By: James Davis
One of the most contentious issues of our political time is the fate of the American healthcare system. Politicians for decades have known that we have a broken system and have proposed many ways to fix it. One of those ways is known as “Medicare For All” or “Universal Healthcare”, a system where healthcare would be paid for by taxes instead of by private expenditure. It is a common thought that private industry is more efficient than the public sector, and while that is oftentimes true I hope to show that the United States health system is in reality a market failure that calls for dramatic increases in government intervention in order to produce better results.Our current healthcare system is a complicated web of private and publicly funded hospitals, health insurance companies, public programs to help people pay, pharmaceutical companies creating drugs and controlling patents and distributing medicine and a thousands of people who fall through the cracks. There are two major government programs designed to subsidize those in the market who cannot otherwise afford healthcare or insurance, Medicare (for seniors) and Medicaid (for poor people). These programs were recently expanded under the Affordable Care Act, or Obamacare, which hoped to reduce prices by improving the government process for subsidizing public insurance plans as well as creating a marketplace to improve competition and reduce prices, in addition to regulating private plans to guarantee everyone gets a minimum level of care. Although this plan has produced good results, it is not nearly enough. Approximately a million people in the United States a year a bankrupted by medical bills and millions more can’t get the quality of care they need for their conditions, hitting poorer people especially. So how can we fix this?
Virtually every high-income country in the world has some sort of government funded healthcare in varying degrees of control. The United Kingdom has its National Health Service, a system of healthcare which quite literally hires all the doctors and nurses and means healthcare is completely funded by taxes. Canada has a single payer system with private hospitals but government run health insurance. Both of these systems produce higher quality care for cheaper. In fact the United States spends 17.7% of its GDP on healthcare. This is nearly twice the roughly 10% of most other developed countries, which all achieve better results than the US including in infant mortality, life expectancy, and maternal mortality, with virtually no bankruptcies as a result of medical care. A tax-funded system also encourages people to get more regular checkups which results in better preventive care, saving money down the line instead of dealing more expensive diseases that could have been caught early.One common argument against single payer healthcare is cost. However, according to conservative estimates of $7.35 trillion annually by 2031 that would have to be absorbed by the federal government, the US would save money overall as private expenditure is expected to be $7.65 trillion annually by 2031. This estimate is conservative because it assumes that prices for medicine, doctors, and hospitals remain the same. However, most estimates assume that a public healthcare system would bring these costs back to an equilibrium significantly below the current level, as evidenced by the costs in other countries with nationalized healthcare. Overall, single payer healthcare is cheaper while producing better outcomes for Americans in need of care. It is time for the US to transform its system of healthcare to one that is better at meeting the needs of its people.
Works Cited
“About Single Payer.” Corporate Social Responsibility in Health Care: No Such Thing - PNHP's Official Blog, pnhp.org/what-is-single-payer/.Amadeo, Kimberly. “Do Medical Bills Really Bankrupt America's Families?” The Balance Small Business, The Balance, www.thebalance.com/medical-bankruptcy-statistics-4154729.
Kliff, Sarah. “12 Questions about Single-Payer Health Care.” Vox.com, Vox Media, 1 June 2015, www.vox.com/2014/6/26/18080458/single-payer.
Roth, Louise Marie. “Single-Payer Health Care Is Better than ObamaCare.” TheHill, The Hill, 16 Nov. 2018, thehill.com/opinion/healthcare/417208-single-payer-health-care-is-better-than-obamacare.
Stein, Jeff. “Does Bernie Sanders's Health Plan Cost $33 Trillion - or Save $2 Trillion?” The Washington Post, WP Company, 31 July 2018, www.washingtonpost.com/business/economy/does-bernie-sanderss-health-plan-cost-33-trillion--or-save-2-trillion/2018/07/31/d178b14e-9432-11e8-a679-b09212fb69c2_story.html?utm_term=.982a733c8f34.
This is a really well written column Jamie. You made great points, but I do disagree on some things. The first premise is that of which the nature of healthcare comes out of, that is, the choice over your own medical decisions. When the government "takes the hit" on all the costs of healthcare, that also means that they "own" all of your health decisions. The very thought that a government could make logical, moral decisions for its people simply isn't possible because all government is subject to tyranny and corruption. If the state runs you, they get to decide whether the state can afford you - and it's quite scary to think about. Next, while the affordable care act did in fact provide medicaid for more people, it also cause many middle-class citizens to have trouble paying for, or even lose their health insurance plans because of the increases in taxes. There's a big hit taken when people have trouble paying for their own plans because they have to contribute to plans of others. Overall, I don't believe universal healthcare is the solution because a government cannot cleanly run a healthcare system efficiently.
ReplyDeleteThanks for your feedback Nick! I appreciate that you took the time to respond to my post and I would like to give you a response. First, while I agree that the government controlling healthcare could have the potential to be used for tyrannical purposes, I feel this fear is largely overblown. We don't see this problem in Canada, Germany, the UK or any other developed country with a government run health system so this is a hypothetical that shouldn't be taken as a given. On the contrary, we do see abuses and corruption with our private healthcare system like pharmaceutical companies increasing the price of life saving drugs to beyond what people can pay for to make a higher profit. As for your concern as to who pays for it, yes it would mean that there would be more taxes. However, the benefit that taxes have is it makes people pay according to how much they can pay not how much they need to cover their own costs. This means that the burden falling on poor and middle class people is less than through private insurance. I agree that your concern about the government running a healthcare system might be inefficient but the private healthcare market is even more efficient as healthcare is a human right, not a good that can be arbitrarily kept form someone. In this way I think that it would be better to have the collective society pay for healthcare so that people aren't priced out of the market.
DeleteThis is a super interesting take on single payer healthcare. I always thought that this kind of healthcare would be far more expensive than private expenditure, but it seems that that is the opposite. I do, however, wonder what kind of disruption this would cause to the heath industry as a whole. Would healthcare providers, doctors, surgeons, nurses, etc., now be considered government workers? Would the overall pay of high caliber doctors decline and result in a decline of incentive to go to medical school and fill these positions? It seems this change needs to happen as healthcare becomes more and more expensive, but I'm curious to see how these changes would affect the overall function of the healthcare industry in the short term.
ReplyDeleteOne of the biggest challenges in switching to a single payer system would be to the healthcare industry. Private insurance would be dramatically downsized and doctors may leave the industry if pay decreases. However, as other countries have shown, in the long run these problems resolve themselves over time as higher quality care. The biggest challenge to implementing single payer would be in the transition and that is something that would need a complicated and comprehensive solution to achieve but will benefit everyone in the long term.
DeleteI completely agree that the government has a responsibility to provide aid to its impoverished people; however, I do not agree that the U.S. should move to a single payer system. As you mentioned in your article, Canada uses this structure, however, it has caused some dramatic problems within their health care sector. Private hospitals have become so expensive that many citizens can no longer afford to be treated there, and must instead go to government clinics where they are subject to longer waits and care of less quality. Therefore, I believe that privatized health insurance (while not perfect) is the best option; by allowing competition within health care, quality and low costs are encouraged. Additionally, the increase in taxes that middle/lower class families would feel by moving to a single payer system may cause them to only have access to government ensured health policies (which are typically of lower quality than the more expensive privatized insurance).
ReplyDeleteThanks for the response! These are valid concerns, however I would point to data specifically from Canada that overall satisfaction with their healthcare system is higher than in the US. Long wait times and lower quality care are blown out of proportion due to the fact that in Canada the most serious medical problems are prioritized over less serious and as a result wait times are sometimes longer. Your argument is a good one and yes private insurance would be more expensive. There are other options to healthcare reform that may be possible, such as a public option competing with private plans, but the current system in my opinion is unsustainable.
DeleteI think that spending taxes on medical will help increase the GDP for the United States. By decreasing the price of medical for the normal people you add more money that they can spend and that will help stimulate the economy people people will be able to spend more money on goods and through the multiplier effect it will increase the GDP by a lot.
ReplyDelete- Kaustav Saha
DeleteAnother point is that healthy people are more productive workers so if people didn't have to worry so much about whether or not they'd have enough money to visit the hospital they would be healthier and improve the overall output of the economy.
DeleteFinally someone said it! I've been seeing a lot of well written responses about how the idea of this is really great but it cannot be executed efficiently, mainly because the middle class/lower class would be suffering by paying higher taxes but that is because we currently have to divert a higher percentage of our income to taxes that the upper class does. If taxes rates were assigned more fairly without giving the 1% a break from taxes, then the expected contribution of middle class taxes would reduce. Also, our taxes currently go to many government funded operations such as road construction, and technically they are the property of the government, but the government doesn't tell you where to drive or where to go. Another argument would be that people would have to settle for less with government clinics but there are currently people suffering in our country because they cannot even afford basic care for diabetes or easily preventable diseases but I think many of our citizens would choose to wait a little longer for care over not getting it at all. Of course, healthy competition is needed, but if we leave it all to private healthcare services, we will have many epipen epidemics where many people will only have one option for a necessary item and they won't even be able to afford that.
ReplyDeleteI would suggest you look at the difference between Canada's and the UK's healthcare systems. Canada has private healthcare companies payed for by the government while the UK National Health Service actually employs and runs the hospitals of the country. Both have advantages and disadvantages, especially in efficiency, but they are both options.
DeleteThis was a very well written piece that I agree with mostly. The biggest issue I have with it is that it is a complete overhaul of a system that has been in places for decades. This is a big structural change that would eliminate millions private insurance plans and would displace millions of healthcare and insurance workers. I think it would be much more beneficial to gradually expand medicare with a public option for people who aren't under it. That way it wouldn't eliminate private insurance but it would provide a cheaper option for those who need health insurance. Even if a majority of Americans want single payer right now public opinion can change very fast and that can change. Single payer is a big step that I think is needed. But it should be implemented slowly and by lowering the age limit for medicare.
ReplyDeleteYou are entirely right! The transition would be the hardest part of implementing any single payer healthcare plan in the US and it is up to our representatives to ensure that this happens smoothly over time. Also, I would like to suggest the option of starting with children and working up towards the medicare age limit so as to cover those who are younger, without jobs or with high student loan debt, before covering those who are older and have a steady job and more assets.
DeleteAlthough I was not surprised by the fact that millions of people go bankrupt from medical bills every year, it was still hard to wrap my head around the fact that people have to give up their leisurely time and happiness in order to pay bills that allow them to survive. If single payer healthcare were implemented and regular checkups were cheaper, then people would be more willing to visit a doctor’s office. This in turn will prevent expensive treatments and medications from being needed by catching the medical problem early. Additionally, as one of the most advanced countries in the world, it should speak volume that the U.S. provides one of the least effective health care plans among other developed countries.
ReplyDeleteThis is exactly right! However care must be taken to balance out limiting how expensive medicine is with allowing for innovation in biomedical technology. New pharmaceuticals and life saving medicines would not be developed without some profit motive but that must be balanced with actually saving lives by delivering them to people.
DeleteGreat article and analysis. The effect on the GDP if we were to switch to single payer healthcare is also an interesting thing to look into. Let's say the US adopted a system similar to Canada with public health insurance but privately run hospitals. Though investment would certainly decrease with the private health insurance industry significantly reduced, government spending would in tandem increase to provide public insurance. As the average cost to the consumer via tax would be less than the cost of private insurance today, consumer spending may increase as not having to pay exorbitant amounts for an epipen or to get past a deductible would give consumers more disposable income allowing them to both save and spend a bit more.
ReplyDeleteThanks so much for taking the time to write this Jamie! I so appreciate your comments regarding preventative healthcare--regular checkups obviously help prevent catastrophic medical emergencies from happening, making it a cheaper expense than the extensive cancer treatment or heart attack rehabilitation. I also agree that looking to Canada or the UK for ideas on how to fix our broken healthcare system is a great idea (single payer in particular), especially considering Rand Paul, someone rather against the United States adopting universal healthcare, went to Canada for his recent hernia surgery. Nevertheless, I think that something both sides of the aisle should be fighting against is Big Pharma, considering how many additional costs are incurred to the consumer because the laws limiting the markup/monopoly are lacking. And by that same token, limiting lobbying/money in politics would likely fix a lot of this, but perhaps that's a discussion for another time.
ReplyDeleteI wholeheartedly agree with this post. You did a beautiful job of demonstrating why single payer is not only affordable, but less expensive than our current system as well as demonstrating why it produces better results. One of the prominent arguments against single payer is the rise in taxes. It would be very interesting to see if consumer spending would e positively or negatively impacted because while taxes would be higher, medical costs would almost evaporate. I wonder if the money saved from not having to pay for medical costs would outweigh the increase in taxes.
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ReplyDeleteI really enjoyed reading this post, but I have a few qualms with it. One of your arguments you make is that the bloated nature of the US healthcare system creates unnecessary complication with no results to boot, though the statistics you've provided showing other OECD nations with socialized medicine systems to be better than the US are highly flawed; each country determines requirements for infant mortality differently for example,with the US counting high-risk infants as live births while countries like Germany and Canada don't, meaning then that this does not count against these other countries as these babies are highly likely to die anyways, thus inflating the US's infant mortality rate. Cancer mortality rates are similarly skewed with even the WHO recommending against trusting data on the subject due to national discrepancies in data quality. The reality is that, while incredibly flawed and inefficient, the US's healthcare system is still incredibly advanced and backed by the some of or if not the most rigorously educated Doctors in the world, and the illusion that it is outperformed in terms of quality by single-payer healthcare systems is simply a lie. While it may not be ideal, the current system works exceedingly well (with exception to payment for care, which is still an undoubtedly huge problem), and switching to a single payer system would be disastrous at best for the US. Canada's medical system is noted the world over for its ridiculously long wait times for care due to an inability for the supply of care and medical professionals to meet its demand, and implementations of single payer care even in the US have been failures; VA's across the country are riddled with corruption and inefficiency, resulting in careless treatment causing needless deaths for some of America's citizens who need care the most (it isn't uncommon for patients at VA's to be dead long before they are declared it due to a lack of attention towards some patients), not to mention that many patients die waiting for care. While I understand your argument and respect your reasoning, I think that, at least right now, single-payer healthcare isn't the right way forward for our society. It just won't cut it.
Your concerns about inaccurate data is justified, however if you are going to call out me for using data that might not be the most accurate don't claim that Canada has ridiculously long wait time when the data doesn't support it relative to other countries despite the anecdotal claims. You are exaggerating the problems with the VA but it is systemically corrupt, largely due to neglect and mismanagement than the fact that it is a problem in of itself. Additionally, you are comparing oranges and apples; the VA is more of a direct comparison to the UK's NHS than Canada's. Also, I would like to point out that being "backed by some or if not most rigorously educated Doctors in the world" is incredibly misleading as the US has some of the highest salaries for doctors in the world, and therefore those doctors prefer the current system rather than one that brings doctor's salaries back into line with the rest of the world. While the US healthcare system is incredibly advanced, it still falls short in metrics beyond the specific ones you mentioned. More information can be found here: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-u-s-highest-rate-deaths-amenable-health-care-among-comparable-oecd-countries
DeleteThis article was very well written. I appreciated your take on healthcare in the US; that has been such a hot topic, from ObamaCare to Donald Trump's new ideas to 'fix' the healthcare act and look at it from a different perceptive. When healthcare is in media, we seem to hear the same sides being debated; ObamaCare is good, or there needs to be adjustments made. I like how you were able to propose a whole new idea. I think what you are discussing is new and fresh, and should be showcased on a larger scale. Although I do not agree with all of the statements that are made, it does offer a new perspective to the highly debated healthcare system, which seems to have our nation in a vicious cycle. Although America could truly benefit from a single payer healthcare system it is going to be nearly impossible for it to be implemented in the near future. It will be an enormous undertaking to gain the approval of American citizens, as well as the stubborn legislative branch. I would be interested to hear your thoughts on how to take your ideas to the next level.
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