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 do not ever qualify for the programs or they do not 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. b According
to Gabriel Zieff, Zachary Y. Kerr, Justin B. Moore, and Lee Stoner, 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.
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). b 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.
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.
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.
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.
Medicaid and Medicare cover the indigent as well as the elderly. On the other hand, CHIP covers
the children. However, there is a pushback to universal health coverage in the United States. The
main goal of universal health coverage is to ensure that all people have access to essential
healthcare services without any kind of undue financial struggle or hardship (Pearson et al., 2016).
It can provide several health, political, as well as economic benefits to the people. It will enable
the poor people to gain access to improved quality health care services.
There are several reasons for the pushback to universal health coverage in the United States. One
of the important reasons is that there would be significant upfront costs. The cost would include
the costs relating to the technological as well as physical infrastructural changes in the healthcare
system, expansion of various services delivered, and treating or ensuring the individuals who were
previously uninsured (Zieff et al., 2020). In addition to these, the high federal taxes would further
increase the overall cost of universal health coverage in the United States.
Apart from the increased federal and individual costs, the argument against universal health
coverage in the United States is the potential inefficiency of the system. It includes hampering
medical innovation and entrepreneurship and long waiting times for the patients (Zieff et al.,
2020). Increased waiting times of patients in the United States will significantly increase the
number of emergency as well as primary care visits. It may even lead to disorganization in the
healthcare setting.
Another prominent reason for the pushback is that the interest groups present in the United
States are not interested in the introduction of universal health coverage. Universal health care
has been on the national political plan for about a hundred years. However, it has failed in being
acted upon as the special interest groups were blocking the reform by means of lobbying the
lawmakers (Mitra, 2018). The interest groups in the United States did not want this reform to
happen.
Another potential reason for the pushback to universal health coverage in the United States is that
the enactment process can be hard for entitlement programs. The political organizations present
in the United States make it quite challenging for the entitlement programs to be effectively
enacted. The political structure of the United States is inclined towards inactivity. Any broad
reform in the nation will have to pass through a complex process of budget evaluations,
congressional boards, and possible vetoes, thereby making the enactment difficult (Mitra, 2018).
“Universal health care is a health care system that provides health insurance to all legal citizens. It
ensures that all legal residents of a country have access to quality basic medical care, regardless of
income, employment, health condition, or other requirements” (Mintlife, 2021). There are some
pros and cons when it comes to universal health care. Some of the pros include reducing health
care costs for both the resident and the healthcare providers, providing the same level of care,
and promoting healthier living (Mint, 2021). The cons of having universal health care insurance are
having a longer wait time for health care services, the government would be more involved, and it
would take up a large amount of the government’s annual budget.
The United States is currently offering its residents two types of health insurance options. The two
types of health insurance options are private and government-funded programs. Some health
insurance companies under the private health insurance sector are Blue Cross Blue Shield, CIGNA,
and Anthem Inc. Some of the government fund programs are Medicaid, Medicare, and Children
Health Insurance Program (CHIP). The U.S. argues that implementing a universal health care
system, would not be as feasible, organized, or financially stable as it is in other countries (Zieff,
2020). The U.S. government believes that the cost to cover the universal health care system would
be costly because the physical and technological infrastructure of the current health care system
would have to change. I believe that many Americans oppose the universal health care system
because they do not want to pay the higher tax required and they do not want the government
having a say in their health insurance options.
The US spends more on healthcare than any other nation, we spend more money on healthcare
for Americans aged 65 and over than it spent for the entire population of any other nation.
(Vladeck, 2003), This high cost in healthcare is not due to higher utilization but the higher cost in
care prices. These high-cost prices are due to inflates drug prices, higher administration costs,
higher salaries for medical professionals, and higher processes for medical services.
Why is the US resistant to universal healthcare? As a culture, many Americans are individualistic
and prefer the ability to make their own choices. Government involvement and interest groups do
not support universal healthcare. Any attempt at comprehensive national health insurance ever be
made, lobbyists would certainly mobilize to prevent its implementation. (Callaghan, 2016)
Many dislikes universal healthcare due to the inconvenience of the healthcare model. There are
long wait times to see providers, higher taxes, changes to the infrastructure, and technological
advancement of services. Implementing universal health coverage can affect the quality of care
that is being provided along with delays in health prognosis. Government agencies increasing taxes
for healthcare coverage and not receiving care at the appropriate time is not ideal for many
Americans with universal healthcare. People rather pay for private insurance and have the luxury
to choose their providers and seek care when it is convenient for them. b
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Vladeck, B, (2003) Universal Health Insurance in the United States: Reflections on the Past, the
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https://doi.org/10.3390/medicina56110580
