peer reviews

1

Healthcare Debate Group 2

MAN 5716

Florida State University

Julia Phillips, Cara Grimme, Isobelle Ellis, Benjamin Robinson, Cody McCaskill, and Noah Green

Dr. William Christiansen

March 28, 2021

Introduction

The United States currently has a free enterprise healthcare system, where prices for healthcare services and goods are set freely by an agreement between healthcare professionals and their patients. Individuals utilize private insurance to help cover the costs, often given to them by employers, and programs like Medicare and Medicaid are available to aid others. It can be debated that the United States would benefit from switching to a universal healthcare system, in which coverage would be provided to all by the government, regardless of insurance or their availability to pay. Some of the arguments made by advocates of adopting a universal healthcare system in the United States include easier ability to seek out preventative care and health education, a healthier workforce, reduction in drug costs, and increasing the size of the healthcare sector. Proponents of the current healthcare system are in favor of the quality of treatment received, minimal wait times, freedom of choice, and resources available, among other benefits.

Universal Healthcare

An advantage of adapting a universal healthcare system in the United States is the creation of a healthier population preventative care. With a universal healthcare system, individuals are all granted access to healthcare and fears of not being able to afford services, or lack of insurance, no longer hinder their ability to seek preventative care and medical treatment. Starting at a young age, parents will easily have the ability to seek out and receive annual visits, preventative care, and health education. As stated by the CDC in 2016, “Early childhood education interventions can improve children’s development and act as a protective factor against the future onset of adult disease and disability.” With all children able to receive education and healthcare under a universal system, they will no longer require visits for preventable illnesses and healthcare costs will be lowered as they get older.

Many adults, fearful of the costs associated with healthcare under a free enterprise system, tend to avoid seeking out care until issues have arisen and a visit to a health care professional can no longer be avoided. According to CDC data on emergency room visits, “79.7% of adults visited the emergency room due to lack of access to other providers,” since they did not have insurance. Universal healthcare would have allowed these adults to seek out preventative care or less urgent care before their health issues had reached a severe point, requiring the emergency room. Studies of universal health care and those with access to preventative care demonstrate this. One three yearlong study of over 10,000 people between the ages of 35-84 years old showed that preventative care “significantly reduced use of the ER in years 2 and 3 and urgent care facilities in all 3 years” (Musich et al). Emergency room visits are far more costly than preventative care and early intervention. Reducing emergency room visits through a universal healthcare system will lower healthcare costs overall.

With access to preventative care starting at an early age and less emergency room visits, a healthier workforce will be created. Under a universal healthcare system, everyone in the workforce will have access to healthcare, preventing them from calling out sick due to preventable illnesses. “A study by researchers at the Universities of Colorado and Pennsylvania showed that workers with health insurance miss an average of 4.7 fewer work days than employees without health insurance” (healthcare.procon.org). Workers with children may also see positive effects and miss less work if their children are receiving care to stay healthier. This will not only be a positive health effect for the employees, but also for their employers and coworkers. It can be more difficult for food service or retail workers to receive healthcare from their employers in the current free enterprise system, often leaving them more vulnerable to going without than other work industries. These are also the industries where call outs can cause significant stress or a mental health strain on employers trying to find coverage for their missed shifts or on their coworkers who are left to help cover their absences.

A healthier workforce also provides benefits to the economy overall, by being able to provide more contribution to it. “According to an Institute of Medicine report, the US economy loses $65-$130 billion annually as a result of diminished worker productivity, due to poor health and premature deaths, among the uninsured” (healthcare.procon.org). When workers are no longer missing as much work, they are earning more income, especially if they do not have sick time benefits to supplement their income. As a result, they are more likely to have a disposable income to spend and stimulate the economy. Similarly, healthy workers benefit their employers economically through higher productivity, resulting in better sales and profits for that business. In addition to the lowered cost of healthcare, universal healthcare is a positive change for the economy.

Another major benefit of the United States adopting a universal healthcare system is that it will drive drug prices down since a single entity would be responsible for the purchasing and price negotiation of prescription drugs. Compared to other countries, Americans pay “somewhere between 80 percent and 150 percent more” for their prescription drugs than citizens of countries where a single entity has set the price (Morgan, 2018). Setting the price low enough for it to be accessible for low-income families will help prevent cost-related noncompliance. It will also keep hospitals from wasteful spending and expenses due to unnecessary follow-up visits on easily preventive diseases such as diabetes and obesity related issues.

Another important issue that universal healthcare will help alleviate is the overwhelming “job lock” employees are feeling across the United States. Job lock is when an employee will not leave their current job because of the insurance benefits they receive through their employment. Delinking health insurance from employers will mean workers will have more career options to choose from rather than staying at a company that can only provide little to no health insurance coverage. Self-employment and the creation of small businesses in the United States will rise and job satisfaction across the country will reach all-time highs (Bivens, 2020). Unskilled workers will be able to receive the same level of care as those whose companies provide health benefits, and organizations can pay their employees higher wages as they don’t have to worry about providing health insurance.

A final benefit of adopting a universal healthcare system is that it will drastically

increase the size of the healthcare sector. Research estimates that “expanded access to health care could increase demand for health services by up to $300 billion annually. Given the current level of health spending and employment, this would translate into increased demand for 2.3 million full-time-equivalent workers in providing healthcare” (Pollin et al. 2018). There will be losses in insurance billing and administration jobs, but the demand for the new jobs will outweigh the losses.

While there are numerous benefits of universal healthcare, there are also many disadvantages. One of the biggest downfalls of a universal healthcare system is the significant amount of money it would cost the government and individuals to maintain it. Most of the proposals include an increase in taxes, specifically for top earners. One specific proposal to finance Medicare for all individuals suggested a payroll tax of 7.5% and a 4% income tax for all Americans; high earners would be subject to even more taxes. Even with these increases, some say that it won’t be enough to pay for healthcare for everyone. Estimated costs range from 30-44 trillion dollars over 10 years, which would result in over a one trillion-dollar deficit each year. (Watson & Miller, 2020)

Additionally, implementing a universal healthcare system will result in healthy individuals paying for healthcare costs of those that have chosen not to take care of themselves over the years. For example, consider a relatively healthy 55-year-old male that eats a balanced diet and exercises 4 days a week and has medication-controlled high blood pressure. Compare him to a morbidly obese 32-year-old male who refuses to eat a healthy diet, exercise, and has numerous health conditions such as uncontrolled high blood pressure, diabetes, chronic lymphedema, and ostearthritis. It is not fair for those that have made a conscious effort to maintain their health to be required to pay for the healthcare of those who did not through their tax dollars.

Universal healthcare is anticipated to result in system inefficiency leading to long wait times for patients, especially for tests and elective procedures. People already witness the effect of long wait times here in the United States, as they see many patients from Canada come to the United States for their elective procedures to avoid waiting for months on end. In Canada, over 1 million patients were on waiting lists for procedures in 2017 (Barua). We can likely expect far higher numbers if the United States adopts universal healthcare because we have a larger population. There is already a shortage of physicians, and this would become even more evident with a change in the healthcare system. The shortage of primary care physicians will inevitably lead to elongated wait times to see a physician. Additionally, physicians will be burdened with the task of prioritizing patients, which can be difficult sometimes. This can lead to mistakes and more malpractice claims, as doctors will be rushing through patients and potentially could miss early warning signs of deadly diseases. This shortage can also contribute to physician burnout and hinder the quality of healthcare services being provided.

Yet another reason why universal healthcare should not be implemented is because the government will be able to more strictly regulate physician decisions including the use of new, innovative therapies, and will also be able to direct payment based on differences in quality of care. This should not be the case because physicians and researchers have the education and experience to determine which therapies are best for their patients. The government should not be able to decide which patients get what specific testing and treatments; this should be left up to the experts in the field.

Medical technology is evolving rapidly. New equipment is being produced that can better diagnose and serve patients. With the high cost of maintaining a universal healthcare system, paying for new innovations has the propensity to fall down the list of priorities. In the long run, this can negatively affect patient health and outcomes, and result in further increasing costs of the healthcare system. Imagine there being a new test to detect heart disease years in advance, but we don’t have the funds to allocate toward getting this new technology around our country. Heart disease results in the death of hundreds of thousands of individuals each year. Not having technology as such would result in our health care not progressing as it should, which in turn would negatively affect our society.

The aforementioned reasons pose a strong argument against universal healthcare. The increasing cost to the government and society along with long wait times for tests and elective procedures are factors that can negatively affect our society. Moreover, a switch to universal healthcare will lead to increased crowding of emergency rooms and more primary care visits, both of which can result in decreased quality of healthcare. The goals of healthcare should be to provide quality care in the most efficient manner to our society. A universal healthcare system would likely negatively more than positively impact these goals.

Free Enterprise Healthcare

The current free enterprise healthcare system in the United States is heavily reliant on a system of direct payment, has different models for targeted populations, and gives higher quality treatment without raising costs for those that are not needing treatment. This is unlike that of those in other countries such as: France, Canada, and Germany. Here in the United States, healthcare is private and most receive it through their employers. There are many pros to this concept of free enterprise healthcare, and they include but are not limited to: better quality treatment, minimal wait times, only paying for your medical care, patients having control, and adequate resources.

A major benefit of the United States healthcare system is the quality of the services. Here in the United States disease treatment rates compared to countries with universal healthcare are significantly better. For instance, annually there are fewer cancer deaths per 100,000 people in the United States compared to that of France and other countries with universal healthcare (Procon.org). This benefit stands out because the whole point of healthcare is to help diagnose and solve problems to keep individuals healthy. This shows the quality of healthcare services here in the US with the market-based system.

An additional major benefit of the United States healthcare system is the minimal wait times for major procedures. In a study done in 2018, half of all patients reported waiting over 4 weeks to see a specialist in France, while in the United States only 28% of patients reported waiting that long (Amadeo). This is definitely an important factor to consider when analyzing the effectiveness of the healthcare system because the longer the wait, the more people that are going to die waiting for procedures and to see specialists. With this benefit comes the guarantee that there are adequate resources available for every procedure. This is not only protecting the doctors working, but also protecting the patient on the table, as more precautions are being taken preventing future health issues from arising.

Another major benefit of the current United States healthcare system is the cost of care for those that are healthy. With how the United States healthcare system is currently set up, individuals are only paying for the healthcare treatment that they are using. In a universal healthcare system, those that are healthy could be incurring thousands of dollars of costs, in the form of taxes or premiums, to help cover the costs of those who need to visit the hospital more often. This is helpful to those that don’t need as much medical treatment, and is fair in the case of those that choose to live unhealthier lifestyles requiring them to need more medical assistance. With the United States free enterprise healthcare system, you only must pay for the treatment you need.

In free enterprise health care systems, the patients are more in control of their providers, rather than the government. The autonomous aspect for consumers makes the free enterprise system attractive. Each patient possesses individual needs specific to their own health. The current market operates similar to a supply and demand market, thus, if the supplier, or business side, does not attract and keep customers, it loses money (Forbes, 2018). This competition is an incentive for insurers and hospitals to offer high quality services, driving an increase in productivity. Further, insurers, acting as independent agents, are able to help the customers make the best economic decision with regards to treatments (Reddy and Mythri, 2016).

One may argue that free market systems are inadequate in handling the needs of a patient due to the perceived objective that they operate to increase profits for shareholders. However, the proper approach for a free market business model is to maximize value for the stakeholders. In the healthcare field, the patients should be viewed as the first-priority stakeholder (Reddy and Mythri, 2016). Contrarily, in government-sponsored taxpayer paid health insurance the government decides what you can or cannot have. This limits the choice of the patient, further obstructing the relationship between the business-consumer by adding in an additional party. For example, in many universal systems patients are limited to a few providers or physicians while the physician acts as the agent who directs the best treatment for a health concern, this may lead to spurious supplier induced demand. Allowing the physicians to scheme patients into services that fit their business model, in the absence of competition (Reddy and Mythri, 2016).

Universal Healthcare may not be perfect, but there are many negatives to the current free enterprise healthcare system that the United States uses today. One of the biggest issues is the cost to have health insurance. Health-care services are expensive, and medical debt is the leading cause of bankruptcy in the United States. If you don’t have insurance, or if you are under-insured, then you will have to pay the medical costs out of your own pocket. These costs can be extremely high, more than most people can afford. If you don’t have medical insurance, you are more limited to the places you can go to receive medical services.

Another issue with free enterprise healthcare is the limit of insurance coverage. Most health insurance is provided through employers. You pay for the medical insurance out of your paycheck, and if for some reason you lose your job, you could find yourself without insurance coverage. Even when you are covered by the insurance your employer provided, you are still limited to the medical care facilities that are in the network of your insurance. In many cases, if you receive care outside of that network, and the insurance doesn’t cover it, you are left to pay for it yourself. If you do receive care, and the place is in the network of your insurance, you will still usually have a deductible or copay that you still have to pay. Overall, when adding in the cost of insurance that is getting taken out of your paycheck, the amount you spend on deductibles/copays, or what your insurance doesn’t cover, you could still be spending thousands of dollars a year. There is also little done about preventative care. There are standards like shots and screening tests that must be done, but outside of that most insurance plans don’t have preventative care plans.

On the billing and pricing side of free enterprise, there’s a lack of transparency and administrative inefficiency. A lot of times, you don’t know how much you are paying for a medical treatment. It could be a doctor appointment where you don’t know what you will owe until after it’s billed to your insurance. Or, it could be a surgery or procedure, where you have costs for the surgeon, the anesthesiologist, and other costs. No matter what it is, you don’t really have an option to shop around, or compare prices before making your decision. On the doctor’s side, a lot of time is wasted on billing and insurance claims. Patients could have multiple insurances, where one insurance would cover one thing, and the other covers the rest. Different plans could also decide on how the insurance covers the cost. This forces doctors to spend hours communicating with insurance companies to provide care.

Conclusion

Universal and free enterprise healthcare systems both have their benefits and weaknesses. There is no simple answer to determine what the best healthcare system for the United States would be. If the United States were to adapt a universal healthcare system, they would have to consider what universal healthcare structure to implement. In some countries with universal healthcare, the government runs their medical facilities while in other countries the government regulates and reimburses them. If a free-enterprise system remains, there may be room for improvement. For example, the United States could focus on making private health insurance easier to obtain or implement regulations to improve the transparency of costs for treatment. Healthcare is a complex issue, and many considerations will need to be made when determining what will be best for the United States and its citizens.

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