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Universal Healthcare in the United States of America: Possible and Necessary

Natasha Walker

Arizona State University

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Universal Healthcare in the United States of America: Possible and Necessary

K Sigrun received a diagnosis of chronic lymphocytic leukemia in 2010. This cancer

diagnosis caused significant stress in Sigrun’s life, for more reasons than one. Before her

treatment, Sigrun was an avid runner living in an apartment alone and did not know how to cope

with the physical and financial changes she would soon experience. Cancer drugs cost too much

for the average family, even with insurance coverage, and some cannot afford the copays.

According to Sigrun, “I was supposed to start treatment in November 2017. I delayed treatment

until January 2018 because I didn’t have financial resources to start treatment. That was a stupid

thing to do, because there was a lot of damage done during those two months” ("Sigrun K.”,

2018). With the help of the nonprofit, Cancer Care, Sigrun finally began treatment because of its

co-pay assistance. She celebrated, “It’s life-changing. With the stress that you’re under with the

disease, you’re falling apart, and then you have to start stressing about finances. Receiving co-

pay assistance took away that horrible additional stress” ("Sigrun K.”, 2018). Sigrun learned to

adjust to her new life, living with her family for support and using a walker to move around the

house.

No one should have to delay treatment because of the cost. As far back as the 1920s, the

cost of healthcare surpassed what the average American can afford. Individuals cannot pay for

their healthcare, so who should? Citizens and governments in the United States heavily debate

this question, as political and sociological ideals either strongly support universal healthcare, or

strongly oppose it.

How did the American healthcare system become what it is today? Policy for universal

healthcare has been pushed since the 1910s, and some of its strongest opposers are the American

Medical Association and unions. When federal governments first introduced the idea of
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government funded health coverage, the AMA lead the opposition, and won. They worry most

about how physicians will be financially compensated when providing free care. Therefore,

every time a government considered providing universal coverage, they received strong

opposition. During the Great Depression, Franklin D. Roosevelt wanted to include a national

health system in his “New Deal,” but felt pressured to only include unemployment and “old-age”

benefits in his Social Security Act of 1935. In the 1940s, when wages stabilized, employers

competed by offering employer sponsored health insurance, which became the primary way of

gaining health insurance in the United States. Also, at this time, Truman released a universal

plan, but many labeled his plan as “socialized” and it received heavy opposition due to the Red

Scare. Lyndon B. Johnson successfully passed the Social Security Act of 1965, which began

Medicare and Medicaid. In the next few decades, policy focused on regulating the employer

sponsored health insurance. Obama released the Affordable Care Act in the 2000s, which began

a government mandated healthcare policy in the United States. Tens of millions of the uninsured

now have insurance through the ACA Marketplace, and the most meaningful part of the ACA

was its policy against companies denying health insurance due to a pre-existing condition: “Prior

to the passing of the ACA, it’s estimated that one in seven Americans were denied health

insurance because of a pre-existing condition” (Griffin, 2017). While this isn’t universal

healthcare, it’s a step in the direction of increased government control and regulations on

healthcare.

In the United States, having or not having health insurance can predict a person’s health.

According to a report by the Kaiser Family Foundation, a nonprofit focused on health care issues

in the US, “Compared to those who have health coverage, people without health insurance are

more likely to skip preventive services and report that they do not have a regular source of health
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care” (Foutz, Damic, Squires, & Garfield, 2018). Essentially, people delay treatment and

checkups due to lack of access to healthcare, so they wait until their sickness becomes life

threatening to avoid copays. Another study also evidences this correlation by the spike in doctor

visits after age 65, when people begin to qualify for Medicare, especially for those underinsured.

According to a paper published in the American Economic Review, “Race and education groups

that experience the largest gains in insurance coverage at age 65 experience large reductions in

the probability of delaying or not receiving medical care, and relative increases in the probability

of an annual doctor visit” (“Evidence from Medicare”, 2004). This study proves that health

insurance dictates a person’s health. Delaying medical care increases the overall cost of

healthcare in the United States, as evidenced by data collected by Debt.org, emergency treatment

usually costs more than standard treatment.

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Figure 1. Emergency rooms vs. urgent care centers (Fay, 2018)

Also, even the insured often cannot afford their medical bills. Richard Dickens, CancerCare’s

director of client advocacy, states, “Many people call us and they are angry. They say I’ve been

working my whole life, I’ve paid my taxes, I’ve been diligent, but now I’m being slammed, I

have to ask for charity ... There’s shame and anger in that” (Olen, 2017). Dickens makes the

point that anyone can become financially burdened by medical expenses.

Surprisingly, the US is one of the only developed nations without universal healthcare.

According to Max Fisher, a foreign news journalist, “The only developed outliers are a few still-

troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest
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nation in the world” (Fisher, 2012). In countries that provide universal healthcare, the people

support the healthcare system. For example, Canada has a popular and effective single-payer

system. Lawrence O. Gostin, JD, director of the World Health Organization Collaborating Center

on Public Health Law and Human Rights, cites, “In 2005, 85 percent of respondents to a national

public opinion survey believed that ‘eliminating public health care’ would fundamentally change

Canada and 87 percent believed that the direction of change would be negative” (Gostin, 2017).

These statistics prove that countries which provide coverage have high public support for

universal healthcare.

One major ideological argument against implementing universal healthcare in the United

States is strong opposition to becoming a socialized country with an overly powerful central

government. Even though Canada has a single-payer system, healthcare is not as centralized as

one may think, as provinces determine much of the spending. Gostin explains:

Over time, courts have recognized a federal “spending power”—federal government may

spend (and attach conditions to spending) in areas of provincial jurisdiction, a role that it

fulfills largely through transfers to provincial governments. The federal government also

makes transfers to “have-not” provinces in an attempt to equalize fiscal capacity.

Accordingly, the federal government accounts for less than 40 percent of total public

spending, although it raises almost half of total government revenues. (Gostin, 2017)

Gostin makes the point that a decentralized healthcare system, which would have more

popularity in the US, proves successful in Canada. States would have more rights than now when

deciding on healthcare.
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More and more people support universal healthcare. In the summer of 2018, younger

members of the AMA convinced the organization to study changing its stance on the topic after

years of being the main opposition. “We believe healthcare is a human right, maybe more so than

past generations,” says Brad Zehr, a 29-year-old pathology resident at Ohio State University,

who took part in the debate. “There’s a generational shift happening, where we see universal

healthcare as a requirement” (Luthra, 2018). The AMA may finally lead the fight for universal

healthcare, as doctors will spend less time on paperwork and billing and more time with patients,

and Canada saw a rise in physician salaries after implementing its current healthcare system.

Support for universal healthcare from the AMA may shift the public opinion strongly in favor of

government provided healthcare.

While it may appear that Americans stand against healthcare reform, public opinion

quickly changes. As cited by Bernie Sanders, the leader of the “Medicare for All” movement,

“According to an April poll by The Economist/YouGov, 60 percent of the American people want

to ‘expand Medicare to provide health insurance to every American,’ including 75 percent of

Democrats, 58 percent of independents and 46 percent of Republicans” (Sanders, 2017). These

statistics prove that not only do Americans want universal healthcare, they support direct

healthcare reform through the “Medicare for All” policy.

Walter McClure, a chairman of the Center for Policy Design, argues that universal

healthcare should be compared to universal public education: “Does government owe people a

public education? Is universal public education a handout to “takers” who ought to go out and

buy it on their own?” (McClure, Enthoven, & McDonald, 2017). Most believe in the necessity of

universal public education for the success of the country. Every person has a right to education to
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contribute to the well-being of the United States, so every person should have a right to quality

healthcare for the same reason.

My family moved to America with almost nothing, except a job. My dad worked as a

nurse while my mom pursued an education. In 10 years, my parents had a 401K and I had a

college fund. Then, my father was diagnosed with chronic lymphocytic leukemia, the same

cancer as Sigrun, and the treatment weakened him until he could not keep up with the physical

demands of nursing. He performed administrative tasks in the same hospital. The cancer and

treatment affected the platelet levels in his blood, and he required monthly infusions to keep his

levels stable. Eventually, all our funds exhausted, and we could not afford the copay for this

infusion. With no other choice, we waited until my father could receive emergency treatment. He

had a stroke, and while recovering in the same hospital he worked in, they fired him, and we lost

our health insurance. We lived on donations from his coworkers for food and clothing, used

finances from our family overseas for rent, and collected hundreds of thousands of medical debts

to keep our father alive.

Stories like mine and Sigrun’s are not uncommon, many suffer from financial struggles

while also suffering from their disease. Sanders recalls, “Oncologists have told me about cancer

patients who have been unable to acquire lifesaving treatments because they could not afford

them. This should not be happening in the world’s wealthiest country” (Sanders, 2017). People

shouldn’t have to suffer because they do not have access to medical treatment. Providing

universal healthcare proves financially and politically possible. According to a research article

published in the Journal of Health Politics, Policy, and Law, “such paradigm changes require

shifts in the political landscape too: the emergence of a set of political actors with the support

necessary to mobilize the relevant loci of state authority and the will to implement substantial
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change” (Tuohy, 2009). American citizens support universal healthcare. The American

government should catch up.

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References:

Cambridge, Mass: National Bureau of Economic Research. (2004). The impact of nearly

universal insurance coverage on health care utilization and health: evidence from

Medicare. Retrieved from ASU Catalog Search

Fay, B. (2018). Emergency rooms vs. urgent care centers. Retrieved from

https://www.debt.org/medical/emergency-room-urgent-care-costs/

Fisher, M. (2012, June 28). Here's a map of the countries that provide universal health care

(America's still not on it). The Atlantic. Retrieved from https://www.theatlantic.com

Foutz, J., Damico, A., Squires, E., & Garfield, R. (2018, March 05). The uninsured: a primer –

key facts about health insurance and the uninsured under the affordable care act - how

does lack of insurance affect access to health care? Retrieved from https://www.kff.org

Gostin, L. O. (2017). Five ethical values to guide health system reform. JAMA: Journal Of The

American Medical Association, 318(22), 2171-2172. doi:10.1001/jama.2017.18804

Griffin, J. (2017). The history of healthcare in America. Retrieved from

https://www.griffinbenefits.com/employeebenefitsblog/history_of_healthcare

Luthra, S. (2018, August 01). The next generation of doctors is pushing for universal healthcare.

Vice. Retrieved from https://tonic.vice.com

McClure, W, Enthoven A. C., & McDonald, T. “universal health coverage? Why?” Medicare's

hospital-acquired condition reduction program, 25 July 2017, Retrieved from

www.healthaffairs.org
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Olen, H. (2017, June 18). Even the insured often can't afford their medical bills. The Atlantic.

Retrieved from https://www.theatlantic.com

Sanders, B. (2017, September 13). Why we need Medicare for all. The New York Times.

Retrieved from https://www.nytimes.com

Sigrun K., Diagnosed with chronic lymphocytic leukemia | Stories of Help and Hope. (2018).

Retrieved from https://www.cancercare.org/stories/59-sigrun_k

Tuohy, C. H. (2009). Single payers, multiple systems: the scope and limits of subnational

variation under a federal health policy framework. Journal of Health Politics, Policy &

Law, 34(4), 453-496. doi:10.1215/03616878-2009-011