The Case For Universal Healthcare

Erika, Darian, Anita, Larry, Carolyn. While seemingly having nothing in common, these five names all belong to somebody who was sentenced to death by our for-profit healthcare system for the crime of having insufficient funds.

These individuals are not alone, however. According to a Harvard study, approximately 45,000 people a year die from a lack of healthcare coverage.

Still, right wing and libertarian critics remained unperturbed by these figures. What argument could possibly justify the suffering of these innocent victims? The answer, of course, being poorly constructed ones.

One common talking point, most notably coined by famed right wing pundit Ben Shapiro, asserts that there are 3 prominent aspects of healthcare, including quality, universality, and affordability. So, in this essay, I will break down all 3 aspects in regards to how they may change under a universal healthcare system.

Affordability

The most common objection you will always hear in regards to universal healthcare is that there is no way we can afford it. The US is over 20 trillion dollars in debt, so it comes as no surprise that many Americans are skeptical of a program such as universal healthcare which inevitably will cost the US trillions of dollars. However, in pointing out how much a universal healthcare system would cost, people only tell half of the story. What people don’t consider is how much our current healthcare system costs the economy. When measuring the affects a policy will have on the economy, it is not sufficient to merely examine the cost. Rather, to accurately determine the net effect, you have to examine the cost in relation to the benefits of said policy. For example, a recent Mercatus study found that one proposed single payer bill would cost a whopping 32.6 trillion dollars over 10 years. However, this same study found that in relation to our current system, these expenditures are actually significantly less than what we currently face. Specifically, the study found that medicare for all would actually save the economy over 2 trillion dollars over 10 years. Furthermore, an economic policy research institute study found that medicare for all would save the economy over 5 trillion dollars. Even if we didn’t have these studies showing us that universal healthcare would be significantly cheaper, all you’d have to do to draw such a conclusion is look at the fact that despite being the only industrialized nation without universal healthcare, we spend more on healthcare per capita than almost every other industrialized nation. For reference, US healthcare spending per capita nearly doubles the comparable country average when compared to a number of other nations (all with universal healthcare systems).

Largely, the reason the US spends so much more on healthcare, according to a recent JAMA study, is due to the administrative complexity and high costs of medicine and equipment among other things. These aspects of healthcare spending can be traced back to the motive of the healthcare providers in the us: to make a profit. Therefore, the reason a single payer healthcare system would be less expensive is mostly due to the fact that the government, unlike private healthcare companies, is not out to make a profit. The study finds, “In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending.” Out of the 10 other countries studied, healthcare spending ranged from a low of 9.6 percent of the countries GDP, to a high of 12.4 percent. The US, on the other hand, was found to spend 17.8 percent of its GDP on healthcare. In conclusion, the idea that we cannot afford a universal healthcare system is completely baseless. In fact, the question should not be “how can we afford to enact universal healthcare”, but rather, “how can we afford not to enact universal healthcare?”

Quality

One would think that because the US spends so much on healthcare, we must at least have better healthcare, right? Well, not quite. In comparison to other countries, US healthcare is about average. One healthcare survey analysis found that out of 11 countries studied, US citizens are least satisfied with their current healthcare system. Out of the countries studied, the percentage of Americans which believe that the healthcare system “woks well” and should only have “minor changes”, is far lower than the comparable countries. On the other hand, the amount of Americans who believe the system should undergo “fundamental changes” or be “completely rebuilt” far exceeds that of other nations.

However, though it is important to consider how the people of a given nation feel about the system in question when gauging the quality of said system, this is not the only method of measurement we can look it. For example, it is also important to look at objective outcomes and more measurable quality of care. Luckily, many studies have done just that. For example, a study from the Peter G Peterson foundation found that despite paying much more on healthcare, objective health outcomes in the US are in general no better, and in many cases worse, than those in other industrialized nations with universal healthcare.

Even if we are to go further, and look at more specific healthcare outcomes individually, it does not look good for the US. For example, the Kaiser family foundation did an analysis of OECD data which found that potential years of life lost in the US is significantly higher than that of the comparable country average. Another analysis of data from the institute for health metrics and evaluation found that the disease burden in the US is also significantly higher than the comparable country average. According to OECD health statistics, 30 day mortality for heart attacks and ischemic stroke are lower in the US than in comparable countries. Perhaps most prominently, however, a 2011 commonwealth fund study found that the US has higher rates of medical, medication, and lab errors than comparable countries. In case there is any concern about me cherry picking data, there was another commonwealth fund study which found that when you look at every aspect of health outcomes together, the US ranks dead last.

It is important to note however, that healthcare cannot only be measured by health outcomes. However, even when you factor in everything there is to consider when looking at healthcare quality, the US is about average, despite paying the most and covering the least people. One study when measuring objective quality, ranked the US healthcare system 5th out of 11 countries studied in regards to quality, and 11th in regards to overall ranking.

This data pretty concretely leads to the conclusion that despite the disproportionately high cost of our healthcare system, we do not see on average better quality or health outcomes than comparable countries with universal healthcare systems which spend less money and cover more people.

Coverage

Now, it’s pretty self evident that countries with universal healthcare cover more people than a country without universal healthcare. Therefore, proving that the US covers less people will not be the point of this section of the essay. Rather, in this section I will outline the various macroeconomic benefits of more people having healthcare coverage.

Firstly, it would spur an increase in entrepreneurship, and subsequently, increase competition, which as these same right wingers who argue against universal healthcare will tell you, is good for the economy. The reason for this is fairly simple: As of right now, hundreds of workers are too afraid to start a business out of fear of losing the healthcare coverage which their work provides them, which disincentivizes them from starting a business. Going by this logic, we can safely conclude that providing all of these workers healthcare unconditionally would inevitably lead to more people starting their own businesses, which would be good for the competition which drives the economy. The increase in entrepreneurship isn’t the only way in which providing universal healthcare would be good for competition and the business climate, however. For example, if the state is providing workers healthcare, that takes the burden off of businesses to provide healthcare for their workers. Furthermore, because workers are more likely to work (and work more productively, for that matter), for companies which provide them healthcare which bigger corporations can more easily afford, providing all workers with healthcare would ease some of the competitive edge which bigger corporations have over smaller business at the present moment, which would increase competition. Besides hurting competition between businesses inside the US, it’s worth noting that businesses having to pay their employees healthcare costs put them at a competitive disadvantage in the context of the international market; This affect would be alleviated if we had universal healthcare.

It’s no secret that healthier workers work more, for obvious reasons. Therefore, if we follow this logic, providing every worker with health care would inevitably increase the productivity of the workforce, which would be good for the economy. Besides this, it would inevitably increase the buying power of many workers as well who have to pay for their own healthcare which causes them to have less money to spend on other things. So, if we provided every worker healthcare, this would increase demand and cause further spending, which would be good for the economy. Besides the cost to people while they’re still alive, what about the cost of death? As I alluded to earlier, thousands of people die a year from universal healthcare: This costs families thousands of dollars. Obviously, universal healthcare will not make people immortal, but giving people healthcare will inevitably result in people dying at a much slower rate, which again will save the working people money.

“It wasn’t real Capitalism”

Whenever you critique the current healthcare system or compare it to that of nations with universal healthcare, you will always get one person who says “Yes, our current system is inefficient, but that’s only because it’s not a free market! It’s a heavily regulated market, and if we just removed regulation it would be better!” This is a fair argument, to an extent. While it is correct that we don’t have a real free market when it comes to healthcare in the US, I would add that there’s a reason for that: Healthcare should not be a free market.

First of all, when it comes to healthcare, in order for there to be a free market, the people have to have some sort of negotiating power with the company providing them the product. However, in an emergency scenario, the consumer is in no position to negotiate or shop for the best price, therefore whatever transactions occur are not consensual, making exploitation effortless. The only way to avoid this emergency scenario is insurance which you purchase beforehand. As author Chris Ladd points out, “Absent a competent regulatory scheme, patients, at the moment in which they make their insurance purchase, have no way to be certain which provider will actually deliver on their promise. They will only discover the answer when their life, or the lives of their family members, depend on it. Under an insurance system without effective, powerful regulation, the market forces that would exist in a face to face transaction between consumer (patient) and supplier (doctor) disappear, replaced with a grim gamble in which the insurance company has every incentive to cheat.” The profit incentive is absolutely vital; as alluded to earlier, in large part the reason the US spends so much on healthcare is due to the profit motive of the insurance companies, which by no means would go away under a free market system.

Let’s look at the food industry: you put a burger in your mouth, and you immediately understand the quality of the product you have received, and can make an informed decision on whether or not to return to the restaurant; This is by no means the case when it comes to health care. How many Americans would you estimate know enough about healthcare to properly assess the quality of the care they’re receiving, and therefore be able to make an educated decision regarding the care they choose? I would assume not many. This disconnect of understanding between the provider and the consumer of the good opens up for easy exploitation.

There’s one thing many people don’t understand about markets: In order for a market to function properly, cost has to align with value. The problem with a free market healthcare system, however, comes in that people who are already healthy tend to purchase healthcare less because they’re not worried about sickness. Sick people, who also tend to be poorer, however, need healthcare. So, because most people are generally healthy and won’t purchase healthcare, health insurers are forced to drive up the cost for the people who need it, which makes healthy people purchase even less, forcing health insurers to drive up costs on the sick even more, etc. This theoretical free market paradise libertarians fawn over is really nothing more than a cycle of exploitation and suffering.

In conclusion, by every prominent metric, a universal healthcare system would be preferable to our current system: All of the evidence suggests it would cost less, we have no reason to believe it would be of less quality, and it would inevitably cover more people, which would come with a plethora of miscellaneous macro economic benefits. Furthermore, this theoretical free market healthcare industry which right wingers who at least admit the failure of our current system use to combat the idea of universal healthcare, is riddled with market failures and defects which disqualify it from being a market based system.

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