It took 114 days for Congress to renew funding for CHIP, the Children’s Health Insurance Program, which insures over nine million children across the country [1]. In the past few years, Republicans in Congress have tried to repeal or alter the Affordable Care Act - which extended coverage to nearly 20 million more Americans - over 60 times [2,3]. The governments of nearly 20 of states have neglected Medicaid expansion [4]. A study published in the American Journal of Public Health estimates that as many as 45,000 people die annually directly due to the lack of health insurance [5]. It should not be radical to believe that every American, regardless of income, should be covered by reasonably priced healthcare.

According to the Universal Declaration of Human Rights, as adopted by the United Nations General Assembly in 1948, all individuals have the right to “life, liberty, and security of person” [6]. America prides itself on the ideal of unabashed freedom. There is no freedom in being condemned to sickness when a shortage of money is the only hurdle in the way of health.  Furthermore, the Declaration proclaims that everyone has the right to a “standard of living adequate for the health and well-being of himself and his family…including medical care…and the right to security in the event of sickness.” The dividing lines between sickness and health; desperation and hope; and poverty and financial security are faint and fleeting. In fact, 61% of Americans self-reported they would be unable to pay for an unexpected $1,000 emergency [8]. At a moment’s notice, the healthy can become sick, the hopeful can become desperate, and the financially secure can become impoverished.

The fact that healthcare is a human right justifies and necessitates the implementation of a universal healthcare system in the United States. This not only means equality of access, but equality of outcome. Rosy words like “access” and “choice” mean nothing to people who cannot afford insurance. Every American has access to healthcare in the same way that every American has access to a brand new car: it can be bought in theory, but it is often out of reach. Healthcare should not be about the illusory concept of access, but the tangible goal of coverage for all.

The head of the Health Policy Division of the OECD, the Organization for Economic Cooperation and Development, Mark Pearson, explains that much of hospital spending in the U.S. can be explained by the fact that services simply cost more in U.S. hospitals, not because U.S. hospitals deliver more services to patients [9]. When factoring in multiple types of hospital services, average prices in the United States are 85 percent higher than prices in other OECD countries [10]. For example, the average hospital stay, about seven days, costs over $18,000 in the United States [10, 11]. The next most expensive hospital stay would be in Canada, the Netherlands, or Japan, where it costs $4,000 to $6,000 less per stay. Moreover, almost half of healthcare spending in the United States goes towards treating just 5% of the population [12].  

Despite the fact that the United States is the wealthiest country in the world, universal healthcare is often rejected by critics based on an argument against the cost. Moreover, critics believe that the notion that the current political climate would not allow for universal care to become a reality is a reason to oppose it. However, rights have never been about practicality, convenience, or changing political tides. If a right exists that is not able to be exercised, then action must be taken in pursuit of its enforcement. Government spending reveals a vastly different set of priorities. The U.S. spends more on defense than the next eight countries combined [15]. In December 2017, Congress passed a tax bill that would add up to $1.5 trillion to the national debt and make permanent large tax cuts for corporations [16]. The Washington Post, building on estimates by the Department of Homeland Security, estimates that President Trump’s proposed border wall would cost $25 billion [17]. If so, the wall would cost more than the budgets of scientific research, the U.S. space program, rehabilitation programs for veterans, disaster relief, and energy conservation [17]. The United States spends over 2.5 times more per capita on healthcare than other developed countries, many of which have nationalized healthcare systems [10]. Contradictory to the amount spent, life expectancies in the U.S. are lower, and infant mortality rates are higher than other developed nations [13]. The U.S. ranks 28th in quality of healthcare, below many other wealthy nations [14].

So how do we fix it? The economist Robert Frank argues that a single-payer system would deliver quality care at a “significantly lower cost” than the current system [18]. This is due to the increased bargaining power of government entities, drastically lower administrative costs, and the elimination of advertising costs for private insurers. To illustrate, Frank uses an analogy relating healthcare to road maintenance [18]:

“By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement.

But if roads would be as well maintained as before, would that be a reason to oppose the move? Clearly not, since the resulting cost savings would reduce your county taxes by more than your state taxes went up. Likewise, it makes no sense to oppose single-payer [healthcare] on the grounds that it would require additional tax revenue. In each case, the resulting gains in efficiency would leave you with greater effective purchasing power than before.”

According to the Pew Research Center, 60% of Americans believe that the federal government is responsible for covering healthcare for all Americans [19]. Michigan Representative John Conyers has introduced the National Health Care Act annually since 2003. In the first year it was introduced, the bill had only 25 cosponsors [20]; In 2017, it had 120 [21]. The presidential campaign of Senator Bernie Sanders put universal healthcare back in the spotlight, and the increasing levels of legislative sponsorship indicate a population that is warming up to the idea. It is time to embrace the simple notion that no one should die because of the economic situation they find themselves in.

References

  1. Kliff Sarah, “CHIP is finally getting funded - after 114 days without a budget”, Vox, Jan 22 2018. https://www.vox.com/2018/1/22/16919640/chip-funding-congress-shutdown

  2. Bakalar Nicholas, “Nearly 20 million have gained health insurance since 2010”, The New York Times, May 22 2017. https://www.nytimes.com/2017/05/22/health/obamacare-health-insurance-numbers-nchs.html

  3. Cowan Richard and Cornwell Susan, “House votes to begin repealing Obamacare”, Reuters, Jan 13 2017. https://www.reuters.com/article/us-usa-obamacare/house-votes-to-begin-repealing-obamacare-idUSKBN14X1SK

  4. “Status of state action on the Medicaid expansion decision”, Kaiser Family Foundation, https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

  5. Cecere David, “New study finds 45000 deaths annually linked to lack of health coverage”, The Harvard Gazette, Sep 17 2009. https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/

  6. “Universal Declaration of Human Rights”, http://www.un.org/en/universal-declaration-human-rights/

  7. Bordreau Richard, “The plausibility of universal healthcare in the United States”, Journal of Clinical Research & Bioethics, Mar 24 2017. https://www.omicsonline.org/open-access/the-plausibility-of-universal-health-care-in-the-united-states-2155-9627-1000298.php?aid=87185

  8. Fottrell Quentin, “Millions of Americans one paycheck away from financial disaster”, MarketWatch, Jan 20 2018. https://www.marketwatch.com/story/most-americans-are-one-medical-emergency-away-from-financial-disaster-2017-01-12

  9. Anderson Gerard et al., “It’s the prices, stupid”, Health Affairs, 2003. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.22.3.89

  10. “Health costs: how the US compares with other countries”, PBS NewsHour, Oct 22 2012. https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries

  11. Torio Celeste and Moore Brian, “National inpatient hospital costs,” Agency for Healthcare Research and Quality, May 2016. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.jsp

  12. Cohen Steven and Yu William, “The concentration and persistence in the level of health expenditures over time”, Agency for Healthcare Research and Quality, Jan 2012. https://meps.ahrq.gov/data_files/publications/st354/stat354.shtml

  13. “Mortality in the United States”, Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/products/databriefs/db293.htm

  14. “Measuring the health-related sustainable development goals of 188 countries”, The Lancet, Oct 8 2016. http://www.thelancet.com/action/showFullTextImages?pii=S0140-6736%2816%2931467-2

  15. “US defense spending compared to other countries”, Peter G. Peterson Foundation, June 1 2017. https://www.pgpf.org/chart-archive/0053_defense-comparison

  16. “Macroeconomic analysis of ‘Tax Cuts and Jobs Act’”, The Joint Committee on Taxation, Nov 30 2017, https://www.jct.gov/publications.html?func=startdown&id=5045

  17. Bump Philip, “The initial estimate is here”, The Washington Post, Feb 10 2017. https://www.washingtonpost.com/news/politics/wp/2017/02/10/the-initial-estimate-is-here-trumps-wall-will-cost-more-than-a-year-of-the-space-program/?utm_term=.a7cf5847a8f4

  18. Frank Robert, “Why single-payer health care saves money”, The New York Times, July 7 2017, https://www.nytimes.com/2017/07/07/upshot/why-single-payer-health-care-saves-money.html?mtrref=www.google.com&gwh=C51BFA64C97227597D016514DDFDC644&gwt=pay

  19. “Public support for ‘single-payer’ health coverage grows, driven by Democrats”, Pew Research Center, June 23 2017. http://templatelab.com/single-payer-healthcare-research/

  20. “H.R. 676”, 108th Congress, https://www.congress.gov/bill/108th-congress/house-bill/676

  21. “H.R. 676”, 115th Congress, https://www.congress.gov/bill/115th-congress/house-bill/676/cosponsors?q=%7B%22search%22%3A%5B%22hr676%22%5D%7D&r=1