The United States does not have Universal Healthcare, unlike most developed countries. Health Care costs are one of the biggest financial drains for people living in the United States. Our privatized health care system is a major factor in keeping us locked into the patriarchal corporatocracy in which we reside. Until we have universal healthcare Americans will be at the mercy of their employers.
Currently, the majority of Americans have health insurance through their employers. The other options for health insurance are Medicare (available only to those 65 and older or disabled), Medicaid (available only to those with low income), and direct-purchased insurance. Purchasing insurance directly can be prohibitively expensive for many and the other options are available only to limited segments of the population.
Is “Obamacare” Universal Healthcare?
The Affordable Care Act (ACA) aka Obamacare was implemented in 2014 and provided low and middle class families with the expenses of medical care. The act provides a premium tax credit to those whose income is between 100% to 400% of the federal poverty level. This same legislation also implemented a number of pro-consumer measures for health care insurance. See this article by Lena Borrelli for additional information on the requirements for and benefits of the ACA.
While a substantial improvement for many Americans, Obamacare is not universal healthcare. Universal healthcare is medical care available to all at an affordable price.
Even with the ACA coverage, health care costs can still be prohibitively expensive. In 2023 the out of pocket maximum for a family is $15,000 under the ACA. That means that a family can still be on the hook for up to $15,000 in medical bills. That is an amount not affordable for many.
Also, this assumes marketplace coverage through the ACA is available in your state. Less than half of the states have implemented their own health care exchange and only 40 states have implemented Medicare expansion. At of February 2023, 11 states have not adopted Medicare expansion and a 12th (SD) has adopted but not implemented it.
The Economic Impact of Universal Healthcare
The lack of truly affordable health care has a negative impact on the economy as well as upon individuals. Most working class and middle class individuals rely upon employer provided health coverage. This means that is the many feel they must chose between no health insurance and finding a job that provides health insurance. And, with the high cost of medical services in our country, having no health insurance is a very risky option that can lead to bankruptcy or lack of care.
Consequently, it is all too common for people in the United States to select their jobs predominantly for the health care coverage. Others work solely to fund their health care.
Over the years I have heard from many individuals who would like to retire, have the finances to retire, and remain employed only because they are not yet 65 and cannot afford private health insurance coverage. I also know many individuals, both personally and professionally, who would love to work reduced hours but are unable to do so because they would lose their health insurance. There are people who want to change jobs or start their own business, but are bound to their current employer for the insurance.
The privatization of health insurance is keeping so many Americans trapped in life styles not of their choosing.
The (faulty) Argument Against Universal Healthcare
Those who oppose universal health care cite lack of freedom and options. They fear long waits and lack of choice in providers. But, under our current health care system, for everyone who received quicker service or more options, there are others who receive no care at all. And clearly, the deciding factor is money. We have a system set up to provide superior medical care to a select few while others go without. And, in between, we have the working class/ the middle class/ the regular folks – whatever title we want to bestow – who have care at great financial and lifestyle cost.
We often hear the argument that we have better care and more choices than those in countries with socialized medicine such as Canada or England. What I actually hear from individuals in the US, however, is frustration with the care and coverage available to them under our current system. Conversely, those I speak to in Canada or the UK seem relatively content with their care.
Lets consider maternal mortality rates in the US as compared to other developed countries. Our maternal mortality rates are more than double those of other developed western nations – most of whom have universal health care. These numbers are a clear indication that our current medical system is failing many.
The Insurance Industry
As it stands, the big winner in health care is the insurance industry. Individuals are paying large portions of their income and forgoing medical care because of the cost.
Medical professionals complain about the restrictions placed upon them due to insurance. The insurance companies are essentially practicing medicine when they tell the doctors what tests or medications they will and won’t cover. If a doctor believes one medication is best but insurance only covers the generic then the patient must either take the less suitable prescription or pay out of pocket.
As patients are paying through the nose and non-doctor medical professionals (nurses, technicians, medical assistants) are being paid inadequately, insurance company profits grow year over year. The link between their increased profits and the lobbying power of the industry in Washington is not a coincidence.
Single payer coverage (another term for universal healthcare) has also been shown to reduce overall medical costs because it increases the bargaining power of the patients. Additionally, if we were to cut out the insurance middle man then both the patients and medical providers would benefit.
The Challenges of Multi-Payer Coverage
As medical insurance premiums rapidly increase year over year, larger premiums are passed through the employer to their employees. Americans are spending large amounts for coverage and are still leery of getting care because of high deductibles.
Additionally, as premiums increase, companies shop around for insurance plans to keep the rates down. The result is that you may stay with the same employer but still find you have different medical coverage every few years. This creates problems with consistency and ease of care.
I recall working for companies that frequently changed their insurance provider. Whenever that happened I had to hunt for a new “in network” doctor who was accepting new patients. I had to figure out what specifically was covered and what may result in a large bill. It was time consuming and emotionally draining. And I had it easy as an individual without chronic health conditions.
We know that, in the long term, preventative healthcare is cheaper for a society. But when individuals change insurance every few years the insurance companies lack the financial incentive to focus on preventative care. Why should ABC insurance company spend money now to prevent an illness that may occur in the future when you will be covered by XYZ company?
How about those things that aren’t covered? Dental and vision, while clearly essential to our health, are not covered under standard health insurance plans. When health care as a whole is parceled out then we lack the coordinated care necessary to ensure we all remain healthy.
The Humanitarian Aspect
The biggest argument for universal healthcare, in my opinion, is that it is the right thing to do. It is the only way to make sure that all people are receiving adequate and comprehensive medical care.
Currently our medical care is ruled by capitalism and the medical marketplace. Do we want to continue to live in a society deems the health of rich people as more important than those of poor people? For a country that prides itself on equal rights for all (I know, I know) we sure don’t seem to value the bodies or lives of the less affluent.
In my work I see that health care is one of the greatest costs my clients encounter. It prevents people for saving for retirement, from following their desired career goals, and even from retiring. Our multi-payer system prevents many from getting adequate care. This affects their quality of life as well as their life expectancy. We will be unable to resolve the many equity issues in our country until we address the need for universal healthcare.