Living Ethics Journal

By Liam Commons.

In order for any society to function, it is imperative that a basic standard of health is maintained. Beyond this, it comes down to basic human decency and allowing everyone to have a sense of comfort in knowing that if they get sick, then they will be taken care of, no matter what. It is the duty of every nation on the planet to have some form of healthcare to ensure that its citizens can be healthy and have this sense of comfort. There are numerous different options regarding how a government or a country establishes its healthcare system. The United States has a privatized healthcare system, where the forces of a market economy are what drive supply and demand for healthcare. 

Under the current system, there are two main options for Americans. The first option is for those who qualify for the governmental-run options Medicaid and CHIP, which are entirely free; the problem with this option is that it only covers about one-third of Americans (Keisler-Starkey & Bunch). The next option is to look toward the private sector to find a medical plan with one of the many different health insurance companies. These are for-profit businesses that Americans can pay a monthly premium to in order to receive medical care when it is needed. A premium is an amount someone pays each month to the insurance company; in 2022, the average annual cost was around $8,000 for a single-person plan and around $22,000 for a family plan (“2022 Employer…”). 

This is the simple part. There are then three main parts to any insurance plan that Americans can pick from: a deductible, a copayment, and an out-of-pocket maximum. This is where it becomes more complicated to think about. A deductible is how much money the policyholder is responsible for before their health insurance company begins to pay for their healthcare, and this tends to be around $2,000 (“Average Annual Deductible”). Then, once someone has reached their deductible, there is a copayment, or copay, which is the fixed amount of money that they are required to pay each time they receive medical care. Finally, the policy will have something called an out-of-pocket maximum, which, as the name implies, means that after a specific dollar amount has been paid over the course of the year, the policyholder will no longer be responsible for any fees regarding the medical care they receive. 

Ordinary Americans are expected to look through thousands of health insurance plans to find one that works for them based on all of the aforementioned factors. However, all those costs add up, and for countless Americans, it is simply too expensive to pay a monthly premium when they can barely afford to keep the lights on. As such, many Americans do not have the comfort of knowing that if they get sick or injured then they will have access to healthcare. So many Americans die every year in the wealthiest nation on the planet because our legislators refuse to consider healthcare a human right like any other. The American healthcare system is broken, and it only works to uphold the drastic wealth inequality in the United States. It is necessary that the United States government provides access to affordable healthcare for all citizens by implementing a Universal healthcare system. This will ensure that everyone has a right to healthcare, regardless of socioeconomic status.

Before getting into the details surrounding whether or not the United States should implement a universal healthcare system, it is important first to understand what it actually is. Across the world, there are examples of universal healthcare systems that have established a precedent for what this type of system could look like and the varying levels of success that have been achieved. Whether it be Canada, all the way to Australia, or any number of countries in Europe, universal healthcare has been tried, and in most cases, it has achieved exactly what it was meant to do: ensure that everyone has access to affordable healthcare. The way it works is far more simple than anything in the United States because there is no need to worry about a deductible or copayment. Instead, the government, at the federal, state, and local levels, all work together to provide one, comprehensive and affordable healthcare plan to all citizens. This means that whenever someone needs some form of primary care when they get injured or sick, it will be paid for by the government, completely free of charge to the patient. That may seem too good to be true, but almost every comparable OECD nation has some form of universal coverage. Three of the countries that show the best results are the Norwegian, Australian, and Canadian systems. In all three countries, 100% of their citizens are covered under their respective systems, solving the main issue with the United States healthcare system: an immense uninsured population (Tikkanen et al., all). 

In the three nations mentioned above, Norway, Australia, and Canada, the federal governments of each guarantee healthcare to all of their citizens respectively, and thus 100 percent of their citizens have basic health coverage. In the United States, however, over 27 million people were without health insurance as of 2021. Although that number is down from nearly 30 million people in 2014, the main source for this decrease was the increase in coverage under government-run programs such as Medicare and Medicaid (“Nearly 30 million…”). This stark difference in coverage is a clear example of why a universal healthcare system would be beneficial. Also, the reason why so many Americans still do not have health insurance is not that they choose not to, but rather that they simply cannot afford it. A study by the International Journal of Health Services found that one in three uninsured Americans reported not being able to receive care when they needed it, and among these people, a majority “(79.4%) cited costs as the reason for not receiving care” (Kennedy & Morgan). This study is especially interesting because it compares these statistics to ones taken from Canada, which found that “only 7.9 percent of Canadians with unmet needs cited cost concerns” which is significantly lower than that in America (Kennedy & Morgan). This shows how the primary benefit of having a universal healthcare system is eliminating cost as a barrier to receiving healthcare.

In order to make the cost of healthcare affordable for all citizens, the government will need to take on the brunt of the costs. This means that the cost of universal healthcare will undoubtedly be great, especially in a country the size of the United States. With almost 330 million people to provide healthcare to, the United States would have to make significant changes to the current system in order to fund such an investment. What many people do not realize, however, is how much the US already spends on healthcare. In 2021, US healthcare spending accounted for about 18 percent of the national GDP, totaling 4.3 trillion dollars; this averages to about $12,914 per person (“National Health Expenditure…”). Comparing this figure to other OECD nations shows that the US “consistently remained around 60% more than the average” for healthcare spending as a percentage of GDP. In fact, according to a study done by the OECD, other “high-income G7 countries” only spend around “4,000 USD” per person, almost three times less than the United States (“Understanding differences…”). To make the argument that the US does not have the funding for universal healthcare would be absurd considering how much more is spent by the United States when compared to other countries that are able to offer universal healthcare.

To find methods for funding public healthcare, many experts suggest looking toward nations like Norway, Australia, and Canada. Healthcare in these three countries is publicly funded for the most part, through different forms of taxation. In Norway, for example, there is an additional marginal tax rate based on income level to help raise funds for their federal program (Tikkanen et al.). This is helpful because it means that low-income communities do not end up paying much more, if anything, and in many cases, those with higher incomes, who hold a majority of the wealth, pay more. This balances out to ensure that healthcare stays affordable for everyone, but especially those who may not be able to afford it otherwise. In Australia, there is an additional form of taxation called the Medicare Levy surcharge, which is a tax penalty on high-income earners who do not purchase private insurance (Tikkanen et al.). This encourages those who can afford to pay for private health insurance to do so, and if they choose not to, it raises funds to help pay for public insurance for those who cannot afford to pay. In Canada, the federal government gives money to each municipality to pay for health expenses based on the population of the region (Tikkanen et al.). This ensures that places with more people, especially major cities with higher poverty levels, are able to provide affordable healthcare to everyone.

These countries and their respective systems could be used as a blueprint for making a unique system to best serve the American people. This is not a new idea, though, and many US politicians have already made proposals on ways we could finance a universal healthcare system; the ever-popular “Medicare for All” plan, coined by Senator Bernie Sanders, includes a number of ways to finance such a system, but the primary way would be increasing federal taxes. This is an idea that scares many Americans though. Understandably, US citizens want to pay as little as necessary in taxes. What they do not realize, however, is that often the proposals for increased taxes come with a benefit as well. For working-class Americans, the increase in taxes would not mean that they are paying significantly more toward healthcare; instead, the plan proposed by Senator Sanders would have them pay around $850 annually (Sanders). This is through a plan to impose an additional four percent  income tax on households. This would save the typical working-class family that makes $50,000 a year over $4000 less than what they currently pay for health insurance, and it would raise around “$3.5 trillion in revenue over 10 years” (Sanders). Another proposal would see the businesses pay a “7.5 percent payroll tax”, which totals “just $3,750, a savings of more than $9,000 a year for that employee”, and would raise “$3.9 trillion over ten years” (Sanders). These proposals for higher Federal taxes, something similar to Australia’s Medicare Levy surcharge and Norway’s progressive income tax would be able to fund a universal healthcare program. For the everyday American, these changes will not affect them significantly, and it will mean that they can receive access to affordable healthcare.

All of this is to say that a universal healthcare system will be far more cost-effective than the current system and promises significant savings. In 2020, an article reviewing twenty-two different studies on single-payer healthcare systems found that “replacing private insurers with a public system is expected to achieve lower net healthcare costs” (Cai et al.). These findings are significant because one of the main arguments against healthcare reform is the supposed cost burden it could impose. This research article found, in nineteen out of the twenty-two studies, however, that the opposite was true; they instead predicted that health expenditure would fall. All of the studies “suggested the potential for long-term cost savings” which varied “from 3.3% to 26.5% (median 12.1%)” (Cai et al.). This comes from lower administrative costs associated with the complexities of the private sector. There would be significant administrative savings because the current decentralized system, and Americans’ demand for freedom of choice, “generates complexity in billing and expenses” which ultimately leads to higher costs (Chernew & Mintz). Having a government-run agency in charge of this would eliminate the “middle-man” and lead to administrative savings. Some people worry that switching to some form of universal healthcare will mean stripping everyday Americans of their freedom to choose who their doctor is and pick where they want to receive care. A commonality among countries that provide universal healthcare, however, is that they all not only guarantee healthcare as a right but do not prevent those who want to purchase private health insurance from doing so. In Australia about fifty percent of people have “supplementary private coverage” and in Canada, that number is as high as sixty-seven percent; in Norway, though, only about ten percent of people choose to have supplementary coverage, which is a testament to how high quality the care is, to begin with (Tikkanen et al.).

The next major form of savings will come through decreased drug prices. In the United States, “prescription drug prices are significantly higher” than in other countries “averaging 2.56 times” the cost. This is even higher for brand-named drugs which average “3.44 times” the cost in comparable nations (Mulcahy). For working-class Americans, this is devastating and results in people paying hundreds, if not thousands, of dollars for prescription medications. An example of this would be the price of insulin. In 2018, one study found that the average price for a vial of insulin was $98.70 in the United States (Mulcahy et al.). This fact alone seems insignificant, but when compared to the $12.00 that people in Canada pay, or the $6.94 that people in Australia pay, it begins to raise some questions (Mulcahy et al.). Why is the price so high when it only costs between “$2.28–3.37” to produce (Beran et al.)? The answer to that question is simple; when healthcare companies, like those in the US, operate with the sole purpose of generating profit, then they are encouraged by the system to charge higher prices, especially when there are no repercussions for doing so. In a universal healthcare system, the government has the ability to negotiate with pharmaceutical companies for lower prices, hence why Canada and Australia pay less. Switching to this kind of system would not only mean that everyday people pay less for prescription drugs, but it would lower costs for the government. In 2020, one study by the Kaiser Family Foundation found that Medicare spent over one billion dollars on insulin, which is up from only a quarter of a billion dollars in 2007 (Cubanski & Damico). Allowing the federal government to negotiate drug prices would mean significant savings, and overall suggests that a universal healthcare system would be less expensive in the long term.

One of the most important reasons why universal healthcare is necessary is because it may help improve the health of American society as a whole. Among eleven other wealthy OECD nations, the United States had the lowest life expectancy (Tikkanen & Abrams). Many people like to claim that the reason healthcare is so expensive in the United States is because of how high the quality of care is. If that were the case, then the United States wouldn’t have “the highest chronic disease burden and an obesity rate that is two times higher than the OECD average” (Tikkanen & Abrams). Instead, people must accept that they live in a country that refuses to consider healthcare a right, and hope and pray that they stay healthy. That is easier said than done when six in ten adults have some form of chronic illness in the United States (“National Center…”). This is not a problem that the entire world faces; the United States has the “highest rate of avoidable deaths” when compared to all the other OECD countries. This is a systemic failure on the part of the healthcare industry. An analysis of the “lost productivity” because of obesity alone indicates a loss of almost “66 billion annually” (Zieff et al.). However, under a universal healthcare system, it is far easier to ensure that everyone with chronic illnesses is diagnosed earlier, and is given the types of life-saving medicine they might need. This could help save billions of dollars in the future because a healthier workforce will be more productive and better for the economy overall. 

A study conducted by Harvard Medical School found that “45,000 annual deaths are associated with lack of health insurance” (Cecere). This figure is staggering and should be evidence alone for a need to ensure that all Americans have access to healthcare. The current healthcare system is failing even by the most basic metrics and must change immediately. Millions of Americans are without healthcare coverage, thousands of people are dying each year, and yet the United States spends more per capita than any other nation on the planet. A universal healthcare system, similar to those used in other wealthy, developed countries, would ensure that all Americans have access to healthcare regardless of socioeconomic status. In order to pay for this new system, the federal and state governments may need to increase tax levels, but for working-class Americans, this will actually be cheaper than their current private insurance. In terms of total healthcare spending, despite claims that it would be too expensive to fund a universal healthcare system, experts predict that the savings associated with decreased administrative costs and prescription drug prices will result in savings in the long term. People that oppose this kind of change might be worried that this will cause increased waiting times and mean they won’t be able to choose their own doctor. Under this system, however, people will be allowed to purchase supplementary private insurance if they have the means to do so. While universal healthcare is not a perfect solution and may increase waiting times for more voluntary medical services, the benefits of providing affordable healthcare to everyone no matter what is undeniable. Thus, the only compassionate and just way to proceed as a society is to implement some form of universal healthcare in the United States.

Works Cited

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