why healthcare should be free persuasive essay

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

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

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

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

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

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

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

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

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

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

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

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

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

photo: Tony Gutierrez / AP Photo

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• Universal Health Care

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

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• 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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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.

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Knowledge at Wharton Podcast

Does the u.s. need universal health care, december 8, 2020 • 11 min listen.

Wharton's Robert Hughes explains the moral and social benefits of universal health care and how such a system might look in the U.S.

• Public Policy

Wharton’s Robert Hughes speaks with Wharton Business Daily on SiriusXM about the need for universal health care in the U.S.

Nothing quite exposes the inequalities that exist in American society more than the health care system. It’s a complex combination of private insurance, public programs and politics that drives up costs, creating significant barriers to lifesaving medical treatment for large segments of the population. In America, access to quality health care often depends on income, employment and status.

Why Should Healthcare Be Free?

Robert Hughes, professor of business ethics and legal studies at Wharton, is an advocate for universal health care coverage. Drawing deeply on his research in philosophy, Hughes believes that equal access to medical care is beneficial for both liberty and social stability. Health, he says, should not be tied to wealth.

“I think it’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance,” he said, referring to the crowdsourcing platform used to help raise money for patient bills. “That’s why I say that truly universal health care would be good for people’s liberty. Because you’re not really free if you’re depending on charity, especially discretionary charity like the kind you see on GoFundMe, for a basic need like health care.”

Hughes recently joined the Wharton Business Daily radio show on SiriusXM to discuss universal health care in the context of the presidential election. (Listen to the podcast at the top of this page.) President-elect Joe Biden has said he will protect and rebuild the Affordable Care Act , which has been under attack since it was enacted in 2010 under President Barack Obama.

Does the U.S. Hhave Universal Healthcare Now That Obamacare Exists?

The ACA, commonly referred to as Obamacare, brought the U.S. closer to providing universal health care through subsidized private health insurance, but Hughes said there’s still a wide gap. He believes policymakers should ensure that everyone has coverage and access to the same needed treatments.

“It’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance.”

“I think it’s totally feasible for us to change the health care system, if we all were willing to do the right thing. But we’re not all willing to do the right thing,” Hughes said.

The professor argued the case for universal health care in a paper titled “ Egalitarian Provision of Necessary Medical Treatment ,” which was published last year in the Journal of Ethics. (The author-accepted version is  here .) He examined the health care systems of the U.K., Australia and Canada, concluding that Canada’s single-payer system is the most advantageous for the U.S.

Private insurance would still exist under such a setup, but it could not be used to pay for treatments already covered under universal health care. This provision would eliminate wealth as the controlling factor in health.

Why Doesn’t the U.S. Have Free Healthcare?

“I don’t understand why there’s so much resistance to the idea of truly universal health insurance in the United States, given that this is something that other industrial countries just do,” Hughes said.

He acknowledged that the U.S. doesn’t have the “political will” to change a system that’s been entrenched since the end of World War II, when employers began offering health insurance to their workers instead of higher wages.

“We can’t wave a magic wand and go back to 1946,” he said. “I don’t see the United States completely uprooting all these insurances. And that means we might need to create a model that keeps a lot of what we have, making it more accessible to more people, rather than creating all new institutions from scratch.”

Knowledge at Wharton interviewed Hughes in 2019 about his paper. For an in-depth look into his research and advocacy, read the interview here .

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

Gabriel zieff.

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

Zachary Y. Kerr

Justin b. moore.

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

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

1. Introduction

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

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

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

2. Argument against Universal Healthcare

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

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

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

3. Argument for Universal Healthcare

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

Preventive Initiatives within A Universal Healthcare Model

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

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

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

4. Conclusions

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

Author Contributions

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

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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Argumentative Essay On Universal Healthcare

Info: 2468 words (10 pages) Nursing Essay Published: 12th Apr 2021

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Universal Healthcare in the United States

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Works Cited

• Cecere, David. “The Harvard Gazette.” 17 September 2009. Harvard News. 11 December 2018. .
• Edwards, Sweetland Haley. “The Health Care Voters.” TIME 12 November 2018: 41.
• “Formosa.” 17 March 2018. Formosa Post. 12 November 2018. .
• Gawande, Atul. “The United States Can Achieve Universal Health Care Without Dismantling the Existing Health Care System.” Universal Health Care . Detroit: Greenhaven Press, 2010. 190.
• Jackson Jr., Jesse L. “The United States Should Guarantee the Right to Health Care Through a Constitutional Amendment.” Grover, Jan. Healthcare . Detroit: Greenhaven Press, 2007. 28.
• “NIMH.” November 2017. National Institute of Mental Health. 12 December 2018. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
• Salyer, Kirsten. “TIME.” 1 July 2016. TIME Web Site. 5 November 2018.
• Tanner, Michael D. “CATO.” 23 February 2009. CATO Institute. 12 November 2018. .
• Wilper, Andrew P., et al. “U.S. National Library of Medicine.” December 2009. U.S. National Library of Medicine. 11 December 2018.

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Should the U.S. Government Provide Universal Health Care?

• History of Universal Health Care

27.5 million non-elderly Americans did not have health insurance in 2021, a decline from 28.9 million uninsured Americans in 2019. The largest group of Americans, almost 155 million non-elderly people, were covered by employer-sponsored health insurance. Less than 1% of Americans over 65 were uninsured, thanks to Medicaid, a government provided insurance for people over 65 years old.

The United States is the only nation among the 37 OECD (Organization for Economic Co-operation and Development) nations that does not have universal health care either in practice or by constitutional right. Read more background…

Pro & Con Arguments

Pro 1 The United States already has universal health care for some. The government should expand the system to protect everyone. A national health insurance is a universal health care that “uses public insurance to pay for private-practice care. Every citizen pays into the national insurance plan. Administrative costs are lower because there is one insurance company. The government also has a lot of leverage to force medical costs down,” according to economic expert Kimberly Amadeo. Canada, Taiwan, and South Korea all have national health insurance. In the United States, Medicare, Medicaid, and TRICARE function similarly. [ 178 ] Medicare is the “federal health insurance program for: people who are 65 or older, certain younger people with disabilities, [and] people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).” Patients pay a monthly premium for Medicare Part B (general health coverage). The 2023 standard Part B monthly premium is $164.90. Patients also contribute to drug costs via Medicare Part D. Most people do not pay a premium for Medicare Part A (“inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care”). More than 65.3 million people were enrolled in Medicare according to Feb. 2023 government data. [ 180 ] [ 181 ] Medicaid “provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.” More than 84.8 million people were enrolled in Medicaid as of Nov. 2022. [ 181 ] [ 182 ] [ 183 ] The Children’s Health Insurance Program (CHIP), often lumped in with Medicaid in these discussions, is a “low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program.” CHIP covers more than 6.9 million patients. [ 181 ] [ 182 ] [ 183 ] TRICARE is the “military health system that provides care to almost 10 million active-duty service members, retired personnel, and their families.” Active-duty military members pay $0 for health insurance, while retired members and their families paid a premium up to $1,165 per month (for a member and family) in 2021. [ 184 ] The United States already successfully maintains universal health care for almost 36% of the U.S. population, according to U.S. Census data released in Sep. 2022. As the Baby Boomer generation continues to age and more of the generation becomes eligible for Medicare, estimates suggest about 73.5 million people will use Medcare and about 47% of American health care costs will be paid for by public health services by 2027. [ 185 ] [ 186 ] If the government can successfully provide universal health care for 36% to almost 50% of the population, then the government can provide univeral health care for the rest of the population who are just as in need and deserving of leading healthy lives. Read More

Pro 2 Universal health care would lower costs and prevent medical bankruptcy. A June 2022 study found the United States could have saved $105.6 billion in COVID-19 (coronavirus) hospitalization costs with single-payer universal health care during the pandemic. That potential savings is on top of the estimated $438 billion the researchers estimated could be saved annually with universal health care in a non-pandemic year. [ 198 ] “Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households,” conclude researchers from the Yale School of Public Health and colleagues. [ 201 ] According to the National Bankruptcy Forum, medical debt is the number one reason people file for bankruptcy in the United States. In 2017, about 33% of all Americans with medical bills reported that they “were unable to pay for basic necessities like food, heat, or housing.” If all Americans were provided health care under a single-payer system medical bankruptcy would no longer exist, because the government, not private citizens, would pay all medical bills. [ 131 ] Further, prescription drug costs would drop between 4% and 31%, according to five cost estimates gathered by New York Times reporters. 24% of people taking prescription drugs reported difficulty affording the drugs, according to a Kaiser Family Foundation (KFF) poll. 58% of people whose drugs cost more than $100 a month, 49% of people in fair or poor health, 35% of those with annual incomes of less than $40,000, and 35% of those taking four or more drugs monthly all reported affordability issues. [ 197 ] [ 199 ] [ 200 ] Additionally, 30% of people aged 50 to 64 reported cost issues because they generally take more drugs than younger people but are not old enough to qualify for Medicare drug benefits. With 79% of Americans saying prescription drug costs are “unreasonable,” and 70% reporting lowering prescription drug costs as their highest healthcare priority, lowering the cost of prescription drugs would lead to more drug-compliance and lives not only bettered, but saved as a result. [ 197 ] [ 199 ] [ 200 ] Read More

Pro 3 Universal health care would improve individual and national health outcomes. Since 2020, the COVID-19 pandemic has underscored the public health, economic and moral repercussions of widespread dependence on employer-sponsored insurance, the most common source of coverage for working-age Americans…. Business closures and restrictions led to unemployment for more than 9 million individuals following the emergence of COVID-19. Consequently, many Americans lost their healthcare precisely at a time when COVID-19 sharply heightened the need for medical services,” argue researchers from the Yale School of Public Health and colleagues. The researchers estimated more than 131,000 COVID-19 (coronavirus) deaths and almost 78,000 non-COVID-19 deaths could have been prevented with universal health care in 2020 alone. [ 198 ] Another study finds a change to “single-payer health care would… save more than 68,000 lives and 1.73 million life-years every year compared with the status quo.” [ 201 ] Meanwhile, more people would be able to access much-needed health care. A Jan. 2021 study concludes that universal health care would increase outpatient visits by 7% to 10% and hospital visits by 0% to 3%, which are modest increases when compared to saved and lengthened lives. [ 202 ] Other studies find that universal health coverage is linked to longer life expectancy, lower child mortality rates, higher smoking cessation rates, lower depression rates, and a higher general sense of well-being, with more people reporting being in “excellent health.” Further, universal health care leads to appropriate use of health care facilities, including lower rates of emergency room visits for non-emergencies and a higher use of preventative doctors’ visits to manage chronic conditions. [ 203 ] [ 204 ] [ 205 ] An American Hospital Association report argues, the “high rate of uninsured [patients] puts stress on the broader health care system. People without insurance put off needed care and rely more heavily on hospital emergency departments, resulting in scarce resources being directed to treat conditions that often could have been prevented or managed in a lower-cost setting. Being uninsured also has serious financial implications for individuals, communities and the health care system.” [ 205 ] Read More

Con 1 Universal health care for everyone in the United States promises only government inefficiency and health care that ignores the realities of the country and the free market. In addition to providing universal health care for the elderly, low-income individuals, children in need, and military members (and their families), the United States has the Affordable Care Act (the ACA, formerly known as the Patient Protection and Affordable Care Act), or Obamacare, which ensures that Americans can access affordable health care. the ACA allows Americans to chose the coverage appropriate to their health conditions and incomes. [ 187 ] Veterans’ Affairs, which serves former military members, is an example of a single-payer health care provider, and one that has repeatedly failed its patients. For example, a computer error at the Spokane VA hospital “failed to deliver more than 11,000 orders for specialty care, lab work and other services – without alerting health care providers the orders had been lost.” [ 188 ] [ 189 ] Elizabeth Hovde, Policy Analyst and Director of the Centers for Health Care and Worker Rights, argues, “The VA system is not only costly with inconsistent medical care results, it’s an American example of a single-payer, government-run system. We should run from the attempts in our state to decrease competition in the health care system and increase government dependency, leaving our health care at the mercy of a monopolistic system that does not need to be timely or responsive to patients. Policymakers should give veterans meaningful choices among private providers, clinics and hospitals, so vets can choose their own doctors and directly access quality care that meets their needs. Best of all, when the routine break-downs of a government-run system threaten to harm them again, as happened in Spokane, veterans can take their well-earned health benefit and find help elsewhere.” [ 188 ] [ 189 ] Further, the challenges of universal health care implementation are vastly different in the U.S. than in other countries, making the current patchwork of health care options the best fit for the country. As researchers summarize, “Though the majority of post-industrial Westernized nations employ a universal healthcare model, few—if any—of these nations are as geographically large, populous, or ethnically/racially diverse as the U.S. Different regions in the U.S. are defined by distinct cultural identities, citizens have unique religious and political values, and the populace spans the socio–economic spectrum. Moreover, heterogenous climates and population densities confer different health needs and challenges across the U.S. Thus, critics of universal healthcare in the U.S. argue that implementation would not be as feasible—organizationally or financially—as other developed nations.” [ 190 ] And, such a system in the United States would hinder medical innovation and entrepreneurship. “Government control is a large driver of America’s health care problems. Bureaucrats can’t revolutionize health care – only entrepreneurs can. By empowering health care entrepreneurs, we can create an American health care system that is more affordable, accessible, and productive for all,” explains Wayne Winegarden, Senior Fellow in Business and Economics, and Director of the Center for Medical Economics and Innovation at Pacific Research Institute. [ 190 ] [ 191 ] Read More

Con 2 Universal health care would raise costs for the federal government and, in turn, taxpayers. Medicare-for-all, a recent universal health care proposal championed by Senator Bernie Sanders (I-VT), would cost an estimated $30 to $40 trillion over ten years. The cost would be the largest single increase to the federal budget ever. [ 192 ] The Congressional Budget Office (CBO) estimates that by 2030 federal health care subsidies will increase by $1.5 to $3.0 trillion. The CBO concludes, “Because the single-payer options that CBO examined would greatly increase federal subsidies for health care, the government would need to implement new financing mechanisms—such as raising existing taxes or introducing new ones, reducing certain spending, or issuing federal debt. As an example, if the government required employers to make contributions toward the cost of health insurance under a single-payer system that would be similar to their contributions under current law, it would have to impose new taxes.” [ 193 ] Despite claims by many, the cost of Medicare for All, or any other universal health care option, could not be financed solely by increased taxes on the wealthy. “[T]axes on the middle class would have to rise in order to pay for it. Those taxes could be imposed directly on workers, indirectly through taxes on employers or consumption, or through a combination of direct or indirect taxes. There is simply not enough available revenue from high earners and businesses to cover the full cost of eliminating premiums, ending all cost-sharing, and expanding coverage to all Americans and for (virtually) all health services,” says the Committee for a Responsible Federal Budget. [ 195 ] An analysis of the Sanders plan “estimates that the average annual cost of the plan would be approximately $2.5 trillion per year creating an average of over a $1 trillion per year financing shortfall. To fund the program, payroll and income taxes would have to increase from a combined 8.4 percent in the Sanders plan to 20 percent while also retaining all remaining tax increases on capital gains, increased marginal tax rates, the estate tax and eliminating tax expenditures…. Overall, over 70 percent of working privately insured households would pay more under a fully funded single payer plan than they do for health insurance today.” [ 196 ] Read More

Con 3 Universal health care would increase wait times for basic care and make Americans’ health worse. The Congressional Budget Office explains, “A single-payer system with little cost sharing for medical services would lead to increased demand for care in the United States because more people would have health insurance and because those already covered would use more services. The extent to which the supply of care would be adequate to meet that increased demand would depend on various factors, such as the payment rates for providers and any measures taken to increase supply. If coverage was nearly universal, cost sharing was very limited, and the payment rates were reduced compared with current law, the demand for medical care would probably exceed the supply of care–with increased wait times for appointments or elective surgeries, greater wait times at doctors’ offices and other facilities, or the need to travel greater distances to receive medical care. Some demand for care might be unmet.” [ 207 ] As an example of lengthy wait times associated with universal coverage, in 2017 Canadians were on waiting lists for an estimated 1,040,791 procedures, and the median wait time for arthroplastic surgery was 20–52 weeks. Similarly, average waiting time for elective hospital-based care in the United Kingdom is 46 days, while some patients wait over a year. Increased wait times in the U.S. would likely occur—at least in the short term—as a result of a steep rise in the number of primary and emergency care visits (due to eliminating the financial barrier to seek care), as well as general wastefulness, inefficiency, and disorganization that is often associated with bureaucratic, government-run agencies. [ 17 ] [ 190 ] Joshua W. Axene of Axene Health Partners, LLC “wonder[s] if Americans really could function under a system that is budget based and would likely have increased waiting times. In America we have created a healthcare culture that pays providers predominantly on a Fee for Service basis (FFS) and allows people to get what they want, when they want it and generally from whoever they want. American healthcare culture always wants the best thing available and has a ‘more is better’ mentality. Under a government sponsored socialized healthcare system, choice would become more limited, timing mandated, and supply and demand would be controlled through the constraints of a healthcare budget…. As much as Americans believe that they are crockpots and can be patient, we are more like microwaves and want things fast and on our own terms. Extended waiting lines will not work in the American system and would decrease the quality of our system as a whole.” [ 206 ] Read More

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Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons

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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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"Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." IvyPanda , 11 Oct. 2018, ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

IvyPanda . (2018) 'Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons'. 11 October.

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1. IvyPanda . "Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." October 11, 2018. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

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Home — Essay Samples — Government & Politics — Health Care Reform — Why is Healthcare Important – the Reason It Should Be Affordable

Why is Healthcare Important - The Reason It Should Be Affordable

• Categories: Affordable Care Act Health Care Reform

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Words: 1200 |

Published: Apr 17, 2023

Words: 1200 | Pages: 3 | 6 min read

Works Cited

• Vaughn, Lewis. Bioethics: Principles, Issues, And Cases. New York : Oxford University Press, 2013. Print.
• Daniels, Norman. Is There a Right to Health Care and, If So, What does it Encompass?

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Reasons Why Healthcare Should Be Free

Many people argue whether healthcare should be free or a privilege. Because of all that is happening around the world right now with covid-19 this is a huge topic that should be discussed. Healthcare is not a privilege or an opportunity in fact it is essential for survival. It is a right that should not be taken from people. Financial issues should not be the reason why a human does not get the medical attention they need. Providing free healthcare to the public is not something that can be done easily and it would take a lot of financing and policies to make this fair to everyone but here are some reasons why it should be considered.

1. bankruptcy

Medical bills can be a huge problem in families because not only is healthcare not free but it is in fact very expensive. Many families struggle with this and cannot get the medical attention needed due to their financial situation. One of my closest friends' mom had melanoma and had to go through multiple surgeries. These bills became very expensive for them and to this day they are still paying them off and this affects the lifestyle they live now. When people are sick this makes them worry how they will possibly pay for the bills and often leaves them wondering whether they even have the option to get the treatment, so making healthcare free or at least more affordable would tremendously help these people to not go bankrupt after receiving medical care. Families should not have to choose between their health and paying their water and food bills.

2. Correct Care

When it comes to health and prescriptions it should come down to what is the best option for the patient. With healthcare being so expensive right now insurance companies are deciding what is best for the patients rather than what the doctor is prescribing. My friend's mom with the melanoma was getting surgeries and treatments based off of her billing plan through her insurance and did not fully get the proper care needed which led to complications in the end. Free healthcare would provide the patients with the doctors orders rather than insurance companies.

3. The Unemployed

The unemployed would especially benefit from free healthcare. Once again healthcare is a right and should not be taken away from people who are in hard times financially. There are so many homeless unemployed people on the streets with signs asking for help. I have seen pregnant women who are homeless and have signs asking for help. Pregnant women need lots of medical care and attention and these unemployed people cannot afford to go see a doctor and are not getting the proper care. Free healthcare would help these suffering women on the streets to protect their baby and have a healthy pregnancy.

4. It is a right

Healthcare is a fundamental human right. This should not be taken away from anyone because they are struggling financially. Having access to healthcare is something that is crucial to have stability in the world. When everyone has access to healthcare we are improving humanity and ending the suffering of many lives. We should ensure we are providing everyone with their appropriate needs including treatments and surgeries for diseases that cause suffering.

5. It can prevent the spreading of diseases

Affordable healthcare could tremendously decrease the spread of diseases and viruses. If everyone is getting treated the amount of people that would get the disease would be much lower. Sometimes when people get diseases they will look into the cost of the treatment and realize the treatment is out of their budget and will then deny the treatment. They will then go on with their life spreading the disease to others. If doctor visits and vaccinations and antibiotics were free the diseases would not travel as much and as often.

6. Equality

One thing that is really big in healthcare is the competition between health service providers. They compete for who gets the most patients and when looking at patients they care for the richest ones. They completely lose sight of what is important and instead focus on who is willing to and can afford to pay for the medical expenses rather than who needs the attention the most. Having free healthcare will ensure that all medical providers are practicing good ethics and are paying attention to the problem rather than the money.

7. Improving the economy

Providing free healthcare would have an enormous impact on the economy. Many people do not work because they have health conditions which they cannot afford to fix. A country with free healthcare would have a stronger economy than those with pricey healthcare. If people were able to get the attention they need to work this would improve their productivity which would then improve the economy. My aunt in Alabama has a bad knee but cannot afford surgery to get it fixed so she does not work. If she was able to afford the surgery she would be able to be more productive for the country and her family.

Overall there are many benefits to free healthcare. It would make our country a better place with a better economy and prevent the spread of diseases. Healthcare is a right that people deserve to obtain. It would make people feel a sense of equality and would help end suffering in many such as the homeless and middle and lower class people. It would be a long process and there would be alot of argumentation to put the right system in place but with all of the benefits that it would provide it is something that needs to be talked about and considered. One question that could help us look further into the problem is 'How does the expensive healthcare system affect different people?'.

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Word count: 972

Error count: 13

Error density: 2%

A Journal of Ideas

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read more about Healthcare Insulin

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

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Persuasive Essay on Seatbelts

How it works

Alright, let’s chat about seatbelts for a bit. You know, those straps we always forget to buckle up? They’re actually super important but often overlooked by many drivers and passengers. This little essay is all about why wearing a seatbelt should be something we all do without even thinking, the science backing them up, and the moral duty we have to protect not just ourselves, but others too.

Alright, first off, what’s the main job of a seatbelt? It’s to keep you in your seat if you get into a crash.

If you’re not wearing one, the crash can throw you forward pretty fast, which can lead to really bad injuries or even death. The folks at the National Highway Traffic Safety Administration (NHTSA) say that wearing a seatbelt can cut the risk of dying by 45% for people in the front seat and the chance of serious injury by 50%. Those numbers alone should make anyone think twice about skipping the seatbelt. Plus, seatbelts stop you from getting thrown out of the car, which is usually fatal or leads to awful injuries. Staying inside the car with your seatbelt on gives you a big edge in staying safe.

Now, onto the science stuff. Researchers have shown over and over that seatbelts save lives. One study in the American Journal of Public Health found that using a seatbelt can prevent about 45% of deaths and 50% of serious injuries in car crashes. That’s some pretty solid proof that we should all buckle up. And seatbelt tech has gotten better too. Things like pretensioners and load limiters make them even more effective. Pretensioners tighten the belt right when a crash happens, keeping you from flying forward too much, and load limiters let the belt give a bit so it doesn’t crush your chest. These improvements show how car makers are working hard to keep us safe.

Lastly, wearing a seatbelt isn’t just about you. It’s about everyone around you too. If you’re not buckled in and there’s a crash, you can hurt others in the car by becoming a human missile. Plus, the costs of injuries from not wearing a seatbelt hit everyone. Medical bills, rehab, and lost work can add up big time. By wearing a seatbelt, you’re helping to cut these costs and showing you care about your community. Setting a good example, especially for kids, is huge. When kids see adults wearing seatbelts, they’re more likely to do it too, which can lead to a safer future for everyone.

So, to wrap things up, wearing a seatbelt is super important. It’s a proven way to lower the risk of getting hurt or killed in a car crash. The science behind it is rock solid, and the new tech in seatbelts makes them even better. Beyond just keeping yourself safe, wearing a seatbelt shows you care about others. By making it a habit and encouraging others to do the same, we can all help make the roads safer for everyone. Let’s make sure we always buckle up and make it a part of our daily routine.

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