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Universal health care debate

In the United States

See also: Health care reform in the United States

Whether a government mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic. Those in favor of universal health care, such as the non-partisan Institute of Medicine of the National Academies of Science, which has called for the U.S. to implement universal health care by 2010, argue that the current rate of uninsurance creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality. Americans have a lower average life expectancy than those in other industrialized nations with universal health care, such as Australia, the United Kingdom, Canada, and Sweden. Infant mortality rates also remain higher in the U.S., despite declines in recent decades, and are higher than the average of the European Union.

Critics of this argument note that there is very little correlation between life expectancy and infant mortality with the quality of health care, due to such factors as alternate causality and variations in the way countries collect their statistical data. In fact, the U.S. led the world in life expectancy twenty years ago with virtually the same health system. Rather, many analysts attribute the lower life expectancy to a great surge in obesity rates. Opponents of universal health care programs argue that people should be free to opt out of health insurance and that government programs would require higher taxes, increase utilization, and reduce health care quality. They also claim that the absence of a market mechanism may slow innovation in treatment and research, and lead to rationing of care through waiting lists. However, contra arguments are also heard. That waiting is actually not uncommon in the United States, that the American system merely "rations by income and insurance status" and a more rational system would take the view that "health care should be considered a right, not a commodity".

Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care provided to them by their government.

Survey research shows that Americans see expanding coverage as a top national priority, and a majority express support for universal health care. There is, however, much more limited support for tax increases to support health care reform. Most Americans report satisfaction with their own personal health care.

Independent fact-check organizations, based on the actual content of the bills currently passing through Congress, have disputed many of the allegations made about America's Affordable Health Choices Act of 2009 (H.R. 3200) and other which claim that the bill would lead to a socialized health care system and government "death panels" that would decide whether a person's life was worth living when no such panels exist in the bill. The bill does not contain provisions for the government nationalization of the health care system, though there are higher taxes for high income individuals and penalties for certain employers not providing health care benefits. Employers with payrolls less than $250,000 p.a. are not assessed for penalties; with annual payrolls of $250,000 the penalty for not providing health care coverage begins at 2% of payroll value, and this rises peaking at 8% for those with payrolls over $400,000. and for individuals who do not have a minimum standard of health care coverage. Private insurance companies will be able to continue to sell new policies but not ones that no longer meet minimum government standards. Neither does the bill permit the extension of subsidies ("affordability credits") to the country's approximately 11 million illegal immigrants. although hospitals and ambulance services are already required by existing legislation to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. Patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.

The proposed government insurance plan would be allowed to pay for abortions just as many private insurance policies do, because the Hyde amendment likely does not apply; the public health care plan will be funded by private dollars (insurance premiums) and not from Federally funded taxation. Pro-choice groups claim this definition of "public funds" is too narrow, while pro-life groups claim it is too broad as the amendment only applies to Medicaid. Affordability credits within HR3200 would allow poor people to buy health insurance, but due the Capps amendment, the plan chosen (public or private) would not be allowed to apply them to abortion, but it is unclear whether other funds in the public plan (i.e. premiums) are "public funds" in the same way as tax dollars are. An NBC News/Wall Street Journal polled Americans on what they felt was "likely to happen" as a result of health care reform: "Health care to illegal immigrants - 55%", "Pay for abortions - 50%", "Government takeover - 54%", and "Government decides on health care for the elderly - 45%".

Proponents state this is a result of advertising and political activism trying to create a culture of fear surrounding health care reform by using straw man arguments. The media has focused on several Town Hall meetings in August that have broken out into noisy and emotional protests on both sides of the argument for reform.

Debate in the United States

The following is a listing of universal health care pros and cons as argued by supporters and opponents.

Common arguments forwarded by supporters of universal health care systems include:

• Health care is a basic human right or entitlement.
• Ensuring the health of all citizens benefits a nation economically.
• About 59% of the U.S. health care system is already publicly financed with federal and state taxes, property taxes, and tax subsidies - a universal health care system would merely replace private/employer spending with taxes. Total spending would go down for individuals and employers.
• A single payer system could save $286 billion a year in overhead and paperwork. Administrative costs in the U.S. health care system are substantially higher than those in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of U.S. health care spending.
• Several studies have shown a majority of taxpayers and citizens across the political divide would prefer a universal health care system over the current U.S. system
• Wastefulness and inefficiency in the delivery of health care would be reduced.
• America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and waiting times, according to the Commonwealth Fund.
• A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.
• Universal health care could reduce the burden of healthcare on business. The Big Three of U.S. car manufacturers cited health-care provision as a reason for their recent financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.)
• The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer be guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.
• A 2008 opinion poll of 2,000 US doctors found support for a universal health care plan at 59%-32%, which is up from the 49%-40% opinion of physicians in 2002. These numbers include 83% of psychiatrists, 69% of emergency medicine specialists, 65% of pediatricians, 64% of internists, 60% of family physicians and 55% of general surgeons. The reasons given are an inability of doctors to decide patient care and patients who are unable to afford care.
• According to an estimate by Dr. Marcia Angell roughly 50% of health care dollars are spent on health care, the rest go to various middlepersons and intermediaries. A streamlined, non-profit, universal system would increase the efficiency with which money is spent on health care.
• In countries in Western Europe with public universal health care, private health care is also available, and one may choose to use it if desired. Most of the advantages of private health care continue to be present, see also two-tier health care.
• Universal health care and public doctors would protect the right to privacy between insurance companies and patients.
• Public health care system can be used as independent third party in disputes between employer and employee.
• Universal health care is compatible with conservative principles, because in countries with universal health care, the government spends less tax money per person on health care than the U.S. For example, in France, the government spends $569 less per person on health care than in the United States. This would allow the U.S. to adopt universal health care, while simultaneously cutting government spending and cutting taxes.

Common arguments forwarded by opponents of universal health care systems include:

• Health care is not a right. As such, it is not the responsibility of government to provide health care.
• Universal health care could result in increased waiting times, which could result in unnecessary deaths.
• Unequal access and health disparities still exist in universal health care systems.
• The performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.
• Many problems that universal health insurance is meant to solve are presumed caused by limitations on the free market. As such, free market solutions have greater potential to improve care and coverage.
• The widely quoted health care system ranking by the World Health Organization, in which the US system ranked below other countries' universal health care systems, used biased criteria, giving a false sense of those systems' superiority.
• Empirical evidence on the Medicare single payer-insurance program demonstrates that the cost exceeds the expectations of advocates. As an open-ended entitlement, Medicare does not weigh the benefits of technologies against their costs. Paying physicians on a fee-for-service basis also leads to spending increases. As a result, it is difficult to predict or control Medicare's spending. Large market-based public program such as the Federal Employees Health Benefits Program and CalPERS can provide better coverage than Medicare while still controlling costs as well.