How to combat 4 common arguments against universal healthcare in the US
32 out of 33 developed countries in the world have universal health care.
When talking about Universal Health Care, it is important to understand that there are different models that the United States can base their system off of. The three definitive models for Universal Health Care is Single-Payer, 2-Tier, and Mandate systems.
Single-Payer: The gov’t taxes its citizens to pay for health care.
Example: Canada pays for services provided by a private delivery system. The gov’t pays for 70% of the care. Private supplemental insurance pays for vision, dental care, and prescription drugs. Hospitals are publicly funded and provide free care to all residents regardless of the ability to pay. The gov’t keeps hospitals on a fixed budget to control costs and reimburses doctors at a fee-for-service rate. Canada also negotiates bulk prices for prescription medicine.
Facts regarding Canada’s System: Health Care spending was 10.6% of Canada’s GDP in 2016 and 10.5% of patients skipped prescriptions because of cost. The life expectancy was 82.2 years in 2015.
2-Tier: The gov’t pays two-thirds, and the private sector pays one-third.
Example: France has a mandatory health insurance system that covers 75% of health care spending. Doctors may be paid less than some other countries, but their education and insurance are free (through taxes). Payroll taxes fund 40%, income taxes cover 30%, and 30% is from tobacco and alcohol taxes. For-profit corporations also only own one-third of hospitals. The government pays most of the health care while the patient would pay a small amount in co-pays.
Facts regarding France’s System: Health care spending was 11% of GDP in 2016. Approximately $4,600.00 per person. 7.8% of patients skipped prescriptions because of cost. The life expectancy was 85.5 years in 2015.
Mandate: The gov’t mandates that everyone buy health insurance, funding comes from payroll taxes. There are co-pays although the government will pay for most of the health care.
Example: Switzerland has mandatory health insurance that covers all residents. Coverage is provided by competing private insurance companies. The gov’t pays for 60% of the country’s health care (dental care is not covered, vision is only covered for children). The gov’t subsidizes premiums for low-income families approximately 30% of the total. 10% coinsurance cost for services and 20% for drugs, with some out-of-pocket costs waived (maternity care, preventive care, and child hospitalization). The government of Switzerland sets prices.
Facts regarding Switzerland’s System: Health care spending was 12.4% of GDP in 2016. That is approximately $7,919.00 per person. There were 11.6% of people who skipped prescriptions because of cost. The life expectancy was 83.4 years in 2015.
|Country||Type||% of GDP||Per Capita||Wait 4+ Weeks||Infant Mortality Rate||WHO Ranking|
United States and its Health care:
The gov’t has some government-run programs and private insurance. The government pays some cost, but also subsidizes private health insurance through the Affordable Care Act (though it has been decreasing effective due to current Administration). The ACA, also known as ObamaCare, is the product of a Conservative Think-Tank. 60% of citizens get private insurance from their employers, 15% receive Medicare (65 and older), and the federal gov’t funds Medicaid for low-income families (the allocation to this fund has been declining). There are approximately 28 million Americans who have no coverage, either through exemptions from the mandate or they cannot afford insurance.
Facts regarding the United States’ System:
Health care spending was 18% of GDP in 2017. That is approximately $10,739 per person. 18% of patients skipped prescriptions because of cost. The life expectancy was 79.3 years in 2015. The third leading cause of death was Medical Error and has been consistently ranked as having one of the lowest qualities of care among other developed countries. According to the United Nations, the U.S. ranks 28th in Health Care.
Why does the U.S. have high costs and low quality?
Many patients don’t pay for their medical services and can not price-shop doctors and hospital procedures. There is also no competitive reason for providers to offer lower costs since the gov’t can only negotiate lower prices for those covered by Medicare and Medicaid. Insurance and Drug Companies don’t want government restricting prices and spend millions a year to prevent any possible Universal Health Care option.
Currently, what the U.S. federal government pays for 37% of the popular is more than what other developed nation pays to look after their citizens, even after adjusting for population size (Norway and Netherlands being exceptions). Due to economic inequality in the U.S., 71% of whites under 65 have insurance coverage, compared to 47% of African Americans and 39% of Hispanics.
Fun fact: in 1965 health care costs made up less than 5% of all government expenditures, but by 1990 it has risen to 15.8%.
A 2018 Reuters polls has 70% supporting a Universal Health Care option. 84.5% of Democrats and 51.9% of Republicans who voted in the poll supported the policy.
A 2000-2013 data collections from the Pew Research Center shows that in 2018, 60% of Americans believe it is the government’s responsibility to ensure health care coverage.
A recent 2019 poll from Politico & Harvard shows that 4 in 5 Democrats want Congress to enact a taxpayer-funded, national health care play such as Medicare for All. 42% of Democratic respondents to the poll support repealing and replacing the Affordable Care Act.
Replacing the United States’ Current System
Removing the current system would a gigantic task. It could definitely cost man jobs for Health and Life Insurance companies. One pro of the amount the government would be saving from Health Care in the long run is that it can allocate some of those funds to retraining people for other professions.
The current Health Care market is worth more than $3 Trillion and firms and providers have no intention or incentive to change to a system where their bottom line could be interrupted. In 2016, hospitals and nursing homes contributed over $95 million to electoral campaigns, while the Pharmaceutical sector gave nearly $250 million (Opensecrets.org).
Senator Sander’s plan, although not perfect, address many issues involved in how health care operates in the United States. His plan is a Single-Payer Plan. Under his plan, Medicare and Medicaid would cease to exist, with exceptions for elective procedures. Studies show that costs would be between $25 Trillion and $32 Trillion over 10 years.
$32 Trillion sounds like quite a high number. Keep in mind that annually, the United States has recently reached $3.5 Trillion spending on health care in 2017, which if continued would be $35 Trillion over a decade (not adjusted for inflation and not including that it is estimated to reach $5.7 Trillion by 2026, projected by CMS). To reiterate an early point, the United States spends more per capita on health care than any other nation on Earth.
Under his plan, there would be no deductibles or co-payments. Although you can not opt-out of this plan, you have the option to buy supplemental care through private insurers if they do not duplicate care provided by Medicare for All Bill. You will not be able to keep the insurance you have, which is beneficial with yearly over-costly premiums and high deductibles that engulf many plans, but your care will be the same. You will also be able to see any doctor and go to any hospital you want and will still be cared for.
Progressive advocates also argue that even though, depending on your income, the taxes may go up in response to the new system, that it will be offset by overall household savings on health-care costs, premiums, and co-pays. It would also cease forcing companies to be writing checks to private insurance companies, as currently mandated.
The plan would not extend insurance to all Americans immediately. It would do it over four years. The first year, Medicare eligibility age would be lowered to 55, second year to 45, third year to 35, and fourth year everyone would be covered. The plan would cover dental and vision (currently not covered by Medicare) and cover beyond what many people’s private insurance plans cover.
Funding for his plan is still being debated, but he has come up with multiple suggestions that could be passed. Redirecting $2 Trillion of current gov’t spending, raising taxes of income over $250,000, raising the marginal tax rate for income over $10 million to 52%. There is also the option to raise payroll tax on employers to 7.5% and 4%. With an example of $52,000.00 annual income, the individual would be taxed approx. $2080.00 a year in comparison of the U.S. average of $440.00 a month ($5280.00 a year). He also proposed an end to big health insurance-related tax expenditures such as the employers’ ability to deduct insurance premiums from their taxes, which has the potential to save the gov’t trillions of dollars over a decade. If you would like to see the benefits of Senator Sander’s change in tax code in correlation to Health care changes, see a simple calculation for proposed tax brackets and this calculator or use this calculator to make an in-depth calculation.
Many problems that would be solved by Sander’s proposal can greatly benefit the U.S. Health Care System. It would reduce the number of uninsured Americans, potentially lower out-of-pocket spending, allow negotiations over drug prices, increase standard of care, and lower overall government spending per capita in regards to health care.
Arguments Against a Single-Payer Health Care System
The cost of U.S. Health Care is too high to be able to lower it.
Koch-funded Mercatus Center at George Mason University published a study about the cost of health care. Although they went into it trying to prove it would break the system, it was clear by Blahous’s own estimates that single-payer would save Americans more than $2 trillion over a decade. His analysis is not without some faults, as it was riddled with assumptions that actually inflated the cost of single payer for taxpayers. He underestimates the main source of savings from single payer: administrative efficiency.
In ‘Annals of Internal Medicine,’ a single-payer system could potentially cut administration by $500 billion annually and redirect that money to care. Blahous credits the fraction of administrative savings to $70 billion. Blahous also wrongly assumes that the United States cannot negotiate to push down drug prices (like the rest of the developed world does) which causes an analysis of only $61 billion in drug savings in 2022.
Re-iterating an earlier point, the United States has recently reached $3.5 Trillion spending in 2017, which increases to rise. $35 Trillion is more than what a Universal Health Care option would cost, would cover all Americans not just those who can afford it, and would limit the amount the individuals would have to pay on procedures, prescriptions, etc. The United States is the wealthiest nation on Earth and spends more per capita on health care than any other nation on else for less coverage, less benefits, and covers substantially less people.
Other countries ration health care; the U.S. will have to too.
A 2010 survey by the Commonwealth Fund surveyed 11 countries regarding rationing of health care. The survey found that adults in the United States are by far the most likely to go without care because of the cost of procedures. 42% of Americans surveyed in 2010 expressed no confidence in being able to afford health care if they found themselves severely ill. In the preceding year, a third of Americans reported they didn’t go to the doctor when sick, didn’t get recommended care when needed, didn’t fill prescriptions and/or skipped doses of medications because of the cost.
To another note, a Harvard Medical School and Cambridge Health alliance study said that 45,000 people die every year, just in the United States, due to lack of health insurance.
People will no longer become doctors and those who are will leave the field.
It is true that those in the Health care industry in universal health care systems make less money than in the U.S. Depending on the country it is generally not substantial. It is also a good point to make that the average cost of medical school for a single year study in 2017 was $32,495 at public med. College and $52,515 for a private med. College.
In 2009, a resident in Germany could obtain their first Medical Degree spending on average $3,393.28 USD (€3000.00 EURO) Considering their education to become a general practitioner is so significantly lower compared to the United States and still maintains an average $112,000.00 salary, doctors have not left the country in droves as some have claimed. Lastly, Germany has 3.4 per 1,000 people (ranked 15th) compared to 2.3 per 1,000 people (ranked 31st).
There will be longer wait times to see a doctor and have medical procedures done.
The only measure that the United States performed slightly better was the ability to get specialist appointments within two months. According to the CDC, more than half of U.S. doctors’ visits are to a primary care physician where they cite the reason as being a cough. Switzerland and the U.K. both are considerably likely to have waited four weeks or less for a specialist appointment than the average American. Commonwealth Fund data in 2016 shows that 8% of ER patients in the UK, which is a public system, waited 4 hours or longer compared to the U.S. with 11% waiting 4 hours or longer.
According to the Canadian Institute for Health Information, the following graph represents how long an individual would have to wait to see a specialist/consultant in the health care system.
Public Average = 50% * Mixed Average = 37% ** U.S. = 25% ***
|COUNTRY||<4 WEEKS (%)||AT LEAST 4 WEEKS (%)||DON’T KNOW/DECLINE TO ANSWER (%)||TOTAL (COUNT)|
|AUSTRALIA (MIXED)||54.7||39.3 **||6.1||2,156|
|CANADA (PUBLIC)||38.0||58.5 *||3.5||2,228|
|FRANCE (MIXED)||60.2||39.8 **||0.0||639|
|GERMANY (MIXED)||71.2||27.4 **||1.4||459|
|NETHERLANDS (MIXED)||64.0||28.9 **||7.1||580|
|NEW ZEALAND (MIXED)||49.3||47.3 **||3.3||404|
|NORWAY (PUBLIC)||36.9||55.5 *||7.7||605|
|SWEDEN (PUBLIC)||48.1||44.7 *||7.2||3,251|
|SWITZERLAND (PRIVATE)||73.2||25.9 *||0.9||810|
|U.S. (PRIVATE)||69.9||25.3 ***||4.8||1,019|
In Switzerland, which has a private universal health care system, only 25.9% waited at least 4 weeks. There are low percentages in other countries such as Germany and the Netherlands, both who have mixed systems. On average it is true that countries with public health care systems have the longest wait times. Canada, Norway, Sweden, and the UK average out together to have 50% of people waiting over 4 weeks to see a specialist. In Mixed systems, the average was 37%. What we see in Switzerland and Germany can give hope that the richest country in the world can be able to give affordable health care without having to wait weeks or months to see a specialist.
It is also important to say that the surgeries that you being waited on are non-life threatening. Obviously, surgeries are prioritized based on urgency of the condition. The thing is, it happens in the United States too. The only difference is that wait times are shorter, often because there are millions of Americans who can’t afford health insurance altogether, the insurance does not cover some life-saving procedures (or even medicine), or it wasn’t discovered quickly enough to be able to have preventative measures (often because going to the doctor for a seemingly smaller issue can cost a great deal of money for some). Health care in the United States operates where if you have money, you can be treated. If you don’t have health care or have insufficient health care, you have a great likelihood of losing your savings, losing your home, or even losing your life. For the wealthiest nation in the world, there is no reason for not being able have a right to health care and a system that protects everyone, not just the people who can afford it.
Health care should be a right afforded to every American. We can not continue to become apathetic to the plight of our neighbors, friends, and families. We must help lift up our fellow Americans and stand up against a system that does not care if the men and women around us go tens of thousands, if not hundreds of thousands, of dollars in debt in order to purchase life saving drugs. We have a duty to our friends, family, future children or grandchildren, and to others living in this country, to treat them as fellow human-beings and not as trash that does not deserve to live because their bank account is not large enough.