There are several pros and cons of having health insurance, but the pros seem to outweigh the
cons. The most obvious pro is that large costs are at least partially covered by an insurance
agency. This can come in handy when an emergency health situation arises or in the case of a
chronic disease that will have long-term costs. One issue of health insurance is that insurance does
not always cover the full cost, which can still lead the insured person to be put into debt.
Additionally, high deductibles pose an issue for many Americans and can impede the willingness to
seek healthcare. Having health insurance also means a higher likelihood of preventing disease as
access to healthcare is increased and preventive screenings and tests are performed (O’Rourke
n.d.).
A con of health insurance is the risk of illness forcing an emergency room trip. This leads to high
costs and according to the Emergency Medical Treatment & Labor Act of 1986, any healthcare
facility that allows for Medicare and offers emergency services cannot turn away any patient
regardless of their ability to pay (Centers for Medicare & Medicaid Services, 2021). Other cons of
health insurance include limited access and the cost if a pre-existing condition is a factor
(O’Rourke n.d.). Many health insurances have loopholes and ways to get out of covering high
costs, leaving the insured person paying out of pocket for many visits, tests, and treatments. While
there are many issues with health insurance, having health insurance will reduce costs to the
system and individuals in the long-run by reducing emergency services and establishing a healthier
population that seeks preventive medicine.
"I don't need health insurance, it's too expensive and I'm healthy". I hear this a lot from my
friends who consider themselves in good health. Then when they get sick and have to go to urgent
care, they get an expensive bill in the mail for the co-pay and visit tests along with the high costs
of antibiotics or other medications for that treatment. Yet they still think it is cheaper than paying
monthly for private insurance plan. This may be a temporary way to save money on medical
expenses as they arise, but it is not a financially stable plan if there was an accident which could
cost up to $30,000 out of pocket for an ER visit or having regular check-ups to detect preventable
chronic health problems. “Research connects being uninsured with adverse health outcomes,
including declines in health and function, preventable health problems, severe disease at the time
of diagnosis, and premature mortality.” (Hoffman).
Health insurance coverage may be expensive but in the long run of preventative health such as
regular check-ups and vaccines, having coverage can improve access to quality care and a longer
healthier life. If you do not make time and invest in your wellness, you will be forced later in life
to pay for your illness. The triangle of health care describes how “the three competing priorities of
health care delivery – cost, quality, and access – are engaged in a zero-sum game” (Van Der Goes).
The ideal solution for most healthcare facilities is to have access to high quality care at a low cost.
However, it is very difficult for most Americans who do not have an insurance plan through their
employment to pay for the cost of medical insurance and deductibles for their family. As
innovative medical technologies advance our healthcare system, so do the costs. So how can we
collectively lower the cost of medical expenses without having universal healthcare to make sure
everyone has access and can afford quality medical care?
In the United States, the healthcare system is set up as to where if you do not have insurance
through a private or government source, you are vulnerable to the exorbitant costs of care. Ashley
Brooks discovers in her study; “The cost of a primary care visit without insurance generally ranges
from $150-$300 for a basic visit and averages $171 across major cities in the United States.”
(Brooks, para. 1, 2021). Obtaining private insurance is generally tied to employment, and
government insurance is not available to every American. This creates gaps in those who are
insured, and those who are not. In 2020, the US Census found that 8.6%, or 28 million Americans
do not have health insurance. (Keisler-Starkey & Bunch, para. 2, 2021) This leads many uninsured
Americans to a tough choice; face the expensive barriers to obtain health care, or, go on without
care to save money.
Many young Americans feel that they do not need health insurance due to perceived wellness.
While the uninsured who make this decision benefit by saving personal finances, they put
themselves at risk of developing illnesses that may go unnoticed. They also drive up the overall
costs incurred within the healthcare system by delaying care. Stephens writes; “when an
uninsured American is ill, and being aware that he or she cannot afford or fully afford the cost of
care, the individual often waits to seek care with the concomitant result that the acuity or severity
of the problem increases (in many cases). Thus, when treatment is sought, the cost of treatment is
much greater than what it would have been had the person sought medical treatment at the
onset of the problem.” (Stephens, para. 8, 2010). Oftentimes illness is caught too late to be
treated efficiently, which leads to more extensive treatment that are more costly.
Primary care is the best way to monitor and maintain a healthy standard of living. Trihealth
discusses the importance of primary care with their quote; “Regular checkups and contact with a
single physician make it more likely that any health issues will be detected early, when they’re
most treatable.” (Trihealth, para. 5, 2017). By assuming they are in good health, these uninsured
Americans are putting themselves in danger, and potentially driving up the costs of overall
healthcare in America.
Despite rising health care costs in the United States, we continue to experience worsening health
outcomes. According to 2019 OECD Health Statistics, health care spending per capita in the United
States exceeds $10,000 and is more than double that compared with the costs in Australia, France,
Canada, New Zealand, and the United Kingdom (The Commonwealth Fund, 2020). Between
January 14 and June 5, 2020, 4,272 adults aged 19 to 64 were surveyed regarding their current
health insurance coverage; these results were published in the Commonwealth Fund Biennial
Health Insurance Survey (The Commonwealth Fund, 2020). The results of this survey were
astounding, approximately 43.4% of American included in this survey were inadequately insured.
In addition to this 12.5% of those surveyed were uninsured, 9.5% reported experiencing a lapse in
their health insurance coverage in the past 12 months, and 21.3% states that they were
underinsured (The Commonwealth Fund, 2020). I found it interesting that although Americans
have higher health care spending overall, they have less physician visits on average than their
counterparts in other regions of the world (The Commonwealth Fund, 2020). I believe this issue is
twofold, first, there is a shortage of viable healthcare providers in the country, which can impact
and limit access to care. Secondly, the cost of healthcare has become increasingly unaffordable,
which has resulted in Americans needing to make very difficult decisions regarding their personal
health and well-being. On average, citizens in the United States are paying approximately $1,122
as out of pocket costs (The Commonwealth Fund, 2020). Due to these expenses American families
are forced to make difficult decisions regarding feeding their families, seeking necessary medical
treatments, or providing other necessities for their families.
As a result of rising health and health insurance costs, healthy Americans may opt to purposely
avoid medical insurance. If they are not in need of medical care, they may not see the benefit of
having and paying for a service they are not utilizing. There are certainly associated pros and cons
to this decision. Americans who do not utilize health insurance can reap financial benefits in the
short term. Previously, individuals without health insurance incurred a tax penalty per the
Affordable Care Act, however, this was rolled back as of 2019 (Williams, 2021). I consider myself a
relatively healthy individual, however, on my recent annual physical my provider heard an
incidental murmur. Although I was asymptomatic, an echocardiogram was ordered to rule out any
concerning cardiac issues; thankfully it was within normal limits. Much to my dismay, I was hit
with a $900 bill despite being adequately insured. I can definitely commiserate with those who are
feeling the burden of excessive health care costs. Although I was not pleased with this cost, I
realize that I would have been hit with a larger bill if I didn’t have health insurance. On the
opposite end of the spectrum, not having health insurance could result in mountains of financial
debt. According to the National Center for Chronic Disease Prevention and Health Promotion
approximately 6 in 10 Americans have a chronic condition (Williams, 2021). Routine preventative
care could be extremely beneficial in early detection, treatment, and management of these
chronic issues before they manifest into critical health care conditions. In these situations, medical
treatment ultimately becomes reactionary rather than preventative, which can result in higher
overall costs long term.
When the question is asked either to have or not have medical insurance one has to ponder the
many pros and cons. Just like the question in our discussion stated that many feel they are healthy
enough and do not need to carry some form of health insurance. Many do not carry health
insurance due to the fact that they cannot afford it, or their employer does not offer any form of
insurance subsidies. b The Affordable Care Act (ACA) has helped increased the number of people
with insurance and helped reduce prices to make it more affordable for Americans. Those
Americans who could not afford health insurance were mandated to get health insurance under
the ACA faced a federal penalty in fines. The federal mandate ended in 2019 but a few states kept
the mandate requirement and penalties in place. These states are California, Massachusetts, New
Jersey, The District of Columbia, and Rhode Island (Bailey, 2021). For some this is considered a pro
and a con, a con because you are mandated to have insurance but a pro because you can save
money for having some form of insurance. Another con of not having insurance is that when you
do get sick, ill, or injured and need to visit a doctor it can cost from a few hundred dollars up to
thousands of dollars. In a 2019 study, found that 2/3 of people who filed for bankruptcy did so
due to medical bills effecting their financial situations (Bailey, 2021).
Bailey, E. (2021, October 31). Is there a penalty for being uninsured? Single Care:
https://www.singlecare.com/blog/penalty-for-no-health-insurance/
The Commonwealth Fund. (2020, August 19). U.S. Health Insurance Coverage in 2020: A Looming
Crisis in Affordability. https://www.commonwealthfund.org/publications/issue-
briefs/2020/aug/looming-crisis-health-coverage-2020-biennial
The Commonwealth Fund. (2020, January 30). U.S. Health Care from a Global Perspective, 2019:
Higher Spending, Worse Outcomes? https://www.commonwealthfund.org/publications/issue-
briefs/2020/jan/us-health-care-global-perspective-2019
Williams, T. (2021, September 7). Don’t Have Health Insurance? What’s the Worst That Could
Happen? Investopedia. Retrieved from https://www.investopedia.com/articles/personal-
finance/120815/dont-have-health-insurance-whats-worst-could-happen.asp
Brooks, A. (2021, October 27). How much does primary care cost without insurance in 2021? Mira.
Retrieved February 1, 2022, from https://www.talktomira.com/post/how-much-does-primary-care-
cost-without-insurance
Keisler-Starkey, K., & Bunch, L. (2021, October 18). Health insurance coverage in the United States:
2020. Census.gov. Retrieved February 1, 2022, from
https://www.census.gov/library/publications/2021/demo/p60-274.html
Stephens, J. H., & Ledlow, G. R. (2010). Real Healthcare Reform: Focus on Primary Care Access.
Hospital Topics, 88(4), 98-106.
https://ezproxy.snhu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-
journals%2Freal-healthcare-reform-focus-on-primary-care%2Fdocview%2F851505374%2Fse-
2%3Faccountid%3D3783
Van Der Goes, D. N., Edwardson, N., Rayamajhee, V., Hollis, C., & Hunter, D. (2019). An Iron
Triangle ROI Model for Health Care. Clinic Economics and outcomes research : CEOR, 11, 335–348.
https://doi.org/10.2147/CEOR.S130623
Hoffman, C. and Paradise, J. (2008), Health Insurance and Access to Health Care in the United
States. Annals of the New York Academy of Sciences, 1136: 149-160. b
https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1196/annals.1425.007
Centers for Medicare & Medicaid Services. (2021). Emergency Medical Treatment & Labor Act
(EMTALA). Retrieved from https://www.cms.gov/regulations-and-
guidance/legislation/emtala?redirect=/emtala/
O’Rourke, P. J. n.d. 25 Important Pros and Cons of Health Insurance. Retrieved from
https://environmental-conscience.com/health-insurance-pros-cons/
