Universal healthcare refers to a healthcare system where all citizens have access to a sufficient level of care, including those who can’t afford it. Currently, the United States has a private insurance system, where health insurance is available through an employer or through personal purchase. Private health insurance plans are supplemented by plans such as Medicare and Medicaid that are managed by the federal government. Nobody is guaranteed a private insurance plan in the healthcare system currently operated in the U.S.
The United States is the only country in the developed world that does not have a universal healthcare system like those found in all Western democracies. Expanding care to a universal system in the U.S. has been debated since the 1930s under the Roosevelt administration, but the same system remains in place with the same arguments being made for decades. This article will try to answer in an easy to follow way exactly what are the pros and cons of universal health care?
When discussing the pros and cons of universal healthcare, three themes are invariably brought up.
- Universality – a pro. Everyone has health coverage and access to medical services. Most importantly, nobody would ever go bankrupt from medical fees.
- Cost – a con. It is argued that universal care is extremely costly and would blow up the national budget.
- Quality of care – a con. It’s argued that universal healthcare systems invariably cause substandard care, long wait times and rationing.
The biggest advantage of universal healthcare is right in the name — universality. What this means is that everybody gets covered and nobody is left uninsured. Approximately 30 million Americans are uninsured under the current private insurance healthcare system.
There are different methods to achieve universality. Universal healthcare systems can be formed through a general tax, like what is found in the U.K. or Canada. They can also be achieved through a mandate, like what you will find in France and Germany. With mandates, people are required to have some type of insurance plan, and it is paid for by a combination of employers, the government and the people themselves. The benefit of this kind of system is that if people cannot pay for insurance, the government or one of the other groups will make up the difference.
Germany’s system differs slightly from France because the actual providers of healthcare — the doctors, nurses and hospitals — are private entities that are funded by the state. Conversely, in the U.K., the healthcare institutions are operated by the government through trusts. These are public sector groups that are established by parliamentary order.
Regardless of what type of universal healthcare system is used by a country, costs are shared by everyone through a process called pooling. This means that all of the money raised for the healthcare system is put into a common fund and dispersed according to each person’s needs and not based upon how much they can afford to pay.
Are there Disadvantages to Universality?
One disadvantage of universal healthcare systems in regards to universality is that while everyone is covered, the systems do not necessarily cover all health conditions or treatments. In the U.K., which has a single payer healthcare system, dentists and optician services need to be paid for by patients after they reach a certain age. Also, certain procedures that are not considered urgent by the National Health Service have to paid for out of pocket.
In any universal healthcare system, inequality of care can still occur. Rich people can still pay for better care or to be more quickly provided for. This can be especially hard on the people left behind on government provided or mandatory health insurance plans because of the lack of competition reduces quality of care.
In the French system, people can be reimbursed up to 100% of their healthcare costs and the system is completely free at the point of use in Canada and the U.K.
According to the Organization for Economic Cooperation and Development (OECD), in 2021 the average cost of health care per person in the United States was about $11,000 per person. In France that total was roughly $5,500 per person. Ironically, in the U.S., the only Western democracy that doesn’t have mandated universal healthcare, healthcare costs about double what universal healthcare systems spend. This fact seems to contradict a supposed big liability of universal healthcare that proponents of the free market system like to bring up — the cost.
However, the argument that there is a lot more bureaucracy in the systems found in countries like Canada and the U.K. does have some merit.
Obamacare: An Example of Increased Costs of Universal Healthcare
Attempts to universalize the U.S. healthcare system through Obamacare led to prices going up on certain insurance plans for the wealthiest of earners, which goes to underline one of the key differences between universal healthcare and free market healthcare. In a universal healthcare system, everybody pays what they can with the rich paying more because they are able to. However, in a free market system where healthcare is more like a commodity, people pay according to what they need. If they need more treatment, they pay more, regardless of whether they are rich or poor.
Obamacare was an attempt to tilt the American healthcare system towards a more universal system where everyone is covered and people pay what they can afford. This would lead to a greater burden of costs being placed on the wealthier members of society through increased premiums, much like can be found in systems funded by progressive taxation similar to those found in Canada and Britain.
Quality of Care
The final group of arguments concerning universal healthcare provisions are arguments about the quality of care provided.
Opponents of universal care have argued that in addition to higher taxes, universal care will lead to rationing of services. The argument goes that this rationing comes about due to increased waiting times in universal systems.
In the U.K. for example, there is supposed to be an 18 week limit on non-urgent, consultant-led treatments, but this is limit is often exceeded. The fact is that countries measure waiting time in different ways. Also, some do not have a national database that tracks waiting times. Therefore the data is inexact and makes comparisons between systems difficult.
The Numbers are Clear
However, when it comes to healthcare results, the numbers are quite clear indeed. If you look at national indicators of healthcare quality like life expectancy and infant mortality, statistics show that the U.S. system falls way behind universal systems.
According the the America’s Health Rankings Annual Report of 2018, the U.S. infant mortality rate was 5.9 deaths per 1,000 live infant births. The the average rate of infant mortality among all 36 OECD countries was 3.9 deaths per 1,000 live births. The U.S. ranked 33rd out of the 36 OECD countries. The same report found the U.S. life expectancy at birth to be 78.6 years, which ranked it at number 28 of the 36 OECD countries
However, one could argue that at least in a free market system consumers are able to vote with their feet and go for other options, thus improving the system through competition. The inability to do this in universal healthcare systems can be represented as particularly unfair when we think about how the richest in society can do exactly that. They can bypass waiting times by purchasing private healthcare, whereas the poorest in society don’t have that option.
Conclusions – Pros and Cons of Universal Healthcare
The main strength of universal healthcare is that it provides a certain level of health coverage for everybody with cost sharing for those who cannot afford to pay.
Concerns about lower quality of care and of rationing are not born out in statistical measurements of health such. The average lifespan and infant mortality rates in countries such as the U.K., Canada, France and Germany outperform those found in the United States.
However, the money to operate a universal care system does have to come from somewhere and that’s usually in the form of higher taxes to the citizenry. Also, complete equality of healthcare does not exist in universal care systems either. The rich can still afford to buy higher quality care. And government influence in the healthcare system does lead to some lack of choice to the average consumer as well as more bureaucracy to administer the system.