Achieving Access to Healthcare for All Americans

 

Introduction/Background

Access to healthcare is one of the major issues facing Americans today. The United States is considered by many to be the greatest nation in the world with great wealth and opportunity for its citizens. However, despite many Americans having access to our advance healthcare system and technology, a significant percentage of our citizens face barriers that prevent them from obtaining basic healthcare services. The problem we face as Americans is our lack of free healthcare for all citizens, as compared to other countries such as Canada who do implement free healthcare to all of its citizens. There are many reasons people do not have access to healthcare. High healthcare costs are still a primary cause for Americans not being able to get the medical attention they need. The most common reason is because people can’t afford to purchase health insurance that would allow them to get in to see a doctor. Health insurance can be hard to obtain depending where you are on the socioeconomic ladder. The Affordable Care Act, which is sometimes referred to as Obamacare, was supposed to fix this problem by creating an insurance system that would allow everyone to afford health insurance regardless of their income. Obamacare is a United States law that reformed both the healthcare and health insurance industries in America. This did help and the latest statistics in 2016 showed that the number of uninsured has decreased from 18% to 13% (Obamacarefacts, 2016). This has not solved the problem completely and there is a lot of concern about the continued high cost of healthcare and the fact that many still don’t have access. At some point in their lives, everyone will need health care or medical treatment, but the cost of this essential service threatens our country’s economy. The cost of healthcare has taken an increasing share of the United States economy, and has been rising for many years. In 2010, the US spent 17.9 percent of the nation’s economy on healthcare, compared to only in 1970 and to 9.5 percent on average across 34 other developed countries (Caitlin & Cowan, 2015). This article shows that increased spending does not equal higher quality. In fact, many other countries’ healthcare systems actually provide higher quality care at a lower cost, suggesting that we don’t always need to spend more to get better care and outcomes (Caitlin & Cowan, 2015). This critical issue of healthcare access has caused many citizens to demand a nationalized or government sponsored healthcare system for all Americans.

Nationalized Healthcare is What All Americans Deserve

Proponents of nationalized healthcare believe that instituting a national health system would lower the cost of health care in the United States.In one study, under a single-payer system, in which all citizens are guaranteed access to healthcare, total public and private healthcare spending could be lowered by $592 billion in 2014 and up to $1.8 trillion over the next decade by lowering administrative and prescription drug costs (Friedman, 2013). In a study in the American Journal of Public Health, Canada, who provides universal access to healthcare, spends half as much per capita on health care as the United States (Lasser, Himmelstein & Woolhandler, 2009). With nationalized healthcare, we could develop a centralized national database which makes diagnosis and treatment easier for doctors and avoids separate record-keeping systems between doctors and different hospitals. It would eliminate wasteful inefficiencies such as duplicate paper work, claim approval, insurance submission, etc. because there would not be a need for maintaining insurance information or wasting time submitting claims. The savings in the duplicate records, banking and postal areas alone would be worth significant annual savings estimated in the Billion dollar range (Backman, Hunt, & Khosla, 2008).

Nationalized healthcare would save lives.In a 2009 study from Harvard, “lack of health insurance is associated with as many as 44,789 deaths per year,” which is a 40% increased risk of death among uninsured patients (Wilper, Woolhandler, Lasser, & McCormick, 2009, p. 2290). In many countries with complete access to healthcare such as Italy, Spain, France, and Norway, people live two to three years longer than people in the United States (Morgan, 2013).  Access to free medical services would encourage patients to practice preventive medicine and inquire about problems early before treatment gets severe. Currently, patients often avoid physicals and other preventive measures because of the unaffordable costs. This behavior not only affects the health of the patient but the overall cost to the system, since preventive medicine costs only a fraction of a full blown illness (Lesser et al., 2006). A government-provided system would remove the deterrent patients have for visiting a medical professional.

Proponents of nationalized healthcare are also quick to point out that good health is a right that all humans deserve. In fact, many believe that in a country as economically and culturally advanced as the United States, it is an embarrassment that we don’t provide this basic service to our citizens. Many European countries with a universal right to health care have a lower Gross Domestic Product (GDP) per capita than the United States, but still provide a right to health care for all their citizens (Backman et al., 2008). Interestingly, in 2005 the United States along with other member states of the World Health Organization signed World Health Assembly Resolution 58.33, which stated that everyone should have access to health care services and should not suffer financial hardship when obtaining these services (United Nations, 2005).

Nationalized Healthcare is Bad for America

Opponents of nationalized healthcare believe that it would bring on economic disaster for the United States because of the increased cost of healthcare. Medicare, Medicaid, and the Children’s Health Insurance Program are government programs that provide a right to healthcare for certain segments of the population. These programs totaled less than 10% of the federal budget in 1985, but by 2012 took up 21% of the federal budget (Korobkin, 2014). Opponents are quick to point out the waste, excess expense and complexities of other government run agencies. As an example of their beliefs, when the United States Government issued a simplified tax guide several years back, it was over 1000 pages long (Kamarack, 2013). Also, the millions of dollars in waste seen in the Pentagon, Postal Service or Department of Motor Vehicles should make any American skeptical that the government could manage healthcare efficiently or effectively.

Nationalized healthcare could increase the wait time and rationing for medical services. Medicaid is an example of a federally funded single-payer health care system that provides access to health care for low-income people. In a 2012 Government Accountability Office report, 9.4% of Medicaid beneficiaries had difficulty obtaining required care due to long wait times compared to only 4.2% of people with private health insurance (United States Government Accountability Office, 2012). Countries with a universal right to healthcare have longer wait times than the United States. In 2013 the average wait time to see a specialist in Canada was nearly 9 weeks but only 18.5 days in the United States (Backman et al., 2008, p. 2055). In addition to the wait to receive healthcare, the government would decide what medical care a citizen deserves. Many countries with universal health care such as Australia, Canada, New Zealand, and the United Kingdom, all ration health care using methods such as budgeting, price setting, and service restrictions (Hoffman, 2013). In this article, the United Kingdom’s National Health Service rations health care using a cost-benefit analysis. For example, in 2008 if a drug provided an extra six months of “good-quality” life and cost less than $15,000, it was automatically approved, while one that costs more would not (Hoffman, 2013). This takes away a person’s right to choose what is best for them.

Providing a right to health care could raise taxes for all Americans. In European countries with a universal right to health care, the cost of coverage is paid through higher taxes. In the United Kingdom and other European countries, payroll taxes average 37%, which is much higher than the 15.3% payroll taxes paid by an average US worker (Gregory, 2013). According to Gregory, a Research Fellow at the Hoover Institution, financing a universal right to health care in the United States would cause payroll taxes to double. There is a belief that our country has an entitlement mentality and believes that the government should pay for many services including healthcare. However, since nothing is free we would have to increase taxes to pay for this additional service. When people are provided with universal health care and are not directly responsible for the costs of medical services, they might utilize more health resources than necessary. According to a 2014 study published in Science, 10,000 uninsured Portland, Oregon residents who gained access to Medicaid had 40% more visits to emergency rooms, even though they already had guaranteed access to emergency treatment under federal law (Taubman, Allen, Wright, Baicker, & Finkelstein, 2014). Since Medicaid provides access to health care for low-income individuals, expanding this to the full US population could worsen the problem of overusing health care resources.

Opponents of nationalized healthcare do not believe the founding documents of the United States provide support for a right to health care. The Declaration of Independence does not guarantee a right to health care. The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare,” not to provide for it. This belief is that one may have a right to life, liberty and the pursuit of happiness but not to services such as health care (Maruthappu, Ologunde. & Gunarajasingam, 2013). 

Assessments of Different Arguments

The issue of healthcare costs in a national healthcare system seem to be best supported by proponents that show reduction in overall costs when they centralize administrative overhead and duplication of paperwork that occurs now between doctors, hospitals and insurance or government payers. The argument that opponents make referencing governmental waste in other programs seems like more of a scare technique than something that would definitely happen with nationalized healthcare. In fact, providing the security of access to healthcare has been shown to increase spending on consumer goods and to promote employees upward mobility to new jobs without the fear of having to maintain health insurance coverage (Gruber, 2009). It would also expand the medical sector to meet the newly covered individuals which would create new and high quality jobs. These would drive economic growth overall. In addition, any rationing of healthcare like that seen in other countries with universal healthcare, would likely reduce costs significantly. It does make sense that increasing the number of individuals by achieving access to healthcare could increase overall costs leading to increase in taxes. However, the thought is that the overall expense reduction by avoiding duplication of services, allowing preventative healthcare to drive down cost of serious illnesses, rationing of health services and increase in economic factors by expanding the healthcare market, would still make this overall a financially positive situation.

When analyzing the different opinions for a National healthcare system, there are several factors that make one more supportive of the opponent’s viewpoint. It is likely that there would be some component of rationing of healthcare services. In most countries with universal healthcare, there is a formula that evaluates the financial costs of a treatment vs. the likelihood of it prolonging life or quality of life. This would change current practice where patients receive less expensive end of life services and might not get surgical procedures as quickly. It would limit the ability for a patient and their Doctor to be the decision maker for all treatment options. There is also a belief by many in the medical community that it would decrease patient’s options for choosing a provider as less physicians would go into medicine (Fleming, 2006).

Finally, there is a significant disagreement between proponents and opponents of nationalized healthcare over whether access to healthcare is a “right” per our founding fathers or a “service” that our Government has no obligation to provide. This issue really comes down to semantics and how one chooses to define “promotion of general warfare” as including health to its citizens. Not surprisingly, proponents or opponents choose to interpret based solely on their desire to support their own argument.

Conclusion

Access to healthcare can be hard to obtain depending where you are on the socioeconomic ladder. Health insurance is supposed to protect Americans from very high healthcare costs. We have just completed 8 years of President Obama attempting to increase access to healthcare. During his initial campaign promises, he vowed to bring healthcare to all Americans and seemed to be a proponent of Universal Healthcare. His trademark legislation, Obamacare, did increase the number of insured persons but it did not accomplish coverage for all. Now, with the recent Trump election, there is a yet to be understood plan that is supposed to repeal Obamacare and replace it with something that will more effectively provide healthcare coverage to all Americans. This is likely to move away from the idea of government sponsored, nationalized coverage and instead have a significant portion that utilizes private or public non-governmental companies to accomplish their goal. This is an uncertain time for many Americans regarding their access to healthcare. The idea of a nationalized healthcare system for all Americans has been a major issue for many years and continues today.

Exploring the many different issues involved with nationalized healthcare provides a clearer understanding of how complicated this issue is with many different viewpoints on both sides. I believe that we cannot continue to allow healthcare costs to increase at their current rate and that as a country, we must provide healthcare to all of our citizens regardless if it is a “right” or a “service”. Despite the advantages of a national healthcare system, I do not believe most Americans are willing to limit their access to physicians or their access to the very best treatment options. Ultimately, I believe a combination of government sponsored and private healthcare will be the best option moving forward. Unlike the current situation, I do believe it will require some form of expansion of government healthcare that does have a component of treatment rationing. There will also need to be a private insurance option and for profit companies in the healthcare environment that provide for the healthcare options that many Americans will demand. As is often the case, the approach of an all or nothing nationalized healthcare system will not work and compromise will be needed. It will require politicians and different factions to compromise on this issue and put aside bipartisan emotions to create a plan that will accomplish healthcare coverage for all Americans.

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