The 2015 Sustainable Development Goals established by the United Nations state that all Member States have agreed to pursue the progressive implementation of universal health coverage (UHC) to achieve this goal by 2030. This commitment includes ensuring all people have access to essential health services without exposing them to financial hardship. The US, which historically used a mixed private-public approach in healthcare, is the only post-industrial society where UHC is not an integral part of the health system. Cons of the UHC system include significant up-front investment, delayed medical care, and constraining medical progress due to the general inefficiency of government-run healthcare.
The considerable geographic size and racial/ethnic and economic heterogeneity render UHC deployment extremely challenging from a financial standpoint. Cost estimations for the universal healthcare proposal range between $-32-44 trillion over ten years, whereas deficit estimations fluctuate between $1.1-2.1 trillion per year, or approximately 5-10% of annual GDP (Zieff et al., 2020). Furthermore, Barber et al. (2020) note that “cost, like UHC, is not a fixed point but a function” that involves substantial variables, ranging from variations in provider payment rates to healthcare system efficiencies (p. 2). In other words, higher health expenditure would not necessarily correspond with a parallel improvement in implementation performance, which could widen the annual budget deficit and disbalance the federal budget. To compensate for this deficit, the government would have to increase federal taxes, possibly for all citizens. Even a moderate proposal of a 4% income tax plus a 7.5% payroll tax on all citizens, with higher taxes for higher-income citizens, would be not sufficient to sponsor this plan (Zieff et al., 2020). Thus, the implementational of UHC may likely be not pragmatic and feasible as in developed countries due to the massive upfront costs.
Alongside federal and individual costs, UHC, due to its bureaucratic government-run nature, would likely result in the general inefficiency of the healthcare system, significantly extending wait-times. Beyond perceived inefficiency, in the UK, for instance, the average wait-time for hospital-based care was 46 days, with some patients even waiting for over a year (Zieff et al., 2020). Along similar lines, lengthy wait-times due to universal healthcare are reflected in Canadians, who were waitlisted for 1,040,791 procedures, with the median wait-time for arthroplasty surgery ranging from 20-52 weeks (Zieff et al., 2020). These inefficiencies caused by the extensive restructuring in the healthcare system would significantly tamper with an individual’s ability to obtain timely medical care, involving inconveniences in arranging appointments, office hours, and lengthy waiting times. This delayed medical attention, combined with the bureaucratic slowdown, would only exacerbate the health disparities for the under-treated marginalized segments of the population, including uninsured citizens, ethnic/racial minorities, and new immigrants (Tulchinsky, 2018). Essentially, the surged care visits due to removing the financial barrier between private and public healthcare, combined with the general wastefulness characteristic of bureaucratic intervention, would likely entail subnormal delayed medical care.
Moreover, the healthcare system inefficiencies due to significant government intervention would likely hinder medical entrepreneurship. The failure of the Clinton health care plan proved that managed care systems are markedly more efficient at cost-containment than the government, which explains their subsequent “tremendous growth” (Tulchinsky, 2018, p. 25). The rhetoric around the Clinton proposal was characterized by “big government inefficiency” and “government meddling” that could hinder medical innovation (Zieff et al., 2020, p. 2). In fact, without bureaucratic intervention, managed care systems, including HMOs, PPOs, and Medicaid, were able to develop “a series of important innovations in health care delivery, payment, and information systems” (Tulchinsky, 2018, p. 25). Moreover, the multisectoral deployment of UHC over an extended period would detract the scarce healthcare workforce from public health leadership, further reducing the efficiency of innovative management systems of health maintenance organizations (Barber et al., 2020). The red-tape intervention in implementing UHC would increasingly embroil healthcare systems in bureaucratic complexities, hindering healthcare entrepreneurship.
In summary, the disadvantages of implementing UHC in the US include significant upfront costs, untimely provision of healthcare, and impeding medical innovation due to the red-tape nature of government intervention characterized by general inefficacy. From a pragmatical view, these challenges render UHC deployment disadvantageous on the financial, service, and medical development fronts. The egalitarian progress towards healthcare equity might come at the cost of timely care and medical progress.
References
Barber, S. L., O’Dougherty, S., Vinyals Torres, L., Tsilaajav, T., & Ong, P. (2020). Other considerations than: How much will universal health coverage cost?Bulletin of the World Health Organization, 98(2), 95–99. Web.
Tulchinsky T. H. (2018). Bismarck and the long road to universal health coverage. Case Studies in Public Health, 131–179. Web.
Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal healthcare in the United States of America: A healthy debate. Medicina, 56(11), 580. Web.