Universal Healthcare Need for Implementation

Introduction

Saying that COVID-19 has been devastating to nations and their citizens seems to be an understatement. The impact that the virus has had on the wellbeing, livelihoods, as well as lives of people not only in the U.S. but across the world is massive. More than 6 million people have so far lost their lives to COVID-19 across the world. In the United States alone, the death toll from the virus is estimated to be more than 900,000 people. It would be prudent to note that in the midst of all this, the pandemic has uncovered some basic truths about our healthcare system as well as services. This is more so the case in relation to the need to ensure that all citizens have access to the relevant healthcare services if, and when, they need them regardless of their financial position or capabilities. This text assesses the need for universal healthcare implementation in the United States. The said assessment will be anchored upon the lessons we have learnt from the COVID-19 pandemic and its impact on populations.

Discussion

The Need for Implementation of Universal Healthcare

From the onset, it should be noted that there exists no standard definition for universal healthcare. Thus, there are a wide range of definitions that have been floated by various authors and organizations in the past in an attempt to explain the nature and conduct of universal healthcare. According to the World Health Organization - WHO (2021), “universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship.” This is the meaning that will be assigned to universal healthcare in the context of this discussion. It should also be noted that as WHO (2021) further indicates, for health coverage to be deemed universal, it should be inclusive of all the health services considered essential. These could be inclusive of, but they are not limited to; the promotion of health and disease prevention, treatment, palliative case, as well as rehabilitation.

To a large extent, the US healthcare system was caught flatfooted by the COVID-19 pandemic. This is more so the case given that as Graves, Baig, and Butin (2021) indicate, the disease came at a time whereby a significant portion of the US population, approximately 29 million people, remained uninsured. This effectively meant that millions of people – specifically those on the lower end of the income bracket – could not be able to access quality, quick, and meaningful interventions when the pandemic hit, specifically with regard to testing and treatment.

In as far as testing is concerned, there is need to indicate that the pandemic exposed the need to ensure that rapid diagnostic options are available to all citizens of this great nation regardless of ability to pay. According to Gaffney, Woolhandler, and Himmelstein (2022), those who do not have insurance may not have access to timely COVID-19 testing. This is an assertion further advanced by the Health Resources and Services Administration – HRSA (2022) which is categorical that although measures had been put in place over the last couple of months to ensure that uninsured persons were able to access free coronavirus tests, this may no longer be the case going forward. This, according to HRSA (2022), is more so the case given that the program under which healthcare facilities have been seeking reimbursement for the testing and treatment of patients who are not insured has run out of funds. This particular program, christened the HRSA COVID-19 Uninsured Program and Coverage Assistance Fund, has been instrumental in efforts to rein in COVID-related mortality. Prior to the introduction of the program, uninsured persons had to pay out of pocket for COVID-19 testing. In the words of Gaffney, Woolhandler, and Himmelstein (2022), “in 2020, uninsured adults (including many with chronic diseases) were less likely than the insured to have been tested for COVID-19 despite having higher rates of positive test results” (1345). It is important to note that various studies have in the past indicated that there is a relationship between early testing and diagnosis and better treatment outcomes, as well as future complications associated with the disease (Gaffney, Woolhandler, and Himmelstein, 2022). This is to say that the earlier persons are tested and diagnosed with COVID-19, the sooner interventions are likely to be deployed to prevent further complications. As a matter of fact, one of the factors that has been blamed for spread of the illness, specifically before targeted measures were deployed by the government to slow the said spread, was failure to ensure convenient and affordable testing for the disease. To a large extent, this is a phenomenon that could also be considered from the perspective of other diseases and illnesses.

Persons who are uninsured are less likely to test for some of the ailments and conditions that continue to affect and afflict a significant portion of the population. The said illnesses are inclusive of, but they are not limited to, hypertension, diabetes, cancer, and heart disease. Like is the case with COVID-19, delayed diagnosis of the said health conditions could have a negative impact on the health and wellbeing of populations – with the end result in this case being an overburdened healthcare system. Universal coverage would come in handy in efforts to ensure that all persons have access to tools meant to promote early diagnosis of various healthcare conditions. Early testing is one such tool. Gaffney, Woolhandler, and Himmelstein (2022) refer to various diagnostic services as life-saving tools. In the words of the authors, “these life-saving tools will only be effective if they are available for the most vulnerable equitably and simultaneously across all states“ (Gaffney, Woolhandler, and Himmelstein, 2022, p. 1347).

On the treatment front, it is important to note that at the onset of the COVID-19 pandemic, a significant portion of the American population – specifically those who were uninsured - could not afford COVID-19 treatment. Indeed, as Graves, Baig, and Buntin (2021) point out, almost 30 million Americans were uninsured when the pandemic hit. The authors further indicate that with close to 40% of households across the country “reporting insufficient savings to cover a $1000 emergency, and 1 in 6 individuals having a medical bill in collections in early 2020, the US faced an acute affordability crisis for patients who required testing and treatment for COVID-19” (Graves, Baig, and Buntin, 2021, p. 108). Most families were forced deeper into financial hardship as they pieced together the available resources to seek treatment for loved ones who had been diagnosed with the disease. According to the Center on Budget and Policy Priorities – CBPP (2022), the earlier months of the pandemic were especially difficult for low-income families with no insurance. Further, as CBPP (2022) indicates, significant hardship was caused by the unavoidable economic fallout that followed.

Reprieve came in the form of what Graves, Baig, and Buntin (2021) refer to as a temporal universal healthcare coverage designed to improve access to COVID-19 testing as well as treatment, i.e. the HRSA COVID-19 Uninsured Program and Coverage Assistance Fund. Thus, from that moment onwards, patients no longer had to settle diagnosis and treatment costs out-of-pocket. However, at this present moment, especially following the removal of the HRSA COVID-19 Uninsured Program and Coverage Assistance Fund, it is going to be even more difficult for the uninsured to access treatment. Indeed, in the words of Kimball (2022), failure by Congress to renew the said emergency federal aid effectively means that “people who don’t have health insurance may face bills for hospital treatment, and free vaccines may not be as easy for everyone to get.”

I am of the opinion that the economic fallout as well as suffering – specifically in the year 2020 and 2021 – could have been avoided if the nation had in place universal coverage. It is important to note that this happens to be one of the triggers of a downturn in economic activity – with experts, as Horsley (2022) observes, indicating that the US could be headed towards a major recession. The inability by households to meet their financial obligations as a consequence of high cost of care has ripple effects across various other fronts. This is more so the case given that households are left with little disposable income – which severely limits their ability to purchase goods and services. As a consequence, businesses close down and people are laid off. This sets in motion a cycle of economic events that could seed severe downturns in economic activity. It therefore follows that the relevance of having in place a universal healthcare coverage cannot be overstated going forward. This would help ensure that persons and households are not pushed to financial destitution by piling healthcare costs. As Ikegami (2014) indicates, "universal health coverage potentially contributes to sustainable economic growth and economic empowerment, and contributes towards SDGs and prosperity” (137).

Barriers to Implementation

In essence, there are a various obstacles or challenges that could get in the way of successful implementation of universal healthcare in the country. One such barrier happens to be funding. This is more so the case in relation to availability of government budgetary resources. To a large extent, the country would have to pay much more for universal healthcare than it does for Medicaid and Medicare. At present, the government has huge deficits and it would be accurate to indicate that not much is available for ventures of this magnitude. It should, however, be noted that according to Tevares (2014), for the US to be able to afford universal healthcare, there would be need for serious planning and prudent management of the resources that the government has at its disposal. For instance, according to the author, “by taking power away from private insurances and pharmaceutical companies, the tax breaks they formerly had could contribute to the funds” (Tevares, 2014, p. 211). Other sources of funds for the government in efforts to implement universal healthcare are inclusive of slight increase in taxes. This has been successfully undertaken in Canada.

Yet another obstacle to the successful implementation of universal healthcare in the US is healthcare system fragmentation. There is no doubt at all that our healthcare system is hugely fragmented. This effectively means that there is little coordination and stakeholders are yet to embrace any meaningful and/or sustainable synergy. Further, governance systems and functions as well as organizations and the relevant players lack coordination and may in some instances appear to be in competition. In the words of Ikegami (2014), “fragmentation may undermine progress towards UHC as health system quality and efficiency can be compromised through multiple providers, diffuse governance arrangements, poor budgetary planning, misalignment of incentives, and duplication and mistargeting of services” (79). One approach of rein in this concern is through directed efforts to improve care coordination. Further, existing incentives misalignment ought to be eliminated.