Universal healthcare in the United States: pros, cons, and policy reform

Part One
The American healthcare system is in a crisis situation, with exorbitant spending unbalanced by “poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions” versus high income countries with universal healthcare systems (Squires & Anderson, 2015, p. 1). The Affordable Care Act was an attempt, albeit an incomplete one, to reform the way healthcare is structured and financed. Universal health care is a concept that has gained some traction in the United States, but its thorough implementation is hindered by values, norms, and fears. Overall, the pros of universal healthcare undoubtedly outweigh the cons. The pros of universal healthcare include reductions in wasteful spending, the promotion of social justice and health equity, and the improvement of overall health outcomes in the United States.
The United States already has some limited forms of universal healthcare, addressing the needs of specific patient populations. For example, the American military healthcare system is essentially a universal healthcare system for members of the military. In a study comparing mainstream and military healthcare outcomes among stroke patients, Holtkamp (2017) showed that the universal system practically obliterated race-related disparities. In other words, universal healthcare has the potential to promote health equity and address the social determinants of health far better than a profit-driven system. A universal healthcare system also aligns itself with the human rights and social justice principles outlined and embedded in constitutional law.
Universal healthcare is not just an ethical imperative but a financial one as well. Economists from nations around the world have worked with the United Nations to develop policy suggestions extolling the virtues of universal healthcare as an “essential pillar of development,” (Summers, 2015, p. 2112). Universal healthcare leads to reductions in wasteful spending, and reductions in the prevalence and severity of preventable healthcare problems, which is why countries with universal coverage fare better in terms of both healthcare financial analyses and healthcare outcomes (Squires & Anderson, 2015).
References
Holtkamp, M.D. (2017). Does race matter in universal healthcare? Ethnicity and Health, DOI: 10.1080/13557858.2018.1455810
Squires, D. & Anderson, C. (2015). U.S. health care from a global perspective. The Commonwealth Fund, http://johngarven.com/blog/wp-content/uploads/2017/07/Spending-Use-of-Services-Prices-and-Health-in-13-Countries-The-Commonwealth-Fund.pdf
Summers, L. H. (2015). Economists’ declaration on universal health coverage. The Lancet, 386(10008), 2112–2113. doi:10.1016/s0140-6736(15)00242-1
Part Two
Diverse stakeholders in healthcare reform exhibit conflicting views and values on the role and importance of universal coverage. The American Medical Association (AMA, 2018) stands strongly in favor of universal health care and equitable access to healthcare. Likewise, the American Public Health Association (1995) advocates for universal health care. Both the AMA (2018) and the American Public Health Association (1995) base their claims not just on ethical arguments but also on financial imperatives. Moreover, the AMA (2018) and the American Public Health Association (1995) show how universal coverage would promote the ultimate goal of health care: which is actually improving health outcomes. Unfortunately, health care policy is driven less by sound ethical principles or data-driven analytics and more by special interests in retaining a for-profit system that benefits the few at the cost to the many. When the arguments made by stakeholders in the insurance industry are held to deep scrutiny, it becomes clear that their cases are not grounded in logic, reason, or data. For instance, Sommers, Clark & Epstein (2018) claim that more Americans are uninsured since the passing of the Affordable Care Act, and uses these statistics to claim that universal coverage proves too challenging and complex an undertaking for the American public. Writing for the Kaiser Family Foundation, Altman (2016) claims that a single-payer model that epitomizes the goals of universal healthcare is not feasible in the near future but fails to identify the reasons why. In fact, universal health care coverage within the single-payer model is certainly feasible, but it will take a major shift in norms and values.
The American healthcare system would benefit tremendously from a single-payer system. One of the reasons why universal coverage is financially feasible is that it would increase spending on lower cost preventative care while reducing unnecessary spending on emergency and critical care needs of the underinsured (AMA, 2018). As the American Public Health Association (1995) puts it, “a privately capitalized, profit-maximizing health care industry is unlikely to be the route to cost-effectiveness and universal access,” (p. 1). Universal healthcare addresses several needs simultaneously: the need for social justice and healthcare equity, as well as the need to revamp healthcare spending.
Even stakeholders within the insurance industry can agree that it is just political culture and ideology that prevent the embrace of universal coverage more widely among the American public (Altman, 2016). Therefore, leaders in the American public have a responsibility to continually educate and inform the public, advocating on behalf of all Americans, and promoting values like social justice. Just as universal public school education has become a normative right in the United States, so too will universal health care coverage also one day be considered a fundamental, undeniable, and inalienable right. The reasons to right now embark on a total restructuring of healthcare policy and the healthcare system in America can be located both in sound financial management and also in the goals of healthcare itself: to improve quality of life for all.
References
Altman, D. (2016). Behind the challenges to universal health coverage. https://www.kff.org/health-reform/perspective/behind-the-challenges-to-universal-health-coverage/
American Medical Association (AMA, 2018). AMA vision on health care reform. https://www.ama-assn.org/delivering-care/patient-support-advocacy/ama-vision-health-care-reform
American Public Health Association (1995). Toward a comprehensive universal national health program. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/31/09/34/toward-a-comprehensive-universal-national-health-program
Sommers, B.D., Clark, K.L. & Epstein, A.M. (2018). Health reform and changes in health insurance coverage in 2017. Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2018/03/health-reform-and-changes-in-health-insurance-coverage-in-2017.html