Thank you in advance for feedback on any aspects of the rough draft of my essay! (grammar, organization, content, etc)
Professor Steven Beech
English 102 - First-Year Composition
Universal Healthcare: Is it time for the U.S. to take the plunge?
On January 20, 2020 a patient in the United States was diagnosed with severe acute respiratory coronavirus 2 by the state of Washington and the US Centers for Disease Control and Prevention (Harcourt). This event marked the first recorded diagnosis in the U.S. of the disease that would later become more widely known as Covid-19. As of the writing of this paper there has been a total of 5,890,532 reported cases of Covid-19 in the U.S. with 181,143 related U.S. deaths (CDC). These staggering figures show that the U.S has had nearly twice as many reported cases as compared with the next closes country, Brazil, and more than five times as many cases as the country of origin, China. By the numbers, the U.S. has arguably experienced the least effective response and recovery of the world's nations. This global pandemic, and the disproportionately high impact to the U.S., has re-ignited the question of whether or not it is the right time for the U.S. to implement a universal health care system as means of improving the access, affordability, and effectiveness of care to its citizens. This prompted me to research further into the historical developments of the U.S. healthcare system, the cultural and political context, the economics of universal health care, and the current attitudes in the U.S. towards universal health care systems. Upon completing my discovery and analysis, I can confidently conclude that the timing and conditions are right for the U.S. to make a shift from privatized health care to a universal health care system.
Besides having the unfortunate distinction of having the most cases of Covid-19 and related deaths, the U.S. also stands apart from all other industrialized nations in the world by being the only country without a universal health care system. To gain a better insight into why the United States hasn't adopted UHC it is important to examine the cultural aspects that are unique to our country. To start, Americans tend to have a more negative attitude about government when contrasted with other democratic nations. This can be traced back to the very formation of our union which was formed through the perception that the role of our government should be limited in order to preserve the independent rights of citizens and to counter the oppressive role that a large government can assume. It can be posited that the circumstances that led to our separation from England during colonial times has had an enduring impact to the lack of trust that Americans have in government. Furthermore, the U.S. differs from most other natures in that American's do not have a sizeable population that identify as a working class. Instead, most Americans self-identify as middle class. The U.S. lacks a labor party like that of other nations, and labor parties have been instrumental to the push for universal healthcare. The lack of a labor party or self-identified working class counteracts the leverage of the people of the united states to support and demand a government provided universal health care system (Vladeck). This is not to imply that the U.S. has not made effort towards enacting significant health care reforms at a national level. In fact, the United States has contemplated a national approach to health care for over a century. Following the passing of the National Insurance Act of 1911 in the United Kingdom, the U.S. pursued universal coverage with the support of Theodore Roosevelt who ultimately lost his party's nomination for a third term in 1912. In 1933, Franklin D. Roosevelt included a provision for publicly funded healthcare programs in his draft of Social Security. Sixteen years later, another U.S. President would propose universal healthcare, Harry S. Truman, but the bill failed to pass under strong opposition from organized private insurers. More recent efforts, starting in the mid 60's have been met with greater success. In 1965, President Lyndon B. Johnson signed into law Medicare and Medicaid which represented the most significant piece of publicly funded, government administered health care coverage (Manchikanti). While more failed attempts at universal health coverage would occur during the Carter and Clinton administrations, the Affordable Care Act passed in 2010 would pave the way for citizens to purchase government subsidized health care plans from a government led marketplace. One year later, Vermont enacted Green Mountain Care, a law that served as the first state-level universal health care system in the United States. The passing of Medicare/Medicaid, ACA, and Green Mountain Care reflect significant change to our countries acceptance of the federal government taking a larger role in health care.
The political structure of the U.S. also makes our country unique when compared with other industrialized nations, including other democratic countries. Although united under a single federal government, the U.S. extends a great amount of political autonomy to each of our 50 states. This design has served the U.S. well in many aspects but also creates a barrier to finding middle ground in establishing federal laws. A recent and relevant example would be to take another look at America's effectiveness in preventing the spread of Covid-19. The sophisticated system of delegation of authority between the federal and state governments contributed to various interpretations on whether it should be up to the states to determine their own mandates or up to the federal government. Ultimately the Governors of our states were tasked with deciding and implementing Covid-19 mitigation efforts. It can be argued that this approach to de-centralized authority coupled with modern travel and transportation was a contributor to the high rate of spread of the virus. Similarly, having a political system that provides for a great amount of de-centralized authority creates some road-blocks for the passage of UHC. Political change can still and the challenges of navigating a de-centralized power structure can be overcome. Historically our greatest periods of change have occurred under circumstances where there is a change in political power. For an example, one can look to the elections of 1928 and 1932, both of which ended a long reign of the Republican party. These elections and the shift in party power and public sentiment resulted in the passing of Social Security in 1935. Similarly, the concentration of Democratic party power resulting from Lyndon B Johnson's election in 1964 directly led to the passing of Medicare and Medicaid in 1965 (Vladeck). If a change to party power occurs in the 2020 election, it could provide the springboard for the passing of universal health care.
While our culture is evolving and an election year is upon us, the next critical factor to consider is the economics of universal health care. It has often been argued that universal health care is simply too expensive both to government revenues and to the tax payers. However, statistics show otherwise. In an article for U.S. News published earlier this year, contributing authors and doctors Lorie A. Sousa, Vicki Lindblade, and Charlotte Markey share statistics on how the U.S. matches up in terms of health care spend in comparison to nations that have universal health care:
In 2017, the U.S. spent twice as much on health care (17.1% of GDP) as comparable Organization for Economic Co-Operation and Development countries (OECD) (8.8% of GDP), all of whom have universal health care. The country with the second highest expenditure after the U.S. is Switzerland at 12.3%, nearly 5% less. Of all these countries, the U.S. has the highest portion of private insurance. In terms of dollars spent, the average per capita health care spending of OECD countries is $3,558, while in the U.S. it's $10,207 - nearly three times as costly.
Further examination of cost comparisons is available through evaluations performed by The World Health Organization and World Bank. The aforementioned organizations provide a universal health care service-coverage index that is used for inter-country comparison. In a journal for Science magazine, Dr. David E. Bloom, Professor of Economics and Demography at the Harvard School of Public Health shares "The WHO and World Bank also offer multiple measures of health spending-related financial hardship in assessing UHC, which do not increase monotonically with increasing income, health spending per capita, or coverage of health services. Rather, catastrophic health expenditures tend to be lower in countries that channel health spending through public social security or insurance programs, rather than private insurance schemes." There is a myriad of factors that affect the amount spent by countries on the cost of healthcare. One factor that can be easily isolated and identified is the added cost of administration that is inherent the privatized health care system in the U.S. Under the current system of privatized insurance, a portion of the dollars spent on health care go to dividends instead of care. This added cost would be eliminated under a government led universal health care system.
Although the numbers show that the current system of privatized insurance is resulting in higher costs than countries with UHC, the U.S. must understand how to recognize fiscal benefits from universal health care for it to be viable. Several proposals have been offered, some of which are rooted in single payer models, and others that offer a hybrid approach to government provided health care and private insurance options. One particular option that has been gaining momentum is a plan put forth by the Human Right to Health Care movement. This plan approaches health care under the lens that it is a human right to have access to affordable, quality health services. The leaders of the movement have proposed a plan for the cost of coverage to be paid for by the public through progressive taxation. The plan has lofty goals, ones that not only fund health care but have the potential to mitigate wage inequality in a way that shrinks the wage gap. The proposal set forth by the HRHC is designed promote equity based on business size in order to safeguard small businesses from adverse impact. Anja Rudinger, Director of Programs at the National Economic and Social Rights initiative describes the key philosophy and features in an article for the Health and Human Rights Journal:
The following design creates a tax that promotes equity based on business size and wage disparity, thereby protecting small businesses, guarding against negative wage effects, and even incentivizing wage increases for the bottom half of wage earners:
·a sliding scale tax rate capped at 20% of payroll, increasing with company size and wage ratio;
·nine size-based tax categories, from businesses with four or fewer full-time equivalent employees to more than 1,000 employees, resulting in gradually increasing tax rates by company size;
·a wage ratio formula that reflects the difference between the wages of the top 1% and the bottom 50% of wage earners in a company, resulting in higher tax rates for companies with greater wage disparity.
The principle of equity is the guiding factor for this design. Only if businesses are asked to pay based on their ability-with size and high executive salaries as proxies-and only if they are encouraged to raise rather than depress the wages of those paid the least, can a payroll tax meet both economic feasibility and rights-based criteria.
The proposal put forth by the Human Right to Health Care movement offers a comprehensive plan for how to fund universal health care in a way that is considerate to the abilities of different sizes of companies. It is one of many proposals to consider and it demonstrates a path way for how universal health care could be funded in order to provide all Americans with access to health services.
In an ever-changing world, so too has the sentiment shifted among Americans in respect to universal health care. This can be evidenced by the meteoric rise that Senator Bernie Sanders experienced in the past two presidential election cycles. Although Senator Sanders did not win the Democratic party nod in either election, he drew very large numbers of loyal fans by running on a platform rooted in democratic socialism. His stated policies of leveraging U.S. tax dollars to fund public education and a single payer health care system resonated with a massive number of voters. This demonstrates, at least anecdotally, a shift in cultural attitudes over the past decade. The shift in sentiment can also be measured quantifiably through the results of recent polls. A Gallup poll conducted in 2020 show that 54% of Americans believe it is the federal government's responsibility to ensure health care for all (Gallup). A CBS News poll published in 2020 shows that 66% of Americans favor a government health insurance plan for all (Backus). These recent trends further support that the timing is right to propose new legislation to enact universal health care.
Perhaps though, there is no reason that is timelier and more relevant for the passage of universal health care than the current global pandemic of Covid-19. Our current privatized healthcare insurance is largely employer subsidized and in early April 5.2 million Americans filed for unemployment with the surge due to the pandemic. The pandemic not only affected the health of the U.S. population, but it also created damage to the health of businesses and the U.S. economy. As businesses laid off employees or closed their doors, Americans found themselves without pay and without subsidized health care at a time when having the ability to receive health care was most needed. And while the curve of Covid-19 cases begins to flatten, economists predict that the U.S. could see up to 30% unemployment by the fall of 2020. Unfortunately, the impact reaches even further than unemployment. Economists also predict that we could see an increase of 40% to the cost of health insurance premiums due to fewer payers in our privatized health care system and more people in need of health care services (Sousa). Americans without employment income, without subsidized health care, and with rising health care costs will find themselves in an extremely difficult position. If the U.S. had universal health care in place, these Americans would have access to health services during this pandemic, and the U.S. government would have tax revenue to fund it.
There are many factors to consider when deciding if the day has come for universal health care legislation in the U.S. It is a complex issue, one that touches on our history, our identity, our political ideals, and our conscience. America has a proud heritage that is deeply rooted in independence, capitalism, and the pioneer spirit. These reasons provide some backdrop to why the notion of following suit with the rest of the world and adopting government administered health care has been a difficult concept for many to consider. However, our nation has also rallied around our people in times where we have needed to unify for the common good. With health care costs surging, with health services in high demand, and with viable options to not only fund health care but reduce cost, this is the right time in our history to adopt universal health care legislation.