I belong to a health care system that does not care, and even when it does, it only cares selectively.
The United States spends more on health care than any of its economically comparable peer countries. While we spend upwards of $15,000 annually per person on health care, Germany, Canada, and Japan spend $9,000; $7,000; and $5,000 respectively—less than half. Still, despite this gross disparity, the United States suffers from poorer health outcomes in nearly every domain.
American mothers are over three times as likely to die from childbirth than those in Switzerland and Australia. Infant mortality is twice as high here as it is in Japan, and our life expectancy is 3.7 years shorter than the first-world global average.
Despite the enormous resources at our disposal to fund a structurally efficient health care system, the United States remains confused on how best to do so. Amid these conversations, a universal health care system presents itself as a necessary solution, but to implement it requires the demolition and subsequent reconstruction of the complex health care system we follow today.
Challenges at the Structural Level
Currently, challenges at the structural level divide health care access along economic lines.
The mixed multi-payer health care system used by the US delivers health care through private practice while demanding payment from a complex mix of public and private insurers. For those who can afford it, insurance premiums can cover the cost of routine physician visits and parts of larger medical procedures. However, insurance is difficult to obtain and a privilege for those who have it.
Health insurance remains a luxury service available to three groups who can access it: (1) those who can afford to pay the premiums themselves, (2) those who are afforded insurance plans through their employer, and (3) those who qualify for government sponsored programs like Medicare and Medicaid.
These pathways create a large group of Americans who cannot afford to subsidize an insurance plan on their own or do not qualify for government assistance, leaving many middle-income individuals to pay medical expenses entirely out of pocket. Of course, routine medical bills may not be an issue for those with adequate income, but periods of economic instability, sudden financial hardship, and medical emergencies can easily thrust these individuals into dangerous medical debt as well.
Moreover, current alternatives to private health insurance are still not accessible to the vast majority of patients who need it. While the Affordable Care Act (2010) established a Health Insurance Marketplace to offer private plans at a cheaper, subsidized rate, premiums are still not competitive enough to make accessing health care affordable.
The result of these disparities is a new sort of caste system that prioritizes health care for those with the economic power to pay and neglects those who cannot.
Universal Health Care as a Necessary Solution
As a young person studying politics in a post-COVID-19 era and a community member attuned to the growing health care needs of her neighbors, I see a universal system as both an exciting and necessary path towards reducing health care disparities in America. This can be achieved in the United States, and our peer countries do well in showing us how.
The United Kingdom serves as a paramount example of how their National Health Service (NHS) infrastructure can support the medical needs of a diverse population. Residents of the United Kingdom do not pay any out of pocket costs to receive medical care through a system that provides publicly served medical treatment and a publicly funded payment method. The benefits of this model manifest themselves in significantly stronger health outcomes—measured by a shining life expectancy, infant mortality, and maternal mortality metrics.
While critics cite financial feasibility as a barrier to implementing a national health system in the United States, many neglect to consider the long-term community health benefits it will produce in turn. Today, the United States spends more on curative health services, like the treatment of chronic disease, rather than less-costly preventative health procedures.
Chronic diseases are difficult to treat. They are costly, and the technology required to provide sufficient medical support is expensive to maintain. Consider, now, the alternative. Rather than waiting to treat patients with severe health conditions, restructuring our health care system to invest in preventative care and public health initiatives will allow our neighbors to access routine checkups, screenings, and early health care interventions.
The results of this shift would be revolutionary. By reexamining the way we think about administering health care, we allow our medical system to address low-stakes medical issues first and avoid heavier medical burdens later. In the long-run, this model will create a virtuous cycle where communities are healthier for longer, and those who require serious medical care can attain it at little-to-no cost to them.
What Holds Us Back
If the solution is simple and the benefits are obvious, our failure to adopt a national health system, like the United Kingdom’s NHS, is perplexing. However, the reason for our rejection of universal health care is deeply rooted in our culture and beliefs.
For many, the belief that health care should remain a privilege—and not a right—still remains a legitimate concern. Further, our determination to keep the health care system a free market, void of government interference, hinders our ability to develop stronger safety nets for our neighbors that need support.
However, if we wish to become a country that can honestly take care of its people and produce consistently positive health outcomes, universal health care is a prerequisite to our success.
Then, not only does universal health care become a promising solution, it also becomes our golden ticket to creating a system that actually cares for its people. In revisiting our health care infrastructure from the ground up, there is hope that those among us who have long been denied care in the gray area of a private health care market can receive the life-saving services that they deserve from a system that cares for them.
