and functional shortcomings of the current American healthcare system, as well as establishing the importance of a more humanistic approach to the provision of health services.
In the very preamble of America’s widely-lauded constitution, six provisions were laid out for the intended functioning of the burgeoning government, as well as the nation at large. While it could easily be argued that each and every one of these ideals were founded on unjust grounds by deluded, slave-owning idealists, the sentiment certainly remains:
“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
For the purposes of this investigation, it would be most effective to address the fifth provision of the list, stating the founding fathers’ commitment to “promote the general welfare.” While some might argue that this assurance doesn’t explicitly establish a governmental responsibility for the maintenance of national health, it certainly doesn’t absolve it of such responsibility either. The American Constitution Society (ACS), whose prime directive is the interpretation of the Constitution as it relates to the rights of modern Americans, has published extensive literature concerning the ambiguity of this particular provision. In 2011, the ACS published an article by Martha Davis, a Northeastern University Law Professor, which states that, while the inclusion of the provision does indicate that issues of social welfare were of concern to the constitution’s framers, the Bill of Rights is largely held to “provide procedural mechanisms for fair adjudication of those rights rather than carving out claims on the government to ensure that individuals actually have any social and economic assets to protect” (Davis). Essentially, this denotes the government’s support of American peoples’ right to have necessary resources, but doesn’t place said government under any particular obligation to provide those resources. This is no surprise, as the U.S. was founded under the pretenses of low government interference and individualism. The passage does, however, raise questions concerning whether personal health (or shall we say life?) is to be considered a resource, or a distinct right in and of itself, as it is described in America’s comparably pivotal Declaration of Independence. Unfortunately, any answers to this question could be discounted as subjective, disappearing like teardrops in the ocean of a much wider conversation. It’s this very ambiguity that has allowed for the deliberate misinterpretation and political weaponization of antiquated documents like the constitution to this very day. Even in the face of rampantly worsening symptoms of systemic malfunction, many elected officials cling to a manufactured dedication to originalist semantics, stalling widespread reform at the expense of human lives.
By no means is Universal Healthcare implementation a newly introduced concept in the U.S., with political advocacy for reform stretching back as far as the 1900’s. In this sense, the amount of deaths that could be attributed to the debate over governmental responsibility is unconscionable. Most recently, the lack of a centralized authority to oversee national response to the COVID-19 epidemic could be cited in connection to almost 580,000 deaths (CDC). To suggest that all of these lives could’ve been preserved under a UHC system would be unreasonable, but it’s certainly safe to assume that those numbers could’ve been significantly minimized under a government that places national health above the intricacies of bureaucracy. In an era of unprecedented perils, might it be best to put semantics aside? Perhaps the question can’t continue to be of whether the government should provide for the health of its people, but of whether it can. It’s a question that’s been asked and answered by nations the world over, leaving the U.S. with few feasible excuses and a wide array of examples to follow.
The World Health Organization defines Universal Healthcare as any system of coverage in which “all people have access to the health services they need, when and where they need them, without financial hardship” (WHO). By this definition, The U.S. is actually the only country in the developed world that has yet to adopt a Universal Healthcare model. In a 2015 article published in the Harvard Public Health Review (“Universal Health Care: The Affordable Dream”), Professor Amartya Sen details the effectiveness of UHC models in fortifying the overall development of poor nations, as well as addressing the causes for many Americans’ suspicions surrounding UHC. By exploring the benefits of implementation in considerably poorer nations, Sen exposes the irrationality of America’s hesitation to enact progressive healthcare reforms:
“The usual reason given for not attempting to provide universal healthcare in a country is poverty. The United States, which can certainly afford to provide healthcare at quite a high level for all Americans, is exceptional in terms of the popularity of the view that any kind of public establishment of universal healthcare must somehow involve unacceptable intrusions into private life.”
Sen goes on to address other frequently cited reservations surrounding implementation, with particular focus on its economic implications. He reveals that, in spite of the widely held belief that a country must secure considerable wealth before it is able to provide for national health, a number of poor countries have shown that “basic healthcare for all can be provided at a remarkably good level at very low cost if the society, including the political and intellectual leadership, can get its act together” (Sen 2). In articulation of this point, Sen observes the successes of a number of distinct nations including China, Sri Lanka, Costa Rica, and Thailand which, prior to 2001, maintained relatively quality medical coverage for only a fourth of its population (〜15.88 million out of 63.54 million). Though Sen makes no claim that these instances of implementation were without complication, he contends that the long-term benefits far outweigh the short-term difficulties. For Thailand, these benefits took the form of significant decreases in infant and child mortality, increased life expectancy, and general increases to national enthusiasm/quality of life assessments. Recent data from the WHO indicates that those benefits aren’t going anywhere (from 2001-2011: 100 infant deaths per 1,000 down to 9.5 // from 2001-2011: 71.8 year life expectancy at birth up to 74.2) (WHO). Additionally, the nation observed a dramatic decrease in households all along the economic spectrum experiencing catastrophic spending on health. Government expenditure on medicine and supplies even stimulated the country’s chemical, energy, trade, and transport sectors.
There is certainly no shortage of countries to serve as encouraging endorsements for the benefits of UHC implementation, but the question of exactly how these services are paid for remains one of the most heated points of contention among American naysayers. The most obvious and sensible means of financing Universal Health Care reform over time is the comprehensive taxation of wages. This is true of most every UHC practicing nation in the global landscape, all of which seem to have more positive than negative opinions about enacted changes. President Donald Trump, along with other American political figures, often malign the function of UHC systems in nations like the UK, dismissing such reforms as irresponsible misplacements of resources and diagnosing the absence of immediate economic returns as failure overall. Statements like this serve as grim reminders of the seemingly irreformable “profit over people'' mindset espoused by many popular American figures. They also tend to deny the importance of even the most basic data, cementing practicing nations like the UK as incapable in the minds of influenceable supporters before they can stumble across the larger truth for themselves. Despite entering the COVID-19 pandemic facing unprecedented shortages in both funding and staff, the UK’s NHS system still garnered a 60% satisfaction rating in 2019 (King’s Fund), which stands in stark contrast to a 2019 Gallup poll revealing that 70% of Americans describe the current U.S. system as being in a “state of crisis” (Gallup). This disparity is accentuated by the fact that, according to data compiled by the OECD, America’s healthcare spending per person more than doubled that of the UK in the very same year (US: 11,071/person // UK: 4,653/person) (OECD). This means that, for all of the scrutiny the NHS receives from American figures, it’s able to provide widely satisfactory care to a grand majority of its population for a fraction of the prices incurred under the American system, which don’t even reflect the staggering portion of the population living with no insurance at all (35.7 million or 11% in the latter half of 2019) (NCHS). So much of the American argument against UHC implementation is based in the targeted invalidation of the necessary investment, while largely ignoring the long-term social and economic benefits that can result from the cultivation of a healthy and enthusiastic population. Unfortunately for the more conservative members of the conversation, the prospective price of implementation is becoming a less and less viable argument against reform, as medical expenses under the current system continue to rise to unmaintainable heights.
There are an unwieldy amount of variables to be considered when projecting the potential cost of UHC implementation. A 2020 study conducted by representatives of PLoS Medicine, and later republished in the U.S. National Library of Medicine’s online database, sought to demystify the price tag associated with an American Universal Healthcare model. By comparing the cost analyses of 22 single-payer healthcare plans for the U.S. and/or its individual states, researchers were able to form a better understanding of the economic and systemic implications of adopting a UHC model. The study excluded plans that featured provisions for private healthcare options, electing only to examine plans pertaining to the formation of a centralized authority for national healthcare provision. Additionally, inclusion required that “all legal residents are permanently covered for a standard comprehensive set of medically appropriate outpatient and inpatient medical services under one payer,” and that “the payer is a not-for-profit government or quasi-government agency” (Cai, et al.). Of the 22 plans examined, 19 (86%) estimated that health expenditures would decrease in the first year following implementation, and all suggested the potential for long-term cost savings (with the majority of these savings being attributable to simplified billing systems and lower drug costs) (Cai, et al.). However, the study also specifically states its inability to account for unforeseen expenses within the first year of implementation, among other unpredictable factors. Examination of the 3 plans of 22 that determined implementation would incur net cost, rather than savings, the study found that all 3 reflected policy choices that resulted in higher prices. These choices included “low or no cost sharing (copays), rich benefit packages, and a lack of savings predicted from reduced medication/medical equipment costs” (Cai, et al.). In summary, the study found that net cost or savings in the first year after implementation varied all the way from a 7.2% increase in the costs of system operation to a 15.5% decrease. At median, the findings reflected a 3.5% net savings of operation costs overall, granting readers a more refined perspective on the prospective impact of implementing an American UHC model. Meanwhile, medical expenses under the nation’s current healthcare system continue to rise, accounting for an increasingly commanding chunk of the GDP each year (reaching 17.7% or $11,582 per capita in 2019). It’s crucial that policymakers are realistic about the possible benefits of UHC implementation, especially in the face of an increasingly dysfunctional and expensive healthcare model. If, for whatever reason, economic implications still aren’t enough to pierce the hearts of reluctant elected officials, I would also urge them to consider the positive influence that UHC implementation could have on longstanding societal issues like Chronic Disease.
Universal Healthcare implementation could grant this nation the opportunity to breathe new life into its battles against long standing societal ills like the Chronic Disease Crisis. The Partnership to Fight Chronic Disease (PFCD) defines chronic diseases as “ongoing, generally incurable illnesses or conditions, such as heart disease, asthma, cancer, and diabetes” (PFCD). They also specify that these conditions are often preventable and/or manageable through early detection, treatment therapy, improved diet and exercise. Over the years, this definition has expanded somewhat, encompassing conditions like depression, obesity, and substance addiction. Chronic diseases are the leading cause of disability and death in the U.S., accounting for 7 out of every 10 deaths (>1.7 million/yr.). With 45% of the population (133 million) living with at least one chronic condition, they have come to account for over 81% of hospital admissions (PFCD). Not only do these conditions exact a gruesome toll on human life, they’ve inspired insurance companies to drastically increase premium prices (which just reeks of “profit over people”). This presents a terrifying cycle in the American health landscape. As poor education, promotion, and provision for personal health in this nation result in the increased prevalence of chronic conditions, insurance companies swoop in to profit off of the American peoples’ miseducation. In addition to the rising costs of premiums, prices for life-saving products like insulin continue to jump as well, threatening to bankrupt individuals whose disabilities may prevent them from working. Under a UHC system, the centralized insurer would be able to negotiate prices with pharmaceutical companies, as well as enact mandates to deter predatory pricing. There’s also the fact that a UHC system would remove the cost consideration of seeking various types of medical care, essentially encouraging a healthier national outlook on health. With the PFCD’s projections indicating that chronic disease will likely affect 〜49% (164 million) Americans by 2025, there isn’t much time left to change the conversation about how we take care of ourselves. As it seems that some are willing to turn a blind eye in order to prey on American unwellness, it falls on the American people to use our voices in the pursuit of what we should legitimately consider life-saving reform.
Aside from the classic objections to the cost of implementation, many anti-UHC system parties contend that the profit-motivated system doesn’t need to be dismantled. Instead, they posit that it needs to be granted even more regulatory power. In 2016, Surgical Neurology International published an article by Miguel A. Faria, in which he details his inspired distaste for the idea of further collectivization within the American medical system. He goes on to state that the healthcare system’s failings are the result of too much government regulation, rather than too little:
“If we truly had an unfettered free-market in medical care, medical care would be competitive, more efficient, cheaper, and still humanitarian, as has been the case from time immemorial for the medical profession.”
Essentially, Faria suggests that medical care be made something like shopping for a car, encouraging patients to shop around between care providers in order to find the most quality care for the best price. Faria also suggests that the failures of centralized government and social systems like Welfare can be observed in every facet of the American economy, with users taking advantage of these systems in order to avoid conventional labor. Seemingly becoming more and more comfortable by the end of the paper, he eventually even refers to socialized healthcare systems as political seductions of practicing populations, progressively readying them to accept tyrannical rule:
“Collectivism has been a failure wherever it has been established, and socialized medicine, in particular, has been the key arch of that socialization, an essential component of collectivism used by demagoguing politicians to seduce the people, making it easier for them to accept tyranny.”
Though the article does communicate a high level of education and intelligence regarding the medical field, it also betrays clear-cut bias and a certain disconnection from the plight of average Americans. Faria’s position certainly illustrates a marked dedication to the maintenance of a for-profit system, with perhaps his strongest argument being for the removal of mandates controlling competitive pricing for medical services. Unfortunately, I don’t think that many Americans would be particularly enamored of this method of securing health services. With many Americans bearing no connection to the world of medicine, finding the right care provider to perform a life-saving surgery wouldn’t exactly be as simple as picking which car you’re driving off the lot. Additionally, any savings secured by allowing for competition between providers would still be marred by the costs of having so many independent care providers and facilities. Part of the beauty of a centralized system is the potential for the consolidation of all those free-floating medical records and billing statements into a comprehensive national database, thereby cutting material costs. Finally, there’s no way that competition amongst insurers stands to benefit the ~35.7 million uninsured people living in the United States. And while that may be of no importance to Mr. Faria, it’s certainly of importance to them.
There’s a certain amount of faith inherent in the idea of Universal Healthcare implementation. At the crux of it, it could probably even be called one of the most expensive social experiments that this country will have ever undertaken. But as all of the above data hopes to convey, many aspects of the current American healthcare system are screaming that something is broken. With so many of those in power having seemingly forgotten their commitment to the people, there’s never been a more pressing obligation to put our beliefs in practice. Our elected government’s inactivity can not become an excuse for our own. If universal care is what we want to see, then we can all start practicing now. That can mean anything from adjusting our own unhealthy misconceptions about personal care to just picking up the check for a friend when their pockets are low (as long as they’re observing a healthy diet to deter chronic disease). It’s my belief that our nation stands at the precipice of an impossible void. Our actions as a people over the next few years will reflect whether we collectively choose to dive into that void as witlessly as ever, or to exercise the compassionate discernment to provide ourselves a parachute. In an age of deadly uncertainty, don’t we owe at least that much to ourselves and our posterity?
