A Values-Based Argument for Universal Healthcare in the United States

https://doi.org/10.56927/335320

Hugh hankenson

Introduction

Throughout the week of January 10, 2023, multiple storms bombarded the Californian coast, with the San Francisco Bay Area and surrounding counties suffering the brunt of the damage.¹ Torrential rain and winds of up to 60 mph resulted in flash floods and mudslides, forcing thousands of people to evacuate their homes and disaster areas to be declared in more than half of California’s 58 counties.² The sequential storms resulted in more than 20 deaths, $1 billion in costs and damages, and uncounted casualties.^2,3

Though Californians are health insured at a higher rate than the United States on average, as of 2018 statistics, more than 2.7 million non-elderly individuals are uninsured for healthcare in the state — many of whom will suffer disproportionate injury or death in the wake of the week’s storms.⁴ It is unacceptable that the United States, which prides itself on being a global power and proponent of democracy, deprives its citizens of the access to quality, affordable healthcare that all people deserve. Contrary to frequent arguments that national healthcare systems inherently contravene core American values, I argue that a system of universal healthcare must instead be constructed to fully realize these ideals — principally, innovation, quality, and liberty of choice.

Innovation

Implicit in any discussion of healthcare innovation is progress. Any innovation in technologies, systems, and ideals is driven by a recognition of some gap, and the notion that the filling of such a gap will lead to the betterment of the innovation’s target. Since its conception, the United States and its constituents have sought progress and innovation, from American imperialism to the Space Race. Too often, however, these efforts have relied on the exploitation of people (Americans and others) who have been stripped of their voices and power by elites, corporations, and political manipulations. The health system of the United States has been constructed in this same manner, and today is dominated by large health systems, drug and technology manufacturers, and insurance companies — all of which receive subsidies and benefits at the expense of the American people.

In 2020, for instance, U.S. healthcare spending totaled $12,530 per person; by comparison, peer countries to the United States, including Germany, France, Japan, and Denmark (all of which guarantee universal healthcare), had average healthcare costs of $5,736 per person per year.^5,6 The United States must innovate, recognizing the gaping cost and access differentials between its own healthcare system and that which is evidentially attainable with political will, as documented in other countries. Policies associated with some systems of universal healthcare, such as free or fixed-cost prescriptions or the ability to receive quality healthcare at any health facility, represent areas of potential innovation.⁷ Moreover, the implementation of universal healthcare in America would decrease the reliance of many citizens and health providers on sources of private insurance, drastically reducing the burden of administrative costs on American patients.⁸

Quality

Daily, products across the United States are touted as being “American made”, a designation intended to invoke not only patriotism in consumers, but associations with high-quality and trustworthy goods. To many of these American consumers, quality intrinsically defines the institutions of the United States, including its people, government, and industries. Undoubtedly, there are many high-quality aspects of the United States' care system — not the least of which are the doctors, nurses, and other healthcare staff — to its focus on developing novel treatments and technologies. However, an essential facet of the American care system that distinctly lacks quality is the inadvertent system of care rationing, which primarily exists in the form of high prescription, deductible, and copay costs, as well as heightened emergency and hospital care.

Specifically, in America, 1 in 3 patients reported not seeking care, ignoring their physician’s recommendations, or not filling prescriptions because of the costs, compared to less than 1 in 10 patients reporting the same behavior in Germany, the Netherlands, and Sweden — all countries with universal healthcare.⁹ Regardless of whether the improvement to the United States healthcare system is incremental or a complete overhaul, it is critical that this progress stays fast to the tenet of quality, and that all constituents remain guided by the issues that do affect the system. By focusing on measures towards a system of universal healthcare, particularly one which provides low- or no-cost care and medication to individuals at the lowest income levels, rates of de facto care rationing in America can be reduced from 1 in 3 patients to rates seen in peer countries.

Liberty

More than innovation or quality, citizens of the United States value liberty. Armed with this value, many Americans fundamentally oppose universal healthcare, arguing that the Constitution contains no “right to healthcare” (although some legal precedent, such as that established in Estelle v. Gamble, furnishes a constitutional right to healthcare in the correctional setting)¹⁰ and that people should be self-sufficient, rather than “forced” to participate in a national system.¹¹ However, this perspective ignores, for one, that the international right to healthcare is in fact recognized by the United States (per the Universal Declaration of Human Rights, of which the United States is a signatory)^12,13 and, more fundamentally, that universal healthcare is arguably more patriotic that the present system in equalizing and elevating care for all citizens.

Currently, 67.3% of insured Americans are dependent on private insurers, which continuously raise premium prices and arbitrarily adjust preauthorizations and what is deemed “medically necessary”.¹¹ Private insurers consider their users merely mechanisms of profit, simultaneously restricting their freedom of choice in provider and determination of needs. By comparison, a national universal healthcare system views all citizens as worthy of support, not as a monthly premium, and in many cases will allow its users the liberty of choice for their care. Specifically, under the current United States medical system, even those citizens who do have insurance are restricted in their choice of provider or hospital to those that are “in-network”, based on arbitrary insurance guidelines.¹⁴

A system where individuals are devoid of free choice of care is inherently one lacking liberty. By comparison, consider the National Health System (NHS) of the United Kingdom, which provides low- or no-cost care to every single British citizen, funded by taxpayers,¹⁵ thus allowing individuals in need of care to receive it wherever necessary. Some argue systems such as the NHS limit freedom by forcing civic participation via taxes. However, this perspective ignores the restrictions already implemented by insurance corporations (institutions in which the public has no voice or power), while misrepresenting the federal government as a limiter of freedom, rather than a place where liberty can be expressed through regular voting. If citizens of the United States wish to restore liberty in their healthcare system, while maintaining the quality of care deserved by all, they must seek the implementation of universal healthcare.

To be sure, in the context of health systems worldwide, the United States’ system is relatively successful, supplying care to millions of people while meeting the diverse needs that exist across great geographical spans. Like much public policy, this complex, multi-payer system has emerged from the American cultural milieu, in which the values of innovation, quality, and liberty are central. However, the present healthcare system does an insufficient job of reflecting these (and many other) core American values, leaving behind millions of uninsured, those forced to ration care, and those forced into crushing medical debt.^9,16 Looking forward, the United States must strive for the genuine expression of its core values — not merely acceptance of a status quo with unequal and at times insufficient care.

About the author

Hugh Hankenson is an undergraduate at Harvard University studying Biomedical Engineering and Social Anthropology. In addition to these concentrations, he is also interested in the intersection between biomedical research, health care, and health policy.

References

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