5 reasons why healthcare should be free essay

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Healthcare Should Be Free: The Definitive Argument

Imagine a world where everyone, regardless of income or job situation, could visit a doctor when they felt sick. No more worrying about expensive bills or putting off treatment because you can’t afford it. This is the reality with free healthcare , a system where everyone has access to the medical care they need.

In this article, we’ll explore the many benefits of free healthcare, understand why advocating for it is crucial, and envision how it could revolutionize the way we approach health in the United States. Healthcare SHOULD be free.

Table of Contents

The benefits of accessible healthcare for everyone.

Think about a time you felt sick. Maybe you had a bad stomachache or a nasty cold. Did you go straight to the doctor, or did you hesitate because of the cost?  Unfortunately, for many Americans, healthcare costs are a major barrier to getting the treatment they need. This can lead to serious health problems down the road (Institute of Medicine (US) Committee on the Consequences of Uninsurance, 2003)

Personally, I come from a first-generation immigrant family meaning that growing up money was not always flowing in our favor. There have been countless times in my childhood when I was not able to have routine doctor visits or dental checkups due to the fact of them being so expensive. I lived for years with cavities that undoubtedly got worse since I was unable to pay the expense to get them filled. 

With free healthcare, everyone can visit a doctor for regular checkups, screenings, and treatment of illnesses and injuries. This leads to a healthier population overall. Here’s why:

• Early detection and treatment: When people can see a doctor without worrying about the cost, they’re more likely to get preventive care and screenings. This can help catch health problems early when they’re easier and cheaper to treat ( American Cancer Society, 2023 ).
• Reduced financial stress: Free healthcare eliminates the financial burden of medical bills, allowing families to focus on getting well and staying healthy.
• Healthier communities: When everyone has access to healthcare, it helps prevent the spread of contagious diseases.
• A More Productive Workforce: When employees are healthy, they’re less likely to miss work due to illness. This translates to increased productivity and economic benefits for businesses.
• Reduced Strain on Emergency Rooms: Free healthcare encourages preventive care, leading to fewer emergencies and a lighter load on already strained emergency room resources ( American College of Emergency Physicians, 2023 ).
• Improved Mental Health: Financial stress related to healthcare costs can be a significant source of anxiety and depression. Free healthcare can alleviate this stress and promote better mental well-being.

Examples of Successful Free Healthcare Systems:

Many countries around the world have established successful free healthcare systems. Let’s explore a couple of examples:

• Canada: Canada boasts a universal healthcare system funded by taxes. All citizens and permanent residents have access to medically necessary services, with wait times often cited as the main drawback.
• United Kingdom: The National Health Service (NHS) in the UK provides comprehensive healthcare funded by general taxation. It’s known for its focus on preventative care and accessibility.

These are just two examples of how different countries have implemented free healthcare systems. While each system faces its challenges, they showcase the feasibility and positive impact of universal healthcare.

Addressing Concerns About Free Healthcare:

• Cost: A common concern is the financial burden of implementing free healthcare. However, studies suggest that a universal healthcare system can lead to overall cost savings by reducing unnecessary treatments and administrative costs associated with private insurance companies.
• Wait Times: Wait times for certain procedures can be longer in free healthcare systems. However, this can be mitigated by increased investment in healthcare infrastructure and personnel.
• Quality of Care: Some worry that free healthcare might compromise the quality of care. However, many universal healthcare systems boast high-quality standards and patient satisfaction rates.

Healthcare should be free in the United States: Financing

There are multiple options for financing free healthcare in the US. Here are a few possibilities:

• Progressive Taxation: Implementing a more progressive tax system where higher earners contribute a greater share could help fund free healthcare.
• Reallocation of Resources: Redirecting existing healthcare spending away from administrative costs and toward patient care could be another option.
• Combined Approach: A combination of increased taxation, reallocation of resources, and potential efficiency savings within the healthcare system could be a viable solution.

The Road to Free Healthcare in the US

The path toward free healthcare in the US will involve collaboration, education, and a continued push for change. Here are some additional steps we can take:

• Public Education: Raising public awareness about the benefits of free healthcare is crucial. Educational campaigns can showcase successful models from other countries and address common concerns.
• Policy Research: Further research and analysis are needed to develop the most cost-effective and efficient model for free healthcare in the US context.
• Building Coalitions: Creating alliances with healthcare professionals, patient advocates, and other stakeholders can strengthen the movement for change.

Advocating for Free Healthcare

• Talk to your friends and family: Share the benefits of free healthcare and encourage them to learn more.
• Contact your elected officials: Let them know that you support free healthcare and ask them for their stance on the issue.
• Join or support organizations that advocate for free healthcare.

By raising your voice and joining forces with others, we can create a movement for free healthcare in America.

Revolutionizing Healthcare

Free healthcare isn’t just about making medical care affordable; it’s about changing the way we approach health in the United States. Here’s how:

• Focus on prevention: With free checkups and screenings, we can identify and address health problems early, leading to a healthier population and lower overall healthcare costs.
• Improved health outcomes: When everyone has access to care, they can manage chronic conditions better and lead healthier lives.
• A more just society: Free healthcare ensures that everyone has the opportunity to live a healthy life, regardless of their social or economic background.

This is the future of healthcare: a system that prioritizes preventative care, emphasizes wellness and guarantees access for all.

Taking Action

Free healthcare is an achievable goal. By understanding the benefits, advocating for change, and working together, we can create a healthcare system that prioritizes the health and well-being of all Americans. Are you ready to join the fight for free healthcare?

This article is just the beginning.  Keep researching, stay informed, and most importantly, use your voice.  Together, we can revolutionize healthcare in the United States.

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Free Healthcare in the United States: A Possible Solution to Public Health Disparities

Nov 23, 2020 | Author Hala Atassi , Public Health Policy

Access to healthcare is one of the remarkable indicators that defines the quality of people’s lives. Despite the thousands of advanced technologies and countless healthcare clinics and hospitals, many people still cannot afford healthcare or health insurance. This has been a global concern for years, which many countries have resolved. However, the United States has yet to significantly progress towards making healthcare more accessible to low-income communities. There are many solutions to this problem that can be implemented today, upon which millions of suffering Americans depend.

Some studies have shown over the years that expensive health care is due to the high cost of defensive medicine, or in other words, physicians ordering expensive tests that may be unnecessary, as a way to deflect legal responsibility from themselves. Deviating from defensive medicine in the healthcare industry might impact physicians economically, but more importantly, it will help achieve affordable healthcare. 

Obamacare (the Affordable Care Act of 2010) is one program that focuses on extending healthcare to Americans and reducing public health disparities. This program lays down a foundation that people under the age of 26 will receive accessible care from their parent or guardian’s health care plans. Afterward, they must pay for their health care plan. Also, the program stipulates that the government provides free healthcare to retired adults from age 55 to 64, to avoid any insurance plan complications. Essentially, Obamacare seeks to expand access to healthcare care, regardless of the scale of one’s medical diagnosis, to ultimately save lives that would have been lost due to the inability to pay expensive medical bills.

Easier access to healthcare will result in a healthier nation. The healthcare system is one of the most important components in life, as the United States’ economy cannot be fully efficient and benefit all people until everyone can access quality, affordable healthcare. Free healthcare (or at least cheaper healthcare) would be the most effective system for America, which other countries like Switzerland and Singapore have demonstrated. The money spent by citizens on their healthcare could be redirected to other social support systems in America, like expanding access to nutritious foods as well. Although free healthcare has many perks, it also has disadvantages. Most notably, overloading health services with a large number of patients would overwhelm already busy healthcare systems. Patients may overuse the perk of free healthcare, leaving not taxpayers to suffer, but rather medical professionals and healthcare systems. Even so, the perceptible advantages of affordable healthcare outweigh the disadvantages. As it is, years of attempts to ameliorate the United States healthcare system have failed the American people, and the situation remains devastating and life-threatening for low-income communities. There should be no debate though as to whether America needs to redesign the public health system, as healthcare is a human right, and nobody should be dying because they cannot afford to live, especially when the government has the economic means to take care of them.

Bibliography:

Gerisch, Mary. “Health Care As a Human Right.” American Bar Association , www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/health-care-as-a-human-right/. 

“Free Health Care Policies.” World Health Organization , World Health Organization, 2020, www.who.int/news-room/fact-sheets/detail/free-health-care-policies. 

Gologorsky, Beverly. “Health Care in the US Should Be Affordable and Accessible.” The Nation , 9 May 2019, www.thenation.com/article/archive/tom-dispatch-health-care-should-be-affordable-and-accessible/. 

Luhby, Tami. “Here’s How Obamacare Has Changed America.” CNN , Cable News Network, 8 July 2019, www.cnn.com/2019/07/08/politics/obamacare-how-it-has-changed-america/index.html.

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Healthcare is a human right – but not in the United States

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The Supreme Court’s ruling on Dobbs v. Jackson in June is just the latest blow to health rights in the United States. National medical associations in the U.S. agree that abortion is essential to reproductive healthcare. So why would abortion not be protected as such? Because the U.S. does not, and never has, protected a right to health.  

Good health is the foundation of a person’s life and liberty. Injury and disease are always disruptive, and sometimes crippling. We might have to stop working, cancel plans, quarantine, hire help, and in cases of long-term disability, build whole new support systems to accommodate a new normal.

The U.S. remains the only high-income nation in the world without universal access to healthcare. However, the U.S. has signed and ratified one of the most widely adopted international treaties that includes the duty to protect the right to life. Under international law, the right to life simply means that humans have a right to live, and that nobody can try to kill another. Healthcare, the United Nations says, is an essential part of that duty. In 2018, the U.N. Committee on Civil and Political Rights said the right to life cannot exist without equal access to affordable healthcare services (including in prisons), mental health services, and notably, access to abortion. The U.N. committee mentioned health more than a dozen times in its statement on the right to life.

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The bottom line is: the U.S. can’t claim to protect life if it fails to protect health. And it has consistently failed on all three of the U.N.’s measures— the latest being access to abortion.

In the U.S., our debates around healthcare, and especially abortion, are hampered by a lack of right to health. Instead, the Supreme Court in 1973 protected access to abortion through the rights to privacy and due process, not health. Privacy is mentioned only twice by the U.N. committee commentary on the right to life.

Since Dobbs, several state legislatures have declared it fair game to criminalize abortion procedures even in cases where pregnancy threatens maternal health or life. Despite ample evidence that restrictive abortion laws lead to spikes in maternal mortality and morbidity—core public health indicators—the Court prior to the Dobb’s decision has defended abortion as merely a matter of privacy, not health or life. We know this is a myth. Abortion is deeply tied to the ability to stay healthy and in some cases, alive.

Regardless, our political parties remain deeply polarized on access to healthcare, including abortion. But lawmakers should know there is historical backing in the U.S. for elevating a right to health. None other than U.S. president Franklin D. Roosevelt, first proposed healthcare as a human right in his State of the Union address in 1944, as part of his ‘Second Bill of Rights.’ His list featured aspirational economic and social guarantees to the American people, like the right to a decent home and, of course, the right to adequate medical care.

Eleanor Roosevelt later took the Second Bill of Rights to the U.N., where it contributed to the right to health being included in the Universal Declaration of Human Rights in 1948. The right to health is now accepted international law, and is part of numerous treaties, none of which the U.S. Senate has seen fit to ratify. The U.S. conservative movement has historically declared itself averse to adopting rights that might expand government function and responsibility. In contrast, state legislatures in red states are keen to expand government responsibility when it comes to abortion. The conservative movement condemns government interference in the delivery of healthcare—except when it comes to reproductive health. The American Medical Association has called abortion bans a “direct attack” on medicine, and a “brazen violation of patients’ rights to evidence-based reproductive health services.”

Excepting access to abortion, U.S. lawmakers have largely left healthcare to the markets, rather than government. True, the government funds programs like Medicaid and Medicare but these programs vary significantly in quality and access by state, falling far short of providing fair, equitable, universal access to good healthcare.

The only two places where the U.S. government accepts some responsibility for the provision of healthcare are 1) in prisons and mental health facilities; and 2) in the military. While healthcare services in the U.S. prison system are notoriously deficient, they nevertheless exist and are recognized as an entitlement, underpinning the right to life. As an example, in 2005 a federal court seized control of the failing healthcare system in California’s Department of Corrections citing preventable deaths. In the military, free healthcare is an entitlement, and the quality of that care is deemed good enough even for the U.S. president.

So why doesn’t everyone in the U.S. have the same rights?

It is an uphill battle in a country that sees health and healthcare as a private matter for markets and individuals to navigate. But if we want to improve public health in the U.S. we need to start legislating healthcare as a right—and recognize that achieving the highest possible standards of public health is a legitimate government function.

photo: Tony Gutierrez / AP Photo

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Does the u.s. need universal health care, december 8, 2020 • 11 min listen.

Wharton's Robert Hughes explains the moral and social benefits of universal health care and how such a system might look in the U.S.

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Wharton’s Robert Hughes speaks with Wharton Business Daily on SiriusXM about the need for universal health care in the U.S.

Nothing quite exposes the inequalities that exist in American society more than the health care system. It’s a complex combination of private insurance, public programs and politics that drives up costs, creating significant barriers to lifesaving medical treatment for large segments of the population. In America, access to quality health care often depends on income, employment and status.

Why Should Healthcare Be Free?

Robert Hughes, professor of business ethics and legal studies at Wharton, is an advocate for universal health care coverage. Drawing deeply on his research in philosophy, Hughes believes that equal access to medical care is beneficial for both liberty and social stability. Health, he says, should not be tied to wealth.

“I think it’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance,” he said, referring to the crowdsourcing platform used to help raise money for patient bills. “That’s why I say that truly universal health care would be good for people’s liberty. Because you’re not really free if you’re depending on charity, especially discretionary charity like the kind you see on GoFundMe, for a basic need like health care.”

Hughes recently joined the Wharton Business Daily radio show on SiriusXM to discuss universal health care in the context of the presidential election. (Listen to the podcast at the top of this page.) President-elect Joe Biden has said he will protect and rebuild the Affordable Care Act , which has been under attack since it was enacted in 2010 under President Barack Obama.

Does the U.S. Hhave Universal Healthcare Now That Obamacare Exists?

The ACA, commonly referred to as Obamacare, brought the U.S. closer to providing universal health care through subsidized private health insurance, but Hughes said there’s still a wide gap. He believes policymakers should ensure that everyone has coverage and access to the same needed treatments.

“It’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance.”

“I think it’s totally feasible for us to change the health care system, if we all were willing to do the right thing. But we’re not all willing to do the right thing,” Hughes said.

The professor argued the case for universal health care in a paper titled “ Egalitarian Provision of Necessary Medical Treatment ,” which was published last year in the Journal of Ethics. (The author-accepted version is  here .) He examined the health care systems of the U.K., Australia and Canada, concluding that Canada’s single-payer system is the most advantageous for the U.S.

Private insurance would still exist under such a setup, but it could not be used to pay for treatments already covered under universal health care. This provision would eliminate wealth as the controlling factor in health.

Why Doesn’t the U.S. Have Free Healthcare?

“I don’t understand why there’s so much resistance to the idea of truly universal health insurance in the United States, given that this is something that other industrial countries just do,” Hughes said.

He acknowledged that the U.S. doesn’t have the “political will” to change a system that’s been entrenched since the end of World War II, when employers began offering health insurance to their workers instead of higher wages.

“We can’t wave a magic wand and go back to 1946,” he said. “I don’t see the United States completely uprooting all these insurances. And that means we might need to create a model that keeps a lot of what we have, making it more accessible to more people, rather than creating all new institutions from scratch.”

Knowledge at Wharton interviewed Hughes in 2019 about his paper. For an in-depth look into his research and advocacy, read the interview here .

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Home — Essay Samples — Government & Politics — Public Policy — Argumentative Essay Should Health Care Be Free

Argumentative Essay Should Health Care Be Free

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Published: Mar 5, 2024

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Why Healthcare Should Be Free? Research Paper

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Introduction

Works cited.

• Specific Purpose: To persuade my audience that health care should be free for everyone.
• Thesis Statement: Given the current state of health care, the US should adopt a system that covers all citizens.
• Organizational Pattern: Monroe’s Motivated Sequence.
• Has anyone here ever been uncovered by health insurance when seeking a new workplace or working part-time?
• In a time when it feels something has gone wrong, what we rely on is health care that is affordable – why not make it free?
• Think about how much risk you take with no health insurance, especially when an average visit to a doctor costs you more than $60 (Fay par. 8).
• Today, I would like to speak about the reasons a free health care system is the solution to the situation we are witnessing.

The current health care issues in the US are drastic and affect us all

• In 2007, the percentage of bankrupt persons due to uncovered medical bills was 62% (Tamkins par. 2).
• Many of them were insured but lost their money due to coverage gaps.
• Health insurance can take, e.g., $150 a month.
• One of the reasons for it is that top health insurance CEOs’ salaries sum up to tens of millions (Eastwood par. 1).
• Other reasons are excess lab testing and malpractice (Wagner par. 17).
• The ACA was aimed at reducing the percentage of uninsured (“Key Facts About the Uninsured Population” par. 1).
• Still, many people remain uninsured because they still cannot afford it.

Transition: Surely our health care system needs improvement, but there is a tangible solution to it.

Let us see how we can benefit from a free health care system

• The system would not be entirely free, but the costs would be reduced (Nicholson par. 2-6).
• It would also concern tests and prescription drugs.
• Every citizen would be covered by health care.
• Health care would be provided when you seek a new job or do not suffer chronically.

Transition: The benefits of free health care being observed, let us see how free health care has been applied to practice.

Massachusetts health program provides health care to nearly all citizens

• Free insurance was given to those beyond the poverty level (Pallarito par. 1-4).
• Young adults seeking a job were insured.
• Death rates were declined by 4.5%.

Transition: A free health care system can literally save lives.

• Today, I have discussed why the US needs free health care, the benefits of it and how it was implemented by Massachusetts.
• The unaffordability and uninsuredness make your fellow citizens suffer.
• You will probably live longer if you are a Massachusetts resident – but the reform should cover the entire country.
• Honest health care that is affordable for everyone is the step that will unite us on the way to our dream.

Eastwood, Brian. Top health insurance CEO pay exceeds $10 million in 2014 . 2015. Web.

Fay, Bill. Doctor Visit Costs . n.d. Web.

“ Key Facts about the Uninsured Population. ” The Henry J. Kaiser Family Foundation . Kaiser Family Foundation. 2015. Web.

Nicholson, David. “ The world needs free healthcare for all, says the ex-NHS boss. ” The Guardian . Guardian News and Media Limited. 2014. Web.

Pallarito, Karen. “ Massachusetts health care reform law lowered death rates, study finds. ” CBSNews . CBS Interactive Inc. 2014. Web.

Tamkins, Theresa. Medical bills prompt more than 60 percent of U.S. bankruptcies . 2009. Web.

Wagner, Neil. Health Insurance: Millions Spent on Salaries, Not Care . 2010. Web.

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Argumentative Essay: Healthcare Should Be Free

Imagine how helpless you would feel if you needed medical attention but could not get it because you were uninsured and could not afford the medical bill. Wouldn’t that make you feel dependent and unsupported because you can't receive the support you are entitled to? The US spends about $12,530 per person’s healthcare. Although the government provides its citizens with healthcare equally, not everyone needs the money for their healthcare, while others need more money than what is already provided to them. I think the American government should collectively spend for all of its citizens and make healthcare free for all Americans.. Healthcare is a human right that we should all be entitled to regardless of our class. It would save thousands of lives every year. Although many people argue that healthcare would increase the debt rate, free healthcare decreases the spending of the US.  Free healthcare should be enforced morally and logistically to all Americans. 

Healthcare should be provided to everyone at no cost because it is a basic human right that all Americans should be entitled to. In the article “Should All Americans Have the Right (Be Entitled) to Health Care?” It says, “The Declaration of Independence states that all men have “unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness,” [42] which necessarily entails having the health care needed to preserve life and pursue happiness.” This shows that healthcare is a right that all Americans should be entitled to. In this sentence, the author explains that the Declaration of Independence states that all men have the right to “Life, Liberty, and Pursuit to Happiness” this shows that healthcare is also considered a right, which falls into life and the pursuit of happiness. 

Healthcare saves thousands of lives which enforces the right to life and pursuit of happiness in the future. Free healthcare could save lives because many people die from illnesses they never got cured because of the cost of healthcare. In the article “Should All Americans Have the Right (Be Entitled) to Health Care?” Says, “According to a study from Harvard researchers, “lack of health insurance is associated with as many as 44,789 deaths per year,” which translates into a 40% increased risk of death among the uninsured.“ This proves that many people die because they were uninsured. This part of the passage shows a 40% increased risk of death among people who cannot get insured due to the lack of medical support given to the uninsured who can also not afford the medical bill. According to the “Centers for Medicare and Medicaid Services,” the number of people under the age of 65 who were uninsured at the time of the interview was 31.2 million people. This shows that many Americans under the age of 65 are uninsured and probably can not afford the medical bill. 

A common argument against this position is that free healthcare for all Americans would increase US debts. In the article “Should America Have Universal Health Care?” It says “From a study funded by the University of Massachusetts at Amherst, under a single-payer system where everyone has a right to healthcare, private and public healthcare spending could be lowered over 10 years by over 1.8 trillion dollars. This would be due to lower prescription and administrative drug costs.” Some people argue that free healthcare for all Americans would increase US debts. However, the text explains that providing free healthcare does not increase the spending of the US. Instead, It lowered the spending by $1.8 trillion because it lowered the price of drugs prescribed to patients. 

In conclusion, healthcare should be free for all Americans. All Americans should be provided free healthcare because it is a basic human right that all Americans should be entitled to. It would also save lives because many people die from illnesses they never got cured of due to the medical support they needed but did not receive and that was because they were uninsured. Logistically and Morally, Healthcare is a fundamental right that all Americans should be entitled to despite their income and what they can afford. This is an issue that requires us to come together and fight for our rights!

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Reasons Why Healthcare Should Be Free

Many people argue whether healthcare should be free or a privilege. Because of all that is happening around the world right now with covid-19 this is a huge topic that should be discussed. Healthcare is not a privilege or an opportunity in fact it is essential for survival. It is a right that should not be taken from people. Financial issues should not be the reason why a human does not get the medical attention they need. Providing free healthcare to the public is not something that can be done easily and it would take a lot of financing and policies to make this fair to everyone but here are some reasons why it should be considered.

1. bankruptcy

Medical bills can be a huge problem in families because not only is healthcare not free but it is in fact very expensive. Many families struggle with this and cannot get the medical attention needed due to their financial situation. One of my closest friends' mom had melanoma and had to go through multiple surgeries. These bills became very expensive for them and to this day they are still paying them off and this affects the lifestyle they live now. When people are sick this makes them worry how they will possibly pay for the bills and often leaves them wondering whether they even have the option to get the treatment, so making healthcare free or at least more affordable would tremendously help these people to not go bankrupt after receiving medical care. Families should not have to choose between their health and paying their water and food bills.

2. Correct Care

When it comes to health and prescriptions it should come down to what is the best option for the patient. With healthcare being so expensive right now insurance companies are deciding what is best for the patients rather than what the doctor is prescribing. My friend's mom with the melanoma was getting surgeries and treatments based off of her billing plan through her insurance and did not fully get the proper care needed which led to complications in the end. Free healthcare would provide the patients with the doctors orders rather than insurance companies.

3. The Unemployed

The unemployed would especially benefit from free healthcare. Once again healthcare is a right and should not be taken away from people who are in hard times financially. There are so many homeless unemployed people on the streets with signs asking for help. I have seen pregnant women who are homeless and have signs asking for help. Pregnant women need lots of medical care and attention and these unemployed people cannot afford to go see a doctor and are not getting the proper care. Free healthcare would help these suffering women on the streets to protect their baby and have a healthy pregnancy.

4. It is a right

Healthcare is a fundamental human right. This should not be taken away from anyone because they are struggling financially. Having access to healthcare is something that is crucial to have stability in the world. When everyone has access to healthcare we are improving humanity and ending the suffering of many lives. We should ensure we are providing everyone with their appropriate needs including treatments and surgeries for diseases that cause suffering.

5. It can prevent the spreading of diseases

Affordable healthcare could tremendously decrease the spread of diseases and viruses. If everyone is getting treated the amount of people that would get the disease would be much lower. Sometimes when people get diseases they will look into the cost of the treatment and realize the treatment is out of their budget and will then deny the treatment. They will then go on with their life spreading the disease to others. If doctor visits and vaccinations and antibiotics were free the diseases would not travel as much and as often.

6. Equality

One thing that is really big in healthcare is the competition between health service providers. They compete for who gets the most patients and when looking at patients they care for the richest ones. They completely lose sight of what is important and instead focus on who is willing to and can afford to pay for the medical expenses rather than who needs the attention the most. Having free healthcare will ensure that all medical providers are practicing good ethics and are paying attention to the problem rather than the money.

7. Improving the economy

Providing free healthcare would have an enormous impact on the economy. Many people do not work because they have health conditions which they cannot afford to fix. A country with free healthcare would have a stronger economy than those with pricey healthcare. If people were able to get the attention they need to work this would improve their productivity which would then improve the economy. My aunt in Alabama has a bad knee but cannot afford surgery to get it fixed so she does not work. If she was able to afford the surgery she would be able to be more productive for the country and her family.

Overall there are many benefits to free healthcare. It would make our country a better place with a better economy and prevent the spread of diseases. Healthcare is a right that people deserve to obtain. It would make people feel a sense of equality and would help end suffering in many such as the homeless and middle and lower class people. It would be a long process and there would be alot of argumentation to put the right system in place but with all of the benefits that it would provide it is something that needs to be talked about and considered. One question that could help us look further into the problem is 'How does the expensive healthcare system affect different people?'.

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Universal Healthcare in the United States of America: A Healthy Debate

Gabriel zieff.

1 Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; ude.cnu.liame@rrekz (Z.Y.K.); [email protected] (L.S.)

Zachary Y. Kerr

Justin b. moore.

2 Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; ude.htlaehekaw@eroomsuj

This commentary offers discussion on the pros and cons of universal healthcare in the United States. Disadvantages of universal healthcare include significant upfront costs and logistical challenges. On the other hand, universal healthcare may lead to a healthier populace, and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation. In particular, substantial health disparities exist in the United States, with low socio–economic status segments of the population subject to decreased access to quality healthcare and increased risk of non-communicable chronic conditions such as obesity and type II diabetes, among other determinants of poor health. While the implementation of universal healthcare would be complicated and challenging, we argue that shifting from a market-based system to a universal healthcare system is necessary. Universal healthcare will better facilitate and encourage sustainable, preventive health practices and be more advantageous for the long-term public health and economy of the United States.

1. Introduction

Healthcare is one of the most significant socio–political topics in the United States (U.S.), and citizens currently rank “healthcare” as the most important issue when it comes to voting [ 1 ]. The U.S. has historically utilized a mixed public/private approach to healthcare. In this approach, citizens or businesses can obtain health insurance from private (e.g., Blue Cross Blue Shield, Kaiser Permanente) insurance companies, while individuals may also qualify for public (e.g., Medicaid, Medicare, Veteran’s Affairs), government-subsidized health insurance. In contrast, the vast majority of post-industrial, Westernized nations have used various approaches to provide entirely or largely governmentally subsidized, universal healthcare to all citizens regardless of socio–economic status (SES), employment status, or ability to pay. The World Health Organization defines universal healthcare as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship” [ 2 ]. Importantly, the Obama-era passage of the Affordable Care Act (ACA) sought to move the U.S. closer to universal healthcare by expanding health coverage for millions of Americans (e.g., via Medicaid expansion, launch of health insurance marketplaces for private coverage) including for citizens across income levels, age, race, and ethnicity.

Differing versions of universal healthcare are possible. The United Kingdom’s National Health Services can be considered a fairly traditional version of universal healthcare with few options for, and minimal use of, privatized care [ 3 ]. On the other hand, European countries like Switzerland, the Netherlands, and Germany have utilized a blended system with substantial government and market-based components [ 4 , 5 ]. For example, Germany uses a multi-payer healthcare system in which subsidized health care is widely available for low-income citizens, yet private options—which provide the same quality and level of care as the subsidized option—are also available to higher income individuals. Thus, universal healthcare does not necessarily preclude the role of private providers within the healthcare system, but rather ensures that equity and effectiveness of care at population and individual levels are a reference and expectation for the system as a whole. In line with this, versions of universal healthcare have been implemented by countries with diverse political backgrounds (e.g., not limited to traditionally “socialist/liberal” countries), including some with very high degrees of economic freedom [ 6 , 7 ].

Determining the degree to which a nation’s healthcare is “universal” is complex and is not a “black and white” issue. For example, government backing, public will, and basic financing structure, among many other factors must be extensively considered. While an in-depth analysis of each of these factors is beyond the scope of this commentary, there are clear advantages and disadvantages to purely private, market-based, and governmental, universal approaches to healthcare, as well as for policies that lie somewhere in-between. This opinion piece will highlight arguments for and against universal healthcare in the U.S., followed by the authors’ stance on this issue and concluding remarks.

2. Argument against Universal Healthcare

Though the majority of post-industrial Westernized nations employ a universal healthcare model, few—if any—of these nations are as geographically large, populous, or ethnically/racially diverse as the U.S. Different regions in the U.S. are defined by distinct cultural identities, citizens have unique religious and political values, and the populace spans the socio–economic spectrum. Moreover, heterogenous climates and population densities confer different health needs and challenges across the U.S. [ 8 ]. Thus, critics of universal healthcare in the U.S. argue that implementation would not be as feasible—organizationally or financially—as other developed nations [ 9 ]. There is indeed agreement that realization of universal healthcare in the U.S. would necessitate significant upfront costs [ 10 ]. These costs would include those related to: (i) physical and technological infrastructural changes to the healthcare system, including at the government level (i.e., federal, state, local) as well as the level of the provider (e.g., hospital, out-patient clinic, pharmacy, etc.); (ii) insuring/treating a significant, previously uninsured, and largely unhealthy segment of the population; and (iii) expansion of the range of services provided (e.g., dental, vision, hearing) [ 10 ].

The cost of a universal healthcare system would depend on its structure, benefit levels, and extent of coverage. However, most proposals would entail increased federal taxes, at least for higher earners [ 4 , 11 , 12 ]. One proposal for universal healthcare recently pushed included options such as a 7.5% payroll tax plus a 4% income tax on all Americans, with higher-income citizens subjected to higher taxes [ 13 ]. However, outside projections suggest that these tax proposals would not be sufficient to fund this plan. In terms of the national economic toll, cost estimations of this proposal range from USD 32 to 44 trillion across 10 years, while deficit estimations range from USD 1.1 to 2.1 trillion per year [ 14 ].

Beyond individual and federal costs, other common arguments against universal healthcare include the potential for general system inefficiency, including lengthy wait-times for patients and a hampering of medical entrepreneurship and innovation [ 3 , 12 , 15 , 16 ]. Such critiques are not new, as exemplified by rhetoric surrounding the Clinton Administration’s Health Security Act which was labeled as “government meddling” in medical care that would result in “big government inefficiency” [ 12 , 15 ]. The ACA has been met with similar resistance and bombast (e.g., the “repeal and replace” right-leaning rallying cry) as a result of perceived inefficiency and unwanted government involvement. As an example of lengthy wait times associated with universal coverage, in 2017 Canadians were on waiting lists for an estimated 1,040,791 procedures, and the median wait time for arthroplastic surgery was 20–52 weeks [ 17 ]. Similarly, average waiting time for elective hospital-based care in the United Kingdom is 46 days, while some patients wait over a year (3). Increased wait times in the U.S. would likely occur—at least in the short term—as a result of a steep rise in the number of primary and emergency care visits (due to eliminating the financial barrier to seek care), as well as general wastefulness, inefficiency, and disorganization that is often associated with bureaucratic, government-run agencies.

3. Argument for Universal Healthcare

Universal healthcare in the U.S., which may or may not include private market-based options, offer several noteworthy advantages compared to exclusive systems with inequitable access to quality care including: (i) addressing the growing chronic disease crisis; (ii) mitigating the economic costs associated with said crisis; (iii) reducing the vast health disparities that exist between differing SES segments of the population; and (iv) increasing opportunities for preventive health initiatives [ 18 , 19 , 20 , 21 ]. Perhaps the most striking advantage of a universal healthcare system in the U.S. is the potential to address the epidemic level of non-communicable chronic diseases such as cardiovascular diseases, type II diabetes, and obesity, all of which strain the national economy [ 22 , 23 ]. The economic strain associated with an unhealthy population is particularly evident among low SES individuals. Having a low SES is associated with many unfavorable health determinants, including decreased access to, and quality of health insurance which impact health outcomes and life expectancies [ 24 ]. Thus, the low SES segments of the population are in most need of accessible, quality health insurance, and economic strain results from an unhealthy and uninsured low SES [ 25 , 26 ]. For example, diabetics with low SES have a greater mortality risk than diabetics with higher SES, and the uninsured diabetic population is responsible for 55% more emergency room visits each year than their insured diabetic counterparts [ 27 , 28 ]. Like diabetes, hypertension—the leading risk factor for death worldwide [ 29 ], has a much higher prevalence among low SES populations [ 30 ]. It is estimated that individuals with uncontrolled hypertension have more than USD 2000 greater annual healthcare costs than their normotensive counterparts [ 31 ]. Lastly, the incidence of obesity is also much greater among low SES populations [ 32 ]. The costs of obesity in the U.S., when limited to lost productivity alone, have been projected to equate to USD 66 billion annually [ 33 ]. Accessible, affordable healthcare may enable earlier intervention to prevent—or limit risk associated with—non-communicable chronic diseases, improve the overall public health of the U.S., and decrease the economic strain associated with an unhealthy low-SES.

Preventive Initiatives within A Universal Healthcare Model

Beyond providing insurance coverage for a substantial, uninsured, and largely unhealthy segment of society—and thereby reducing disparities and unequal access to care among all segments of the population—there is great potential for universal healthcare models to embrace value-based care [ 4 , 20 , 34 ]. Value-based care can be thought of as appropriate and affordable care (tackling wastes), and integration of services and systems of care (i.e., hospital, primary, public health), including preventive care that considers the long-term health and economy of a nation [ 34 , 35 ]. In line with this, the ACA has worked in parallel with population-level health programs such as the Healthy People Initiative by targeting modifiable determinants of health including physical activity, obesity, and environmental quality, among others [ 36 ]. Given that a universal healthcare plan would force the government to pay for costly care and treatments related to complications resulting from preventable, non-communicable chronic diseases, the government may be more incentivized to (i) offer primary prevention of chronic disease risk prior to the onset of irreversible complications, and (ii) promote wide-spread preventive efforts across multiple societal domains. It is also worth acknowledging here that the national public health response to the novel Coronavirus-19 virus is a salient and striking contemporary example of a situation in which there continues to be a need to expeditiously coordinate multiple levels of policy, care, and prevention.

Preventive measures lessen costs associated with an uninsured and/or unhealthy population [ 37 ]. For example, investing USD 10 per person annually in community-based programs aimed at combatting physical inactivity, poor nutrition, and smoking in the U.S. could save more than USD 16 billion annually within five years, equating to a return of USD 5.60 for every dollar spent [ 38 ]. Another recent analysis suggests that if 18% more U.S. elementary-school children participated in 25 min of physical activity three times per week, savings attributed to medical costs and productivity would amount to USD 21.9 billion over their lifetime [ 39 ]. Additionally, simple behavioral changes can have major clinical implications. For example, simply brisk walking for 30 min per day (≥15 MET-hours/week) has been associated with a 50% reduction in type II diabetes [ 40 ]. While universal healthcare does not necessarily mean that health policies supporting prevention will be enacted, it may be more likely to promote healthy (i) lifestyle behaviors (e.g., physical activity), (ii) environmental factors (e.g., safe, green spaces in low and middle-income communities), and (iii.) policies (e.g., banning sweetened beverages in public schools) compared to a non-inclusive system [ 34 , 35 , 36 ].

Nordic nations provide an example of inclusive healthcare coupled with multi-layered preventive efforts [ 41 ]. In this model, all citizens are given the same comprehensive healthcare while social determinants of health are targeted. This includes “mobilizing and coordinating a large number of players in society,” which encourages cooperation among “players” including municipal political bodies, voluntary organizations, and educational institutions [ 41 ]. Developmental and infrastructural contributions from multiple segments of society to a healthcare system may also better encourage government accountability compared to a system in which a select group of private insurers and citizens are the only “stakeholders.” Coordinated efforts on various non-insurance-related fronts have focused on obesity, mental health, and physical activity [ 41 ]. Such coordinated efforts within the Nordic model have translated to positive health outcomes. For example, the Healthcare Access and Quality (HAQ) Index provides an overall score of 0–100 (0 being the worst) for healthcare access and quality across 195 countries and reflects rates of 32 preventable causes of death. Nordic nations had an average HAQ score of 95.4, with four of the five nations achieving scores within the top 10 worldwide [ 42 ]. Though far more heterogenous compared to Nordic nations, (e.g., culturally, geographically, racially, etc.), the U.S. had a score of 89 (29th overall) [ 42 ]. To provide further context, other industrialized nations, which are more comparable to the U.S. than Nordic nations, also ranked higher than the U.S. including Germany (92, 19th overall), Canada (94, 14th overall), Switzerland (96, 7th overall), and the Netherlands (96, 3rd overall) [ 42 ].

4. Conclusions

Non-inclusive, inequitable systems limit quality healthcare access to those who can afford it or have employer-sponsored insurance. These policies exacerbate health disparities by failing to prioritize preventive measures at the environmental, policy, and individual level. Low SES segments of the population are particularly vulnerable within a healthcare system that does not prioritize affordable care for all or address important determinants of health. Failing to prioritize comprehensive, affordable health insurance for all members of society and straying further from prevention will harm the health and economy of the U.S. While there are undoubtedly great economic costs associated with universal healthcare in the U.S., we argue that in the long-run, these costs will be worthwhile, and will eventually be offset by a healthier populace whose health is less economically burdensome. Passing of the Obama-era ACA was a positive step forward as evident by the decline in uninsured U.S. citizens (estimated 7–16.4 million) and Medicare’s lower rate of spending following the legislation [ 43 ]. The U.S. must resist the current political efforts to dislodge the inclusive tenets of the Affordable Care Act. Again, this is not to suggest that universal healthcare will be a cure-all, as social determinants of health must also be addressed. However, addressing these determinants will take time and universal healthcare for all U.S. citizens is needed now. Only through universal and inclusive healthcare will we be able to pave an economically sustainable path towards true public health.

Author Contributions

Conceptualization, G.Z., Z.Y.K., J.B.M., and L.S.; writing-original draft preparation, G.Z.; writing-review and editing, Z.Y.K., J.B.M., and L.S.; supervision, L.S. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Point Turning Point: the Case for Universal Health Care

An argument that the COVID-19 pandemic might be the turning point for universal health care.

Why the U.S. Needs Universal Health Care

As we all grapple with our new reality, it's difficult to think of anything beyond the basics. How do we keep our families safe? Are we washing our hands enough ? Do we really have to sanitize the doorknobs and surfaces every day? How do we get our cats to stop videobombing our Zoom meetings? Do we have enough toilet paper?

Win McNamee | Getty Images

The more we read the headlines, the more we feel the need to do something, or at least say something. Change is happening – ready or not. Maybe talking about some of these important issues can lead to action that will help us steer out of this skid.

Historically, Americans have found ways to meet their circumstances with intention, moving in mass to make heretofore unimaginable change that has sustained and improved our lives to this day. The Great Depression lead to the creation of the New Deal and Social Security. The Triangle Shirtwaist Factory fire brought about change in labor conditions. The Cuyahoga River fire lead to the founding of the Environmental Protection Agency.

Could the COVID-19 pandemic be the turning point for universal health care? We can't think of a more propitious time. In the first two weeks of April, 5.2 million Americans filed for unemployment. Economists believe that 30% unemployment is possible by fall. For most Americans, our health care is tied to our employment, and because of this, millions of Americans are losing their health care just when they may need it the most. Economists predict that health insurance premiums will likely increase by 40% in the next year due to less payers and more who are in need of care and the eventual collapse of private health care insurance .

Our current circumstances have illustrated the need for universal health care in a way that is obvious and undeniable. Below we have listed the most frequent arguments in opposition followed by an evidence-based rebuttal.

1. Point: "Governments are wasteful and shouldn't be in charge of health care."

Counterpoint: 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.

Bottom line: Among industrialized countries with comparable levels of economic development, government-provided health care is much more efficient and more economical than the U.S. system of private insurance.

2. Point: "U.S. health care is superior to the care offered by countries with universal health care."

Counterpoint: According to the Commonwealth Health Fund , in the U.S., infant mortality is higher and the life span is shorter than among all comparable economies that provide universal health care. Maternal mortality in the U.S. is 30 per 100,000 births and 6.4 per 100,000 births on average in comparable countries, which is nearly five times worse.

In addition, the U.S. has the highest chronic disease burden (e.g., diabetes, hypertension) and an obesity rate that is two times higher than the OECD average. In part due to these neglected conditions, in comparison to comparable countries, the U.S. (as of 2016) had among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.

The Peterson-Kaiser Health System Tracker , which is a collaborative effort to monitor the quality and cost of U.S. health care, shows that among comparable countries with universal health care, mortality rate is lower across the board on everything from heart attacks to child birth. The U.S. also has higher rates of medical, medication and lab errors relative to similar countries with universal health care.

Bottom line: With our largely privately funded health care system, we are paying more than twice as much as other countries for worse outcomes.

3. Point: "Universal health care would be more expensive."

Counterpoint: The main reason U.S. health care costs are so high is because we don't have universal health care. Unlike other first world countries, the health care system in the U.S. is, to a great extent, run through a group of businesses. Pharmaceutical companies are businesses. Insurance companies are businesses. Hospital conglomerates are businesses. Even doctors' offices are businesses.

Businesses are driven to streamline and to cut costs because their primary goal is to make a profit. If they don't do this, they can't stay in business. It could mean that in the process of "streamlining," they would be tempted to cut costs by cutting care. Under the current system, a share of our health care dollars goes to dividends rather than to pay for care, hospitals are considered a "financial asset" rather than a public service entity and a large portion of their budgets are dedicated to marketing rather than patient care.

Given all these business expenses, it shouldn't be surprising that the business-oriented privately funded health care system we have is more expensive and less effective than a government provided universal system. In addition, for the health care system as a whole, universal health care would mean a massive paperwork reduction. A universal system would eliminate the need to deal with all the different insurance forms and the negotiations over provider limitations. As a result, this would eliminate a large expense for both doctors and hospitals.

The economist Robert Kuttner critiques the system this way: "For-profit chains … claim to increase efficiencies by centralizing administration, cutting waste, buying supplies in bulk at discounted rates, negotiating discounted fees with medical professionals, shifting to less wasteful forms of care and consolidating duplicative facilities." As he points out, "using that logic, the most efficient 'chain' of all is a universal national system."

Evidence to support these points can be found in a recent Yale University study that showed that single-payer Medicare For All would result in a 13% savings in national health-care expenditures. This would save the country $450 billion annually.

Bottom line: Universal health care would be less expensive overall, and an added benefit would be that health care decisions would be put in the hands of doctors rather than insurance companies, which have allegiances to shareholders instead of patient care.

4. Point: "I have to take care of my own family. I can't afford to worry about other people."

Counterpoint: It is in all of our best interests to take care of everyone. Aside from the fact that it is the compassionate and moral thing to do, viruses do not discriminate. When people don't have insurance, they won't go to the doctor unless they're gravely ill. Then, they're more likely to spread illness to you and your family members while they delay getting the care they need.

In addition, when people wait for care or don't get the prophylactic care then need, they end up in the emergency room worse off with more costly complications and requiring more resources than if they had been treated earlier. Taxpayers currently cover this cost. This affects everyone, insured or not. Why not prevent the delay upfront and make it easy for the patient to get treatment early and, as an added bonus, cost everyone less money?

In addition, the health of the economy impacts everyone. Healthy workers are essential to healthy businesses and thus a healthy economy. According to the Harvard School of Public Health , people who are able to maintain their health are more likely to spend their money on goods and services that drive the economy.

Bottom line: The health of others is relevant to the health of our families either through containment of infectious diseases such as COVID-19 or through the stability of the economy. Capitalism works best with a healthy workforce.

5. Point: "Entrepreneurship and innovation is what makes the U.S. a world leader."

Counterpoint: Imagine how many people in the U.S. could start their own businesses or bring their ideas to market if they didn't have to worry about maintaining health care for their families. So many people stay tethered to jobs they hate just so their family has health care. With workers not needing to stay in jobs they don't like in order to secure health insurance, universal healthcare would enable people to acquire jobs where they would be happier and more productive. Workers who wanted to start their own business could more easily do so, allowing them to enter the most creative and innovative part of our economy – small businesses.

In his book, "Everything for Sale," economist Robert Kuttner asserts that it's important to understand that businesses outside of the U.S. don't have to provide health care for their employees, which makes them more competitive. From a business point of view, American companies, released from the burden of paying employee insurance, would be more competitive internationally. They would also be more profitable as they wouldn't have to do all the paperwork and the negotiating involved with being the intermediary between employees and insurance companies.

Bottom line: Unburdening businesses from the responsibility of providing health insurance for their employees would increase competitiveness as well as encourage entrepreneurship and innovation, and allow small businesses room to thrive.

6. Point: "The wait times are too long in countries with universal health care."

Counterpoint: The wait times on average are no longer in countries with universal healthcare than they are in the U.S., according to the Peterson-Kaiser Health System Tracker . In some cases, the wait times are longer in the U.S., with insurance companies using valuable time with their requirements to obtain referrals and approvals for sometimes urgently needed treatments. On average, residents of Germany, France, UK, Australia, and the Netherlands reported shorter wait times relative to the U.S.

Bottom line: Wait times are longer in the U.S. when compared with many countries with a universal health care system.

7. Point: "My insurance is working just fine, so why change anything?"

Counterpoint: A comprehensive study conducted in 2018 found that 62% of bankruptcies are due to medical bills and, of those, 75% were insured at the time. Most people who have insurance are insufficiently covered and are one accident, cancer diagnosis or heart attack away from going bankrupt and losing everything. The U.S. is the only industrialized country in the world whose citizens go bankrupt due to medical bills. And, if you survive a serious illness and don't go bankrupt, you may end up buried in bills and paperwork from your insurance company and medical providers. All of this takes time and energy that would be better spent healing or caring for our loved ones. Besides, we don't need to abolish private health insurance. Some countries like Germany have a two-tiered system that provides basic non-profit care for all but also allows citizens to purchase premium plans through private companies.

Bottom line: Private insurance does not protect against medical bankruptcy, but universal health care does. The residents of countries with universal health care do not go bankrupt due to medical bills.

8. Point: "I don't worry about losing my insurance because if I lose my job, I can just get another one."

Counterpoint: We can't predict what will happen with the economy and whether another job will be available to us. This pandemic has proven that it can all go bad overnight. In addition, if you lose your job, there is less and less guarantee that you will find a new job that provides insurance . Providing insurance, because it is so expensive, has become an increasingly difficult thing for companies to do. Even if you're able to find a company that provides health care when you change jobs, you would be relying on your employer to choose your health plan. This means that the employee assumes that the company has his or her best interests in mind when making that choice, rather than prioritizing the bottom line for the benefit of the business. Even if they're not trying to maximize their profit, many companies have been forced to reduce the quality of the insurance they provide to their workers, simply out of the need to be more competitive or maintain solvency.

Bottom line: There are too many factors beyond our control (e.g., pandemic, disability, economic recession) to ensure anyone's employment and, thus, health care. Universal health care would guarantee basic care. Nobody would have to go without care due to a job loss, there would be greater control over costs and businesses would not have to fold due to the exorbitant and rising cost of providing health insurance to their employees.

9. Point: "Pharmaceutical companies need to charge so much because of research and development."

Counterpoint: It's usually not the pharmaceutical companies developing new drugs. They develop similar drugs that are variations on existing drugs, altered slightly so that they can claim a new patent. Or they buy out smaller companies that developed new drugs, thus minimizing their own R&D costs. Most commonly, they manufacture drugs developed under funding from the National Institutes of Health, and thus, the tax payers are the greatest funder of drug development via NIH grants provided to university labs.

Oddly, this investment in R&D does not appear to extend any discount to the tax payers themselves. In "The Deadly Costs of Insulin, " the author writes that insulin was developed in a university lab in 1936. In 1996, the cost of a vial of insulin was $21. Today, the cost of a vial of insulin could be as much as $500, causing some without insurance to risk their lives by rationing or going without. The cost of manufacturing the drug has not gone up during that time. So, what accounts for the huge increase in price? In " The Truth About Drug Companies ," the author demonstrates that drug companies use the bulk of their profits for advertising, not R&D or manufacturing. A universal health care system would not only not need to advertise, but would also be more effective at negotiating fair drug prices. Essentially, the government as a very large entity could negotiate price much more effectively as one large system with the government as the largest purchaser.

Bottom line: Taxpayers contribute most of the money that goes into drug development. Shouldn't they also reap some of the benefits of their contribution to R&D? Americans should not have to decide between their heart medication and putting food on the table when their tax dollars have paid for the development of many of these medications.

10. Point: "I don't want my taxes to go up."

Counterpoint: Health care costs and deductibles will go down to zero and more than compensate for any increase in taxes, and overall health care needs will be paid for, not just catastrophic health events. According to the New York Times , “…when an American family earns around $43,000, half of the average compensation when including cash wages plus employer payroll tax and premium contributions, 37% of that ends up going to taxes and health care premiums. In high-tax Finland, the same type of family pays 23% of their compensation in labor taxes, which includes taxes they pay to support universal health care. In France, it’s 2%. In the United Kingdom and Canada, it is less than 0% after government benefits.”

Bottom line: With a universal health care system, health care costs and deductibles will be eliminated and compensate for any increase in taxes.

11. Point: "I don't want to have to pay for health care for people making bad choices or to cover their pre-existing conditions."

Counterpoint: Many of the health problems on the pre-existing conditions list are common, genetically influenced and often unavoidable. One estimate indicates that up to 50% – half! – of all (non-elderly) adults have a pre-existing condition. Conditions on the list include anxiety, arthritis, asthma, cancer, depression, heart defect, menstrual irregularities, stroke and even pregnancy. With universal health care, no one would be denied coverage.

It's easy to assume that your health is under your control, until you get into an accident, are diagnosed with cancer or have a child born prematurely. All of a sudden, your own or your child's life may rely on health care that costs thousands or even millions of dollars. The health insurance that you once thought of as "good enough" may no longer suffice, bankruptcy may become unavoidable and you (or your child) will forever have a pre-existing condition. Some people may seem careless with their health, but who's to judge what an avoidable health problem is, vs. one that was beyond their control?

For the sake of argument, let's say that there are some folks in the mix who are engaging in poor health-related behaviors. Do we really want to withhold quality care from everyone because some don't take care of their health in the way we think they should? Extending that supposition, we would withhold public education just because not everyone takes it seriously.

Bottom line: In 2014, protections for pre-existing conditions were put in place under the Affordable Care Act. This protection is under continuous threat as insurance company profits are placed above patient care. Universal health care would ensure that everyone was eligible for care regardless of any conditions they may have.

And, if universal health care is so awful, why has every other first-world nation implemented it? These countries include: Australia, Austria, Bahrain, Belgium, Brunei, Canada, Cyprus, Denmark, Finland, France, Germany, Greece, Hong Kong, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Singapore, Slovenia, South Korea, Spain, Sweden, Switzerland, United Arab Emirates and the U.K.

Changing collective minds can seem impossible. But there is precedent. Once unimaginable large-scale change has happened in our lifetime (e.g. legalization of gay marriage, election of the first black president of the U.S. and the #MeToo movement), and support for universal health care has never been higher (71% in favor, according to a 2019 Hill-HarrisX survey ).

Point: As Chuck Pagano said, "If you don't have your health, you don't have anything."

Counterpoint: If good health is everything, why don't we vote as if our lives depended on it? This pandemic has taught us that it does.

Bottom line: Launching universal health care in the U.S. could be a silver lining in the dark cloud of this pandemic. Rather than pay lip service to what really matters, let's actually do something by putting our votes in service of what we really care about: the long-term physical and economic health of our families, our communities and our country.

Photos: Hospital Heroes

Tags: health insurance , health care , Coronavirus , pandemic , New Normal

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Should healthcare | be free?

Access to good healthcare is vital so shouldn't it be available to everyone regardless of their financial situation? But can anything ever truly be 'free'? There's a range of different ways to fund healthcare but which is fairest? Let's dig deeper...

Build your own healthcare system - how would you organise and pay for it?

Should people who have medical conditions that are affected by their choices, e.g. lung cancer in people who smoke, have to pay more for their treatment?

• B : Yes, people who get an illness related to their lifestyle should pay more.
• A : No, it isn’t always clear whether a condition was caused by a person’s choices. We shouldn’t punish people by making it harder for them to access treatment. 

How do you think people should pay for healthcare?

• A : Collectively (e.g. through taxes) - people pay based on how much they earn, meaning richer people pay more and poorer people pay very little, regardless of how much treatment they need.
• B : Individually - people pay for each treatment only when they need it. Healthy people don’t pay as much, but sicker people pay more, and some poorer people may not be able to afford treatment.

People who are from poorer backgrounds often have worse health. Do you think:

• B : Money should be spent in a way that means people overall get the best possible health outcomes - we shouldn’t prioritise one group over another. 
• A : More money should be spent on people from poorer backgrounds to improve their health, even at the expense of some healthcare for wealthier people, to try to reduce health inequality.

Paying for healthcare collectively through taxes means that some new, very expensive treatments may not be affordable. Would you rather:

• A : Some treatments aren’t available for anyone because they are too expensive, but what is available is accessible and affordable to everyone who needs it. 
• B : Everyone is able to access all treatments, but they have to pay for it, meaning some people might not be able to afford them. 

Paying for healthcare collectively means that individuals don’t get to choose how much they spend on healthcare instead of other things, as paying for it is mandatory. Would you rather:

• B : People make their own decisions about how much to spend on healthcare. This means they risk not having enough money to pay for healthcare if they get very sick in future, but if they stay healthy they will have more money for other things.
• A : People are guaranteed healthcare over their lifetime, but they might not have as much money for things like education, food and hobbies - even if they are healthy and don’t use it.

Your spending decisions: what’s the bigger picture?

Did you answer A to more questions, or B? Let's see what this could mean in terms of real-life health spending. 

If you mostly chose A:

You prefer a healthcare system that favours giving everyone access to healthcare (also known as universal health care). Your healthcare system would probably look a lot like the National Health Service in the UK, where healthcare is paid for through taxes, and is mostly free to patients. It could also be paid for through mandatory insurance whereby citizens don’t get to choose how much they spend on healthcare, instead, it depends on how much they earn. But when they do get sick, they don’t have to pay extra, no matter how much healthcare they need. This collective payment system is usually cheaper overall, but it does sometimes mean that expensive treatments aren’t affordable.

If you chose mostly B:

You prefer a private healthcare system, like those in the USA or Switzerland. In these countries, patients pay for healthcare only when they need it, although most take out some kind of private insurance, in case they do get sick. The advantage of this system is that people get to choose how much they spend on health compared to other things, so healthy people can spend more on hobbies, travel or education, for example. There are also no national limits on what is affordable, so people with the money to pay for it can access the very latest treatments. The disadvantage is that the costs can be very high if you don’t have insurance. Even with insurance, costs are higher in non-mandatory private systems because fewer healthy people take out insurance. Healthy people paying into the health system can help make healthcare cheaper for people who need it. The result of this is that it is hard for poor people to get treatment they need, and health inequality is worse in these countries. 

A world tour of health funding

Most countries have a mixed model of funding healthcare for their citizens. However, generally, they can fall into one of the four systems explained below…

• This is a model that is famously adopted by the UK’s National Health Service (NHS) which ensures that ‘all people and communities can receive the health services they need without financial hardship’ (World Health Organisation, 2018). Although the majority of funding for the NHS comes from income taxes, you don’t have to be in work to be able to access NHS healthcare and, in this way, it is free at point of use. For some items such as prescriptions or dental procedures, there are additional charges, but these can be waived for certain groups. For example, you’re entitled to free prescriptions if you’re over 60 or under 16, among other reasons. This is in place to remove any potential barriers to care. The main limitation of this health care funding model is that it cannot provide every medical treatment for everyone. This particularly affects the newest treatments, which are often very expensive. In the UK, there is a body in place called the National Institute for Health and Care Excellence (NICE) which determines whether new treatments are cost-effective and therefore worth spending money on. 
• This is a common model of health funding adopted by most European countries and it can also provide universal health coverage by providing health care for all, regardless of personal income. In this system, every citizen buys a mandatory health insurance scheme, usually tied to their employment. The premium they pay depends on their income. By making insurance mandatory, healthy people have to buy insurance, pooling risk and making premiums more affordable for people with existing health problems. Those who can’t afford to pay (for example, those who are unemployed) are still enrolled and therefore able to access healthcare. Similar to UHC (see section above), there are limitations in the medical treatments that can be provided within this model of health funding, and organisations like NICE also exist in these countries. The key difference between the social insurance model and UHC is that the more you pay in can affect the quality of care you receive. So you might have shorter waiting times, for example, if you pay for a more expensive insurance scheme. In Germany, for example, those earning over an upper-income threshold (~EUR 60,000) can opt to purchase private insurance and gain access to a wider range of services and treatments.
• The private insurance model of healthcare funding is primarily used in the United States and Switzerland, although you can pay into similar schemes in other countries - including the UK - should you choose to. Unlike social insurance, private insurance is not linked to your earnings in the form of a tax or premium cap. You have to take out a policy as an individual, and your premium will depend on your health needs rather than your ability to pay. Unlike UHC and social insurance models, there are no limits to the kind of advanced and new medical treatments available within the private insurance system. But in reality, even with a comprehensive private policy, many of these treatments would be far too expensive for most patients to afford. Overall, within this model, healthcare access is based on what a person can afford rather than what they need. For some low-income people, families, pregnant women, elderly and disabled people, there is support with medical costs within government programs (such as US programmes Medicaid and ‘Obamacare’). However, there are still some people who struggle to qualify for this support and consequently struggle to afford any kind of medical cover.
• This is the model which tends to be in place when a country does not have a national funding structure, and as a result, it’s usually found in very low-income countries such as parts of sub-Saharan Africa. In other words, when you need to see a doctor, you have to pay for it yourself, without any kind of insurance or government support. This means there can be a lot of uncertainty for those who are unwell and many people are left in a vulnerable situation not knowing how they will cover the costs of care. In these countries, people frequently go without healthcare because they can’t afford it, although global initiatives are now seeking to bring UHC to these countries. 

The NHS in numbers

The UK National Health Service (NHS) celebrates its 70th anniversary in 2018. Take a look at this animation to see how it has changed over time. 

https://www.youtube.com/watch?time_continue=87&v=tn5Pt2TEgq4

Pre-1800: Healthcare was largely provided by untrained local people using homemade medicines.

1800: Doctors thought infection was caused by “bad air” they called “miasma”. Diseases spread fast and surgery was risky. 

1900: Developments in anaesthesia and sterile techniques meant patients could receive basic surgery without pain.  

Early 1900s: The World Wars posed a huge challenge for healthcare on the battlefield and at home. Many volunteers were needed like in this Oxfordshire hospital ward during the First World War. 

1948: Happy Birthday to the NHS! The service turns 70 in 2018. 

1950: Vaccination programs and antibiotics became mainstream, keeping people safe from serious diseases like smallpox, polio and tuberculosis.

2000: Thanks to better medical practices and healthier lifestyles, we're now living longer. If this trend continues, healthcare will need to keep up with the needs of an ageing population.

2018: Many predict that apps will take over diagnosis in the future. Would you trust an app with your healthcare? 

Should healthcare be free?

What does it mean when we say healthcare is ‘free’? Should there be a variety of healthcare providers on offer or just one national one? Prof. Joshua Hordern, Associate Professor of Christian Ethics at the University of Oxford answers these questions.  

If you’re ill or get badly injured in Britain, the chances are that you’ll seek help from the National Health Service (NHS for short). You’ll get treated by medical staff for free at your doctor’s surgery or at the hospital, and you won’t be issued with a hefty bill afterwards.

The NHS has existed for 70 years and Prof. Hordern says that it has a unique place in British society, even if people aren’t quite sure about how it works.

Taxing times

Prof. Hordern points out first of all that healthcare is not free in every sense in the UK but paid for by taxes. 

'We all pay for it,' he explains. 'Even those of us who don’t pay income tax still contribute towards healthcare through VAT and other taxes.' VAT stands for value added tax - it is a small amount of the price of many purchases and goes to the government.

He suggests that some people might even be willing to pay more taxes to fund healthcare, which is unsurprisingly an expensive undertaking. This is because in the UK, people feel very strongly about the importance of the NHS. 

'I think it’s peculiarly British,' he says. 'I think there’s a sense of national mission and vision around the NHS. It came out of the Second World War - but the founders never imagined the level of care now being provided.'

Part of the problem with the stretched NHS budget is that the UK's population is growing and people are living longer partly because of the quality of care they receive from the NHS throughout their lives. That means the NHS and society at large have more people to look after and many more people in their old age who need care.

Prof. Hordern says that lots of universities and other organisations now work with the NHS to do research into expensive treatments for illnesses and conditions, and this all costs money. He adds that these treatments might actually save us all money eventually but there isn’t any way to know that before the research starts. 

Responsibilities and costs

Although NHS healthcare might be free financially at the point of use, it isn’t free in other ways. For example, Prof. Hordern says that patients ought to use the shared resource of the NHS responsibly - we aren’t just free to do what we like. A good example is that people who have received an organ transplant should live in a way which honours the gift they have received, or if you make a doctor’s appointment you should make sure that you really need it and turn up to it on time.

He also says that the NHS is not free from personal cost for health service staff because of the long hours they work and the difficult things they do. That means that they - and their families - may suffer personal stress and strain. This is similar in some ways to the strains placed on armed service personnel and their families.

Private healthcare

Of course, people can also access health care outside the NHS but they would have to pay for it directly, whether through insurance or by finding the money afterwards. 'A good number of consultants work in the private sector as well as the public,' says Prof. Hordern. 'Some elements of private care are clearly very effective and good.'

He adds that there is considerable waste in the NHS, because it is hard for the people who work there both to be aware of how much things cost and to take tough decisions. If a hospital or a surgery is run as a business, it is possible - though by no means certain - that they will use money better.

The future of healthcare

What Prof. Hordern thinks is important is the way people view health and healthcare in the 21st century, and how they think about other national values.

'How do we think about our healthcare, as part of what identifies us and marks us as a nation?' he asks. 'How do we care for the most vulnerable in our society, especially the elderly?' With a large elderly population, it’s possible that older people will be suffering both psychologically and physically from loneliness and Prof. Hordern thinks that this is a huge health problem.

'The NHS isn’t set up to sort out loneliness,' he points out. He thinks that friends, family, neighbours and religious communities have a bigger role to play in supporting people who are ill or frail. If people aren’t seriously sick they don’t need to be in a hospital bed, and they could stay in their own homes if they had someone to look after them - but this can be difficult in the modern world, especially with the serious strain on public and private providers of social care at the moment.

'More and more of us are working, often long hours and in unstable employment,' he says. 'Life is demanding and expensive. So how do we build links in society? That’s an element of our lives which we have to work hard at renewing if we are to avoid social death for many people. In other words, a death before death, of isolation, of loneliness, of falling through the cracks.'

What health and care needs do you think we as a society should spend our money on? Would you be happy to pay for medical treatment? Do you think local communities could do more to take care of their most vulnerable members?

What changes could we make?

Dr. Marco Springmann discusses a new report from the Oxford Martin Programme on the Future of Food. It shows that a global switch to diets that rely more on fruit and vegetables than meat could save lives, reduce greenhouse gas emissions, lead to healthcare-related savings and avoid climate damages of $1.5 trillion (US). Would you be willing to make these changes? 

https://www.youtube.com/watch?v=MMnyFURBKAo

• The benefits of a digital healthcare system
• NHS funding’s north-south divide: why the ‘sicker’ north gets less money
• Should healthcare be free? Take this further...
• The biggest challenges for global healthcare
• The economics of tropical diseases
• The history of the NHS
• Vaccinations and the fight against poverty
• Medicines from the past - would you have tried them?

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NCAA signs off on deal that would change landscape of college sports — paying student-athletes

A major change could be coming for college athletes — they may soon start getting paid.

A tentative agreement announced Thursday by the NCAA and the country’s five biggest conferences to a series of antitrust lawsuits could direct millions of dollars directly to athletes as soon as fall 2025.

The nearly $2.8 billion settlement, which would be paid out over the next decade to 14,000 former and current student-athletes, “is an important step in the continuing reform of college sports that will provide benefits to student-athletes and provide clarity in college athletics across all divisions for years to come,” NCAA President Charlie Baker said in a joint statement Thursday night with the commissioners of the ACC, the Big 10, the Big 12, the Pac-12 and the SEC.

The federal judge overseeing the case must still sign off on the agreement, but if it is approved, it would signal a major shift in college sports in which students would play for compensation, not just scholarships, exposure and opportunities.

“This landmark settlement will bring college sports into the 21st century, with college athletes finally able to receive a fair share of the billions of dollars of revenue that they generate for their schools,” said Steve Berman, one of the lead attorneys for the plaintiffs. “Our clients are the bedrock of the NCAA’s multibillion-dollar business and finally can be compensated in an equitable and just manner for their extraordinary athletic talents.”

The NCAA and power conferences called the settlement a “road map” that would allow the uniquely American institution to provide unmatched opportunity for millions of students and write the “next chapter of college sports.”

The case, which was set to go to trial early next year, was brought by a former and a current college athlete who said the NCAA and the five wealthiest conferences improperly barred athletes from earning endorsement money. Former Arizona State swimmer Grant House and Sedona Prince, a former Oregon and current TCU basketball player, also contended in their suit that athletes were entitled to a piece of the billions of dollars the NCAA and those conferences earn from media rights agreements with television networks.

Michael McCann, a legal analyst and sports reporter at Sportico , told NBC News in an interview on Top Story with Tom Llamas the case has two components that “move away from amateurism” — one that deals with how players are paid for the past loss of earnings, including money they could have made for name, image and likeness.

“The going forward part is that colleges can opt in, conferences can opt in, as well, to pay players, to share revenue with them, to have direct pay, and that would be of course a radical from the traditions of college sports,” McCann said, adding many would say that change is warranted. “Now the athletes, at least at some schools, will get a direct stake.”

Terms of the deal were not disclosed, though some details have emerged in the past few weeks. They signal the end of the NCAA’s bedrock amateurism model that dates to its founding in 1906. Indeed, the days of NCAA punishment for athletes driving booster-provided cars started vanishing three years ago when the organization  lifted restrictions on endorsement deals  backed by so-called name, image and likeness, or NIL, money.

Now it is not far-fetched to look ahead to seasons when a star quarterback or a top prospect on a college basketball team not only is cashing in big-money NIL deals but also has a $100,000 school payment in the bank to play.

A host of  details are still to be determined . The agreement calls for the NCAA and the conferences to pay $2.77 billion over 10 years to more than 14,000 former and current college athletes who say now-defunct rules prevented them from earning money from endorsement and sponsorship deals dating to 2016.

Some of the money would come from NCAA reserve funds and insurance, but even though the lawsuit specifically targeted five conferences that comprise 69 schools (including Notre Dame),  dozens of other NCAA member schools  would get smaller distributions from the NCAA to cover the mammoth payout.

Schools in the Big Ten, the Big 12 and the Atlantic Coast and Southeastern conferences would end up bearing the brunt of the settlement at a cost of about $300 million apiece over 10 years, the majority of which would be paid to athletes going forward.

The Pac-12 is also part of the settlement, with all 12 current schools sharing responsibility even though Washington State and Oregon State will be the only league members left by this fall after the 10 other schools leave.

Paying athletes

In the new compensation model, each school would be permitted but not required to set aside up to $21 million in revenue to share with athletes per year, though as revenues rose, so could the cap.

Athletes in all sports would be eligible for payments, and schools would be given the freedom to decide how the money is divvied up among sports programs. Roster restrictions would replace scholarship limits by sport.

McCann said the back pay would disproportionately go to some sports — such as football and basketball.

“The schools that I think that are certainly big football schools will probably opt in because they’re going to want to compete, they’re going to want to get the best players, because college football generates a lot of revenue,” he said. 

Whether the new compensation model is subject to the Title IX gender equity law is unknown, along with whether schools would be able to bring NIL activities in-house as they hope and squeeze out the booster-run collectives that have sprouted up in the last few years to pay athletes. Both topics could lead to more lawsuits.

“There are all sorts of areas of turbulence that could present themselves,” McCann said of roadblocks that could arise.

More sports coverage

• Four decades after Michael Jordan, Caitlin Clark is getting her own line of Wilson basketballs
• Mario Andretti: Formula 1 owner personally threatened to shut out team Andretti
• Student-athletes are inking lucrative endorsement deals, but a patchwork of laws has created chaos in college sports

Other cases

The settlement is expected to cover two  other antitrust cases  facing the NCAA and major conferences that challenge athlete compensation rules. Hubbard v. the NCAA and Carter v. the NCAA are also in front of judges in the Northern District of California.

A fourth case, Fontenot v. NCAA, creates a potential complication, as it remains in a Colorado court after a judge  denied a request  to combine it with Carter. Whether Fontenot becomes part of the settlement is unknown, and it matters because the NCAA and its conferences don’t want to be on the hook for more damages should they lose in court.

“We’re going to continue to litigate our case in Colorado and look forward to hearing about the terms of a settlement proposal once they’re actually released and put in front of a court,” said George Zelcs, a plaintiffs’ attorney in Fontenot.

Headed in that direction

The solution agreed to in the settlement is a landmark but not surprising. College sports have been trending in this direction for years, with athletes receiving more and more monetary benefits and rights they say were long overdue.

In December, Baker, the former governor of Massachusetts who has been on the job for 14 months,  proposed creating a new tier of Division I athletics  in which the schools with the most resources would be required to pay at least half their athletes $30,000 per year. That suggestion, along with many other possibilities, remains under discussion.

The settlement would not make every issue facing college sports go away. There is still a question of whether athletes should be  deemed employees  of their schools, which Baker and other college sports leaders  are fighting.

Some type of federal legislation or antitrust exemption would most likely still be needed to codify the terms of the settlement, protect the NCAA from future litigation and pre-empt state laws that attempt to neuter the organization’s authority. As it is,  the NCAA still faces lawsuits  that challenge its ability to govern itself, including setting rules limiting multiple-time transfers.

“This settlement is also a road map for college sports leaders and Congress to ensure this uniquely American institution can continue to provide unmatched opportunity for millions of students,” the joint statement said. “All of Division I made today’s progress possible, and we all have work to do to implement the terms of the agreement as the legal process continues. We look forward to working with our various student-athlete leadership groups to write the next chapter of college sports.”

Federal lawmakers have indicated they would like to get something done, but while  several bills have been introduced , none have gone anywhere.

Despite the unanswered questions, one thing is clear: Major college athletics is about to become more like professional sports than ever before.