According to the World Health Organization, universal healthcare is defined as “[ensuring]
that all people have access to needed health services (including prevention, promotion,
treatment, rehabilitation, and palliation) of sufficient quality to the effective while also
ensuring that the use of these services does not expose the user [to] financial hardship” (Zieff
et al., 2020). With the passage of the Affordable Care Act, health care coverage was extended
to millions of Americans, however, there is still a mix of private and public insurers greatly
involved in this process. The idea of universal health care is a highly contested issue in the
United States. There are various factors that can impact an individual’s access to health
insurance in the United States including socioeconomic status, employment status, race,
sexuality, gender, and ability to pay. Globally, there are various iterations of universal
healthcare which could successfully serve as guidance if the United States were to implement
a single payer model. Universal healthcare in the United Kingdom is traditional in the sense
that it is mainly comprised of minimal options and there is rare use of private insurance (Zieff
et al., 2020). Meanwhile, universal healthcare in European nations is a mix of governmental
and market sponsored options (Zieff et al., 2020).
Although there are governmental programs in place that currently provide health insurance
coverage to children, elders, and citizens with limited incomes, there are still many
Americans who believe that the government should have a limited role in healthcare. The
cultural, ethnic, political, socioeconomic, and religious composition of the United States
could make implementation of the universal health difficult compared to its counterparts.
Additionally, adversaries to the implementation of universal healthcare note that the upfront
costs and associated tax increases would be unjustified. Zieff et al., note that implementation
of universal healthcare could result in a 7.5% payroll tax increase in addition to a 4% income
tax increase absorbed by all Americans (Zieff et al., 2020). Those who opposed the extension
of coverage to all citizens also argue that this would decrease access to care, increase wait
times for services/procedures, and have a significant impact on the quality of care delivered
(McFarlane, 2021). Although universal healthcare will continue to be a highly contested
topic, it is agreed upon that there is certainly the need for further reform within the system to
improve its current barriers and inefficiencies.
The principles on which the U.S. was founded were anti-tyranny, freedom, and autonomy. As
a result, the founding fathers constructed our country with checks and balances built into
government processes and limited government intrusion on the lives of its citizens. Therefore,
one can argue that a universal health care system run by the government that mandates
coverage for all citizens goes against the very principles that built this country. I truly believe
that this has been the foundation for much of the resistance to a government-run single-payer
health care system in the US. In many ways, this resistance has been slowly eroding over
time, and our health care system has evolved from something that looked like a free-market
system to today’s patchwork system that is more closely resembling a single-payer structure.
There have been and continue to be many obstacles to universal health care in this country
based on a foundation that many Americans feel that health care is not a responsibility of our
government (Rashford, 2007). In fact, most physicians polled support national health
insurance but oppose the government as the single payer (Rashford, 2007). One of the reasons
our physicians, nurses, and medical staff have some of the highest incomes in the world is
based on private insurance money that flows into the health care system, not Medicare and
Medicaid (McDonough, 2017). Countries with single-payer health care systems pay medical
staff at much lower rates and provide fewer specialized services than the U.S. (Rashford,
2007). Therefore, it is not difficult to understand why the American Medical Association
lobbies so hard against a government-run system. Our government is not a unified centralized
one, like you find in the UK and Sweden; our government has multiple legislative chambers,
courts, lobbyists, and state governments that can enact or block legislation (Greer et al.,
2019). As a result, our system is designed for opponents of a policy to wield enormous
impacts. The U.S. has a history of rejecting government-established spending limits, which
would be required under a universal health care structure; this drives the opposition from
insurance companies, health care providers, and other businesses in the medical industry
(Rashford, 2007). Finally, there has been a lack of agreement on the structure of funding
sources for a single-payer system (Rashford, 2007).
The obstacles mentioned have led to the failures by three states to implement a single-payer
system within their borders: California in 1994, Oregon in 2002, and Colorado in 2016
(McDonough, 2017). In these states, voters could not be convinced that the proposed systems
would be financially sound. In addition, tax rate sticker shock destroyed an attempt by
Vermont in 2014 to pursue a single-payer system when income taxes were projected to rise to
9.5% and payroll taxes to 11.5% to finance the system (McDonough, 2017). I believe that
universal health care in this country is inevitable; however, who will finance the system is
still open for debate. Many obstacles remain to be overcome.
A reason the United States has a pushback to compulsory health coverage is because of a
political culture that we have adopted. Conservatives believe that the government should have
limited roles in society (US News, n.d.). Many people feel that the government should only be
allowed to make limited decisions on behalf of the American people (US News, n.d.). Though
Medicaid and Medicare have been around for years, it is geared towards low-income families
and the elderly, which is paid for by the government. Also, many Americans seem to self-
identify as middle-class citizens. Meaning they are not rich, but not poor either. "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" (Zieff et
al., 2020). The United States does not have universal healthcare, but has the worse health
outcomes than any other country such as Japan, Australia, Canada, the United Kingdom,
Germany, and France considering other avenues of health coverage (US News, n.d.). The
United States also holds a lower life expectancy with its healthcare system with higher infant
mortality and higher obesity rates than other countries, especially considering the indigent.
So, does it really make a difference whether there is universal coverage or private/public
healthcare, if this is the community that is supposed to benefit from government induced
healthcare? A lot of pushback comes from Americans who may feel that the government does
not have their best interest at heart and they may be correct because it is essentially a
business.
In the United States, healthcare primarily is focused on the market justice theory. In this
perspective of healthcare, health is viewed as a commodity rather than a human right. Most
healthcare providers open their doors to make a profit. The concept of Universal healthcare
focuses on the opposite side of the spectrum which is the social justice theory. In this theory,
health is viewed as a basic human right where all humans deserve equal care. APHA states;
“Social justice is the view that everyone deserves equal rights and opportunities — this
includes the right to good health” (APHA, para. 1, 2021). Profits are taken out of the
equation, and ideally, care is distributed equally.
Market justice theory is difficult to change as it is deeply rooted in America’s history. Budetti
states; “Market justice runs deeply in health care in the United States. Well into the 20th
century, both buyers and sellers participated in a fully functioning market.” (Budetti, para. 2,
2008). Implementing universal healthcare threatens the ideas of freedom that Americans have
built their country on. Many Americans feel very strongly about keeping their markets open,
and unfortunately this has led to healthcare being viewed as an open market. Government
interventions are intended to sway this idealism, but fall short as only certain Americans
qualify for government care.
Another reason why universal healthcare is opposed by many is the fact that it will increase
taxation on the American population. Of course, universal health care comes with a price.
“This is an affordable cost, yet many believe that it imposes on their rights. 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”. (Zief et al., para. 7, 2020). As we have discussed before in this course, universal
healthcare for all would equate to a tax increase of $36 per month. Some view it as too much,
yet some believe the cost is worth the benefit.
This has adverse effects on the public health of the population. The KFF “found Half of U.S.
adults say they put off or skipped some sort of health care or dental care in the past year
because of the cost. Three in ten (29%) also report not taking their medicines as prescribed at
some point in the past year because of the cost.” (Kearney, para. 3, 2021). Individuals who
must pay for healthcare are often unhealthier than individuals with coverage. Market theory
of healthcare directly affects health amongst American citizens, yet is still upheld within this
country.
Although universal healthcare seems ideal it comes with consequences especially in the
United States. Medicare, Medicaid, and CHIP program are regulated through the government
however individuals must meet certain requirements to receive these kinds of benefits. For
Medicare the patient must be 65 or older and have worked and paid Medicare taxes for 10
years and the patients that are under 65 usually qualify for Medicare because they have a
known disability. Receiving Medicaid, the patient is usually low income that covers pregnant
women, children and individuals who receive supplemental social security. The children’s
health program is for children 18 or younger and do not qualify for Medicaid. These programs
are easy to regulate because most people don’t ever qualify for the programs or they don’t
reach the age limit, especially with Medicare. Universal health care is controversial because it
is hard for the government to relate, and it would cause issues when the patients want to
receive care in a timely manner. According to Gabriel Zieff, Zachary Y. Kerr, Justin B.
Moore, and Lee Stoner, b b b b b b b b b 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 . 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
(Zieff, Kerr, Moore, stoner,2020). Universal health care would cost the united tons of money
and continue to put the country in debt. Master class staff stated in some countries with
universal health care, patients see long wait times or even must wait months to be seen at all.
Governments focus on providing essential and lifesaving health care and may neglect to cover
rare diseases or elective procedures. With universal health care it is possible that the patients
will see a decrease in quality of care because hospitals, medical offices, and urgent are seeing
triple the patients and to see them all in a day they are doing the bare minimum care to be able
to go see the next patient. Overall universal healthcare can be beneficial but the government
would have to find a way not to tax the patients so much in taxes and cause the government to
go in financial debt trying to offer free healthcare to everyone.
The United States spends substantially more on health care than any other nation in the
world, spending more money on health care for those over the age of 65 than any other nation
spends for its entire population. Although the United States offers the most sophisticated and
advanced treatments that exist in the health care industry, we still suffer from worse health
outcomes, including lower life expectancy, higher infant mortality rate, and higher obesity
than other countries such as Australia, Canada, and the United Kingdom (Vladeck, 2003).
Although President Obama’s Affordable Care Act (ACA) moved toward the direction of
expanding access to health care to more people and ensuring that insurers can’t deny coverage
because of an applicant’s preexisting conditions, it was criticized for its flaws and President
Trump pushed to repeal it. The question remains as to why universal health care in America
isn’t currently being considered, although Medicare, Medicaid, and CHIP do currently serve
to protect some of the nation’s most vulnerable populations.
b b b b One reason there’s pushback regarding universal health care coverage in America is the
unique political culture. Americans, especially conservatives, hold a strong belief in classical
liberalism and feel that the government should have a limited role in society. The
International Social Survey Program discovered that a lower percentage of Americans believe
health care is a government responsibility when compared to individuals in other advanced
countries, such as Germany or Sweden (Callaghan, 2016). Furthermore, interest groups that
influence political processes play a strong role in universal health care opposition. For
example, in 2009 the legislative battle over the ACA generated $1.2 billion in lobbying. The
insurance industry alone spent over $100 million shaping the ACA and keeping private
insurers (as opposed to the government) as the major power holders in American health care.
When discussions regarding universal health care are raised, these lobbyists are quick to
mobilize to prevent implementation. Additionally, America’s political institutions make it
difficult for entitlement programs to be implemented. Policy experts have explicitly shared
that the U.S. “doesn’t have a comprehensive national health insurance system because
American political institutions are structurally biased against this kind of comprehensive
reform.” Any major attempts at comprehensive reform must pass through congressional
committees, budget estimates, conference committees, amendments, and a potential veto
while opponents of reform publicly scrutinize the bill (Callaghan, 2016). This makes it
extremely difficult for any major reform to successfully pass through the obstacle course.
Lastly, Americans are worried that universal health care will create greater costs to them in
the form of taxes. Many Americans are against the idea of having to pay more out of pocket in
an effort to keep the entire population protected. Since Americans already have to pay such
high health care costs, the thought of having to pay even higher costs is out of the question for
them.
I have heard many times over that Universal Healthcare is a big no-no for our Country, but I
never actually researched the reason why this is such a pushback. I came from a country who
did have Universal Healthcare; however, I have always heard that care was not as great as the
care we would receive in the US, and many times, I have heard that it is nearly impossible to
find a specialist in a timely fashion. I have also heard that it is very costly for the population,
as taxes are very high.
According to US News, (2016), there are 3 reasons why there is such a pushback over
universal healthcare. One reason is that our culture simply does not want it because they
believe that the government should have limited involvement in healthcare. Another reason is
that interest groups and lobbyist are not interested in having universal healthcare. Lastly, it
would be very difficult and expensive to enact. (Callaghan, 2016)
An article from the National Library of Medicine, claims that there are benefits to have a
universal healthcare system, such as a healthier population and less disparities, however, there
are also cons. Some of these cons that have given pushbacks against this matter include: 1.
Increased federal taxes, as high as 7.5% payroll, and 4% income tax; 2- system inefficiencies,
such as length wait times for patients seeing specialist and having elective procedures done; 3-
unorganized government systems. (Zieff, Kerr, Moore & Stoner, 2020)
It is safe to say that people seem to be very concerned with the cost this may imply on the
population, especially since may people already pay large a large amount of money for
healthcare insurance and out of pocket costs, as well as high taxes to provide government
healthcare plans. People also seem to have a push-back against the government being too
involved in healthcare. Worries of our healthcare quality decreasing may also be a concern.
Healthcare in the United States is governed by a complicated bureaucracy. "Over the last
century, American health care has thrived. Rather than impeding advancement, the
complicated regulatory framework, for all of its failings, may have actually contributed to
nourish and foster the broader industry" (Field, 2008). Unlike the rest of the world, where
medical facilities are generally controlled by governments or private enterprises, the majority
of hospitals and clinics in the United States are owned by public institutions or private
organizations. However, the United States has the highest healthcare prices in the world.
Although these costs are borne mostly by public payers such as federal organizations or state
and municipal governments, they may also be privately insured and borne by individuals. At
the same time, unlike most developed countries, the United States' healthcare system does not
cover the entire population. Because there is no single national health insurance system, the
United States is mainly reliant on employers to offer health insurance for employees and their
dependents on a voluntary basis. Furthermore, the government offers programs that tend to
pay the expense of health care for disadvantaged groups in society, such as the old, disabled,
and destitute. These programs are all unique, and each one caters to a distinct demographic.
The US government does not provide health insurance to everyone, and it is not essential for
those who live in the US to have health insurance. This is optional, but highly recommended
and necessary due to the exorbitant cost of health care in the United States, which is higher
than in any other country on the planet. "Health systems that fail to adapt to changes in
fundamental public health ideas face enormous inequities and consequences from preventable
disease, disability, and death" (Theodore, T and Elena, V., 2014). In the United States, there
are two types of health insurance: private and public. Most individuals use a mix of the two
public health insurance programs in the United States, which are Medicare, Medicaid, and the
Children's Health Insurance Program. Although insurance prices are reduced, this does not
translate into decreased medical costs. Obamacare's patient benefits will be repealed,
resulting in the loss of coverage for millions of Americans' medical treatment but still, incur
high insurance costs.
Why don’t American’s want universal health coverage? There are several reasons, but it
boils down to two key tenants: it is un-American, and they don’t trust the government. That
sounds harsh, does not it! Let us look at the details more closely.
Americans in general, compared to other large industrial nations, embrace the idea that
government should have a more limited role in society. “As a nation that began on the back of
immigrants with an entrepreneurial spirit and without a feudal system to ingrain rigid social
structure, Americans tend to be more individualistic” Wilson (2012). Universal coverage
clashes with this belief. Universal coverage is equivalent to socialized medicine in the minds
of many and that is un-American (Callaghan, 2016).
b Another compelling reason that we do not have universal coverage in America is because
interest groups do not want it. The health insurance industry has been a key player in
influencing the political process. The health insurance industry is big business and according
to IBIS World in 2021 the health insurance industry was a $1.1T industry. They do not want
things to change, and they are spending $100M (2009 data) to keep private insurers as
opposed to the government as the key player in American healthcare (Callaghan, 2016).
Lastly, while most Americans support Medicare, they do not want to trade their patient
centric private insurance for a government plan. Private plans are accountable to the patient
and the “vast majority of our citizens do not trust their government” Dalen (2015). Americans
have seen the reality of universal coverage in countries such as Britain and Canada and seen
millions of patients facing frustrating delays and denials, experiencing long and often painful
waits for care (Moffit, 2022). Generally, most Americans are satisfied with their current
coverage, despite the cost and do not want to be forced to move to an “ill conceived,
economically inefficient and outdated government intervention” Moffit (2022).
The development of national health insurance presents logistical challenges and will require
large upfront costs related to changes in healthcare technology infrastructure, expanding the
range of healthcare services provided, and treatment of a large portion of the population that
is healthy and previously uninsured (Zieff, Kerr, Moore, & Stoner, 2020). The increased costs
is just one reason that Americans are against the idea of national healthcare coverage- because
it will increase their taxes. Another argument that Americans make against national health
insurance is because of the potential for an inefficient system including longer wait times and
impeded medical innovation. They compare wait times in Canada and UK for procedures and
surgeries that range anywhere from 3 weeks to a year. The disorganization and increased wait
times could result in an influx in people seeking care in the emergency room and subsequent
increases in wait times for emergency services (Zieff, Kerr, Moore, & Stoner, 2020).
Another reason that citizens do not want universal healthcare coverage is due to distrust of
government officials. Research has shown that Republicans are especially distrusting of the
government’s role in healthcare although most Americans are in Favor of programs such as
Medicare (Dalen, Waterbrook & Alpert, 2015). I think there is a lot of pushbacks for
universal healthcare coverage that stems from decades ago when universal healthcare
coverage was initially proposed. In the 1930s physicians campaigned to prevent federal
officials from including national health insurance in the social security act (Quadagno, 2004).
Then in 1945 Truman proposed national health insurance and the AMA lobbied against it
with the message that national health insurance was socialist and part of a Communist plot to
destroy freedom (Quadagno, 2004). Although many years has passed since then, there are still
lingering subconscious thoughts and opinions that national healthcare coverage is bad.
Most developed nations such as Japan, Canada, the United Kingdom, South Korea, and
Switzerland provide universal health care to their citizens, however, the United States has yet
to adopt this system (New York Department of Health, 2011). The question becomes why?
There are pros and cons to universal health care. The cons include large costs to implement
the system and create the processes needed while obtaining resources to run the new system
(Zieff, Kerr, Moore, & Stoner, 2020). Another con includes the projected higher federal taxes
for the population. Many people may wonder why they are paying more in taxes to pay for
someone else’s healthcare. Lastly, a big argument many Americans make is that they do not
want the government involved in more than is necessary. This philosophy aligns with the
laissez-faire system where there is a free system and the government does not interfere.
After considering these cons, it is important to note all of the pros of universal healthcare.
First, while there may be large upfront costs for implementing this system, in the long-term,
the economic costs would decrease as the nation becomes healthier with free access to
healthcare (Zieff, Kerr, Moore, & Stoner, 2020). Aligned with the pro of lowering cost, the
decrease in chronic disease would likely be a benefit of universal healthcare as Americans are
not worried about the cost, insurance hassle, or access to healthcare and are more likely to
seek out help. Additionally, universal healthcare would work to eliminate some major
disparities seen in access to healthcare as well as quality of healthcare. There are many pros to
universal healthcare that would benefit everyone but the strong argument against government
involvement prevents the implementation of such a system.
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