For the past couple of weeks, I have been busy enrolling in Medicare Part B. As I do so I am once again amazed at the choice we made as a country to not implement a universal healthcare system. Universal healthcare is far superior to what we do here in the US by almost every measure. It is cheaper, it provides support for all citizens, it provides greater freedom to take risks in work, and is fairer in that healthcare does not just become something that only the well off can afford.
Before going further, let me just provide a brief synopsis of our current healthcare system in the United States. It is usually provided by the employer- but not all employers. Almost all employers have the employee pay part of the cost of the insurance monthly. This is in addition to any co-pays and deductibles the person has to pay. All to receive coverage whose final approval is done not by the doctors with the individual, but by for profit companies. Companies who might and probably are genuinely concerned about providing good healthcare, but whose highest priority is creating profit.
So, given this, why do so many oppose universal healthcare. Let me list and deal with the ways.
1. People do not want the government to control their healthcare.
Insurance companies control which doctors a person can go to. They control what medications are covered and which are not. They control if a given procedure is paid for or if numerous other steps have to be done first. Extra steps done not because they might provide better healthcare service to the individual but that could possibly get results for cheaper and help save the bottom line for a for profit industry. Insurance companies make both the company and the individual pay. Essentially, it is a private tax. And both the company and individual are now out of money that could have been better spent elsewhere.
A government is more responsive to the people than private companies.
2. People do not want to wait for their needed medical procedures.
People in countries with universal healthcare do not wait longer than in the US. On average, some are longer, but many have shorter wait times. From World Population Review:
“A common misconception in the U.S. is that countries with universal health care have much longer wait times. However, data from nations with universal coverage, coupled with historical data from coverage expansion in the United States, show that patients in other nations often have similar or shorter wait times.”
This report from the OECD iLibrary gives a bit more detailed breakdown.
Let me at this point mention something that many who are against universal healthcare do not seem to realize. There is not just one system to achieve this. Each country has it set up and financed differently. Some are totally government paid for. Others are a mixture of government and private. The commonality is that all citizens can get quality healthcare regardless of income. And without all the massive amounts of paperwork (administrative savings alone would be hundreds of millions of dollars a year).
3. People do not want to have inferior medical care.
They do not receive inferior medical care under universal healthcare. We pay much more for healthcare – in 2022 US paid $12,555 per person whereas the next highest spending on healthcare, Switzerland, only spent $8,049. And the results of the care are essentially the same. In fact, in some areas such as life expectancy, untreated diabetes, infant healthcare – the US does worse than those countries with universal healthcare.
I misspoke when I said that the results of the US healthcare system and those countries with universal healthcare are essentially the same. One significant difference, they do not have people dying or suffering due to not being able to pay medical bills, they do not have people going bankrupt trying to pay their medical bills, they do not have people forgoing needed healthcare because they could not afford it. Which is why I imagine our infant healthcare numbers, untreated diabetes, and life expectancy are worse.
Now, lets look at the flip side. Why we should have universal healthcare.
In those countries that have it, it has proven more cost effective than our system.
In those countries that have it, medical care is as good as in the US.
In those countries that have it, the medical decisions are between the patient and the doctor. No one else.
In those countries that have it, since individuals do not have to worry about healthcare, they are more willing to open and start new businesses or change jobs.
In those countries that have it, there is far far less paperwork in getting needed medical care.
In those countries that have it, businesses do not have to provide healthcare to employees, freeing up that money for other areas within their business.
In those countries that have it, people do not die because they cannot afford healthcare.
And in those countries that have it, things such as in this link do not happen, where a woman who worked as a middle school counselor and had insurance wound up in a coma for five weeks and now needs extensive medical care, but is unable to afford it. This is causing the family and friends to beg for donations and help through a Go Fund Me page. Something seen far too frequently in the US.
Final Questions/Objections
What about personal responsibility? What about freeloaders?
The personal responsibility part comes in choosing to use it, or not. In choosing to get medications, or not. In choosing to follow, or not, what the doctor recommended.
As for freeloaders, access to good healthcare is something that should be the right of all citizens. Doing so provides a benefit for society and for the government. And for businesses.
A 2020 Lancet study found that:
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. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.
A 2022 PNAS study on what the effects would have been of having a Medicare for all system in place during the pandemic concluded this:
The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. Universal healthcare could have alleviated the mortality caused by a confluence of negative COVID-related factors. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a Medicare for All system.
In addition to individuals universal healthcare would also benefit businesses, as discussed in this link to the Economic Policy Institute.
“Specifically, it could:
- Boost wages and salaries by allowing employers to redirect money they are spending on health care costs to their workers’ wages.
- Increase job quality by ensuring that every job now comes bundled with a guarantee of health care—with the boost to job quality even greater among women workers, who are less likely to have employer-sponsored health care.
- Lessen the stress and economic shock of losing a job or moving between jobs by eliminating the loss of health care that now accompanies job losses and transitions.
- Support self-employment and small business development—which is currently super low in the U.S. relative to other rich countries—by eliminating the daunting loss of/cost of health care from startup costs.
- Inject new dynamism and adaptability into the overall economy by reducing “job lock”—with workers going where their skills and preferences best fit the job, not just to workplaces (usually large ones) that have affordable health plans.
Produce a net increase in jobs as public spending boosts aggregate demand, with job losses in health insurance and billing administration being outweighed by job gains in provision of health care, including the expansion of long-term care.
Universal healthcare is one of those areas where the whole society benefits. Even if there are freeloaders, although I am not sure what that term means in this context, the benefits for all are worth it. Just as with public education, public libraries, police, the military, and so forth.
Universal healthcare is better for the individual, for society, for businesses, and for the government. We have taken a wrong turning in our choices of healthcare systems. That’s understandable. Mistakes happen. What is not understandable is that we continue to choose this, and even praise it at times, instead of changing to something that is not only better but badly needed.