Universal Healthcare
The United States is one of the wealthiest countries in the world; however, it is the only developed country that has not established a universal healthcare system for all its citizens. Millions of Americans do not have access to healthcare, or it is minimal; many of them suffer from conditions that could have been prevented had they obtained adequate care in time. A high number of deaths could also have been prevented if the healthcare policy ensured universal access to medical help. The debate over whether a universal healthcare system should be implemented has been ongoing in America for decades. This paper will examine the historical context of the issue as well as the current state of healthcare in the United States and the benefits of introducing universal healthcare through a comprehensive evidence review.
Historical Context
Healthcare in the United States became institutionalized in the 19th century, when medical schools and hospitals began to be established. Previously, practitioners worked separately and individually or within local hospitals (Paguyo, 2020). Medical care was not accessible to all, and it was particularly unaffordable for those who could not afford it or those who lived in remote rural areas.
It was not until the 20th century that efforts to improve healthcare access for broader populations began to emerge. At the beginning of the 20th century, the healthcare system did not exist as a regulated mechanism (Paguyo, 2020). One of the first presidents to attempt to introduce changes and implement a national health insurance program was Theodore Roosevelt in 1912 (Paguyo, 2020). The attempt, however, was fruitless at the time, and no changes were made.
The 1930s and the Great Depression made it apparent that it was necessary to introduce measures that would help the most vulnerable populations access medical care. Franklin D. Roosevelt introduced various social measures to mitigate the consequences of the economic crisis, which were supposed to include healthcare measures as well (Paguyo, 2020). Eventually, however, the provisions regarding healthcare accessibility were excluded, and no substantial progress was made.
In 1940, Harry Truman attempted to implement a national health insurance program. He was, however, not supported in Congress, and the idea was opposed by the American Medical Association (Paguyo, 2020). The most significant changes occurred during Lyndon B. Johnson’s presidency in the 1960s. It was a period in history when programs such as Medicare and Medicaid were introduced, which, in comparison to previous attempts, were successful in improving the lives of millions of Americans. These programs, however, were still limited in scope, and the introduction of those measures was far from the implementation of a universal healthcare system.
Nixon’s proposal of a Comprehensive Health Insurance Plan was met with opposition in Congress as well. Bill Clinton proposed a healthcare security plan known as the Health Security Act (Paguyo, 2020). The idea, however, failed to garner support among Republicans and representatives of the healthcare industry (Paguyo, 2020). Neither initiative led to progress in terms of unifying healthcare access or helping the most disadvantaged populations.
Significant developments were achieved in the 2010s, particularly under the presidency of Barack Obama. He signed the Affordable Care Act (ACA), also known as Obamacare, whose purpose was not to establish a universal healthcare system but to make coverage affordable to all American citizens (Paguyo, 2020). ACA expanded Medicaid to cover more individuals, required all individuals to have health insurance, and included other provisions aimed at increasing the accessibility of healthcare (Paguyo, 2020). Overall, the measure has contributed to a reduction in the percentage of Americans without insurance, from 16% in 2010 to 8.6% in 2019 (Paguyo, 2020). However, it has still not achieved universal healthcare, and many individuals continue to struggle to access medical help.
Overall, numerous attempts have been made to make healthcare more accessible and affordable. Most of those attempts were unsuccessful, with the minority being moderately successful. The issue of universal healthcare is a human rights issue, and it will remain relevant until a completely inclusive system is implemented. The ideas to change the current state of affairs, however, still face considerable opposition, and the future of healthcare in America remains unclear.
Current State of Affairs
Despite the progress made after the adoption of the ACA, the number of uninsured people and people suffering from inadequate care is still alarmingly high. According to Galvani et al (2020), more than 78 million Americans “do not have adequate health insurance,” with 37 million people not having any medical insurance at all (p. 524). When compared to the general population of the United States, the significance of this issue becomes apparent (Bardach & Patashnik, 2019). Currently, individuals with insurance are at risk of losing coverage due to numerous initiatives in Congress that aim to undermine the progress made by the ACA.
The health outcomes for Americans are also significantly worse than in the rest of the First World countries. Galvani et al (2020) mention in their study that “the USA ranks below 30 countries for many public health indicators, including preventable deaths, infant survival, maternal mortality, and overall life expectancy” (p. 524). The primary reason for these statistics is the lack of universal healthcare. Therefore, to improve the quality of life for all Americans, enhance health outcomes, and increase the effectiveness of the healthcare system, it is necessary to make it inclusive for all recipients.
Advantages and Disadvantages of Universal Healthcare
The advantages and disadvantages of implementing a universal healthcare system have been debated by politicians and representatives from the healthcare industry. They have also been examined by researchers such as Zieff et al (2020). Zieff et al (2020) state that “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” (p. 2). In their work, they analyze the arguments for and against universal healthcare in the United States.
One of the major arguments against implementing universal healthcare is the cost of modifying the existing system. Zieff et al (2020) mention that those who oppose this initiative claim that the changes to the infrastructure would need to be so global that the costs would be overly high. This would also imply changes in the tax system, as the new healthcare structure would require increased federal taxes (Zieff et al, 2020). Other arguments against include the doubts regarding the efficiency of a universal healthcare system and reduced stimuli for innovation among healthcare entrepreneurs (Zieff et al, 2020). Overall, the pressure on the system would be particularly high, which could lead to its collapse.
In terms of health outcomes for Americans, however, the transformation of the healthcare policy would bring more advantages than disadvantages. In particular, Zieff et al (2020) mention that “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” (p. 3). This would not only be beneficial for healthcare recipients but also for the US economy, which is burdened by mitigating the consequences of chronic diseases (Zieff et al, 2020). Overall, it is the individuals with lower socio-economic status who are at higher risk of suffering from the consequences of chronic diseases. Therefore, universal healthcare would be particularly beneficial for them and would alleviate the economic constraints they suffer from due to their conditions.
Proposed Solutions
Some of the proposed solutions for establishing universal healthcare include private-based care, while others suggest rebuilding the system entirely so that it can be completely public. The American Academy of Family Physicians advocates for a single-payer system. It supports the framework that suggests moving towards a system based on primary healthcare (Healthcare for All, n.d.). Overall, they suggest a system in which the government serves as the sole payer, with funding directed to primary care.
Conclusion
The United States is one of the countries most affected by adverse health outcomes, especially related to untreated chronic illnesses. One reason for this is the lack of a universal healthcare system. Historically, numerous attempts have been made to introduce changes, with most yielding only modest results. Despite some speculations about the negative consequences of introducing this type of system, it is apparent that the advantages for the vulnerable populations and the economy outweigh them.
References
Bardach, E. S., Patashnik, E. M. (2019). A practical guide for policy analysis: The eightfold path to more effective problem solving (8th ed.). SAGE Publications.
Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. The Lancet, 395(10223), 524–533.
Health care for all: A framework for moving to a primary care-based health care system in the United States. (n.d.). AAFP.
Paguyo, N. A. (2020). Healthcare for all Americans: Healthcare crisis USA – A comprehensive solution. Amazon Digital Services LLC – Kdp.
Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal healthcare in the United States of America: A healthy debate. Medicina (Kaunas, Lithuania), 56(11), 1-7.