Why America Needs Guaranteed Healthcare

For over 100 years, the United States has had various grass-roots movements attempting to implement and expand universal health insurance coverage. During the late 1800s and early 1900s, campaigns backed by progressives and socialists to pass universal healthcare legislation were opposed and blocked not only by conservatives, but eventually their own allies in labor unions due to the union's collective fear of losing power over paid-benefits (and thus their usefulness) in an era before there were legal protections for organized labor. While many European nations were beginning to provide 'sickness insurance' and subsidizing mutual benefit societies which helped workers cover medical costs, America's struggle for any forward momentum on the subject led to the issue being handed over to individual states. The states in turn mostly handed the responsibility over to private insurance companies and non-profits, a practice they've perfected through the decades.

Throughout the early New Deal Era of the 1930s, 40s and 50s, when the nation was brought to its knees by the Great Depression before a hard-fought future was being forged after World War II, a broad coalition of Americans agreed some form of guaranteed financial protections should be implemented by the federal government. Yet, only Unemployment Insurance, Social Security for the elderly and Disability payments managed to become the law of the land. As needed as these protections were, federally-guaranteed medical coverage remained nowhere to be found.

During the 1960s, President Lyndon Johnson managed to capitalize on goodwill the American people collectively held in the aftermath of President Kennedy's assassination, and passed several sweeping reform bills. While the Voting Rights Act and Civil Rights Act often get their well-deserved credit for being produced in this era, less remembered are the Social Security Amendments of 1965, which created the Medicare program of health insurance for the elderly, as well as the Medicaid system of subsidies for state-run insurance programs for low-income individuals and families. While not covering everyone in the US, at least the most vulnerable in society were finally guaranteed coverage.

Little momentum for universal healthcare manifested during the Neoliberal-ascendant years of the 1970s and 80s. Conservative's red-baiting cries of "Socialism" at any policies remotely promoting the public good proved very successful, effectively killing nearly any attempt at advancing the cause. By the 1990s, public opinion had warmed to healthcare reforms enough that First Lady Hilary Clinton spearheaded an effort to expand Medicaid, provide insurance-subsidies for all income levels and create insurance 'assemblies' for each state in the Union. Unfortunately, stiff political resistance on all sides doomed the effort before it truly got off the ground. Yet, the core ideals put forth then were repackaged and finally passed in 2010 through President Obama's Affordable Care Act. Finally, America seemed close to guaranteeing universal healthcare coverage for its citizens.

Except, things didn't actually work out that way. Many red-leaning states didn't accept the additional funding for Medicaid, leaving millions of their most vulnerable without available support. Few states actually added funding or incentives to insurance companies and buyers participating in their exchanges, making the effort remarkably ineffective for many. The Supreme Court of the US also eventually struck down the Individual Mandate, a requirement for every adult to pay into a health insurance plan or pay an additional fee on their taxes to help fund the subsidies and expansions. So, more than ten years after the most sweeping healthcare legislation America could muster, for-profit insurance companies have more power and higher profits than ever before, while millions of Americans remain without needed healthcare.

Today, America spends more per capita on healthcare than any other advanced nation on the planet, yet our health outcomes are far from the best in the world and remain incredibly uneven across the population. We have among the most expensive pharmaceutical drug costs in the world, despite developing many of these products here at home. Between 2008 and 2018, healthcare premiums rose by 55%, almost twice the 26% increase in average worker's wages during the same timeframe and far outpacing inflation. Nearly half of US adults under 65, 45%, are uninsured or underinsured, totaling around 88 million people unable to get reasonable insurance or paying premiums for services they can't afford. Nearly half of Americans report they've avoided going to the doctor due to related costs. Compared to other developed nations, America ranks near the bottom of several health indicators, ranging from infant mortality, life expectancy, preventable mortality, maternal death related to childbirth, obesity and equality of care.

In short, America's healthcare system is great if one has money to blow on its related costs, yet it's barely passable or pretty terrible for the rest of us. America has leaned so heavily into the for-profit private sector for its healthcare needs we now find ourselves hostages to a system more accountable to its shareholders, board members and investors than the public good. Over the last several decades the US healthcare system has seen its overall effectiveness drop while prices have soared. Wealthier Americans continue to stay above the statistical bell curve of worsening quality, yet they're paying ever more to keep this privilege. These trends are unsustainable for all but the very richest of Americans.

Fortunately, there are some very straightforward and common sense reforms which would help negate all of the downsides Americans currently face with their healthcare, while retaining the best qualities of the current system. Most people nowadays call the proposal I speak of Medicare For All, popularized by Senator Bernie Sanders from Vermont, yet the important thing is having a publicly-funded, universal, compulsory healthcare insurance system. This mean everyone working pays into the medical system, much as we already pay taxes towards Medicare, Social Security and Medicaid now. Every worker would see their payroll taxes rise due to the increased number of people added into the new system, yet our private insurance costs would drop off almost instantaneously. No copays or additional premiums would be required, with everything from drug prices to hospital visits seeing a precipitous drop in cost. Overall, every American would be provided coverage and all of us would see our healthcare costs drop despite the people added to the system.

The existing Medicare, Medicaid and Veteran's Affairs healthcare programs would be melded into the new system, producing an overarching regime with less red tape, easier approvals for needed treatment, lower administration costs, people-focused care and virtually no advertising budget. Additionally, this Medicare-For-All system wouldn't eliminate private health insurance coverage, as is regularly claimed. In the same way private and non-profit insurance companies manage customers with Medicare and Medicaid now, these companies could continue to do so with the wider public, albeit at lower negotiated rates rather than those they'd prefer to set.

Private insurance would also lose the ability to decide what coverage is denied or approved, a net benefit for nearly all of us. Additionally, while basic health, dental, vision and mental health care would be provided via the universal system, additional benefits and higher-end care packages could still be sold by private insurance companies to those interested. Even private employers would benefit from a Medicare-For-All system, paying less per employee into the federal system and only providing enhanced benefits if desired.

In totality, America would see a boost to wages and salaries due to less spent by workers and their employers for insurance, increased job quality by ensuring ever worker has full coverage from the outset, and lower stress levels or shock to families due to loss of employment or moving between jobs no longer resulting in loss of health insurance. Universal healthcare would free millions from 'job lock' wherein they choose to remain in jobs they dislike due to their insurance benefits, and would support millions more who are or would like to be self-employed or start their own business. Workers in this new job market would be more adaptable and have more funds to spend, contributing to a virtuous cycle of economic growth.

To be sure, if implemented overnight, a universal healthcare system would create a massive shock in the US economy. There's also the issue of paying medical doctors and other personnel fairly, as many take on thousands of dollars in student loan debt to acquire the degrees and experience needed to perform their jobs. I'd argue reform of the higher education system, wherein further investments are made to ensure doctors, nurses and other medical professionals emerge from universities and colleges with little to no debt would be ideal, there are undeniably such realities to consider when reforming healthcare. Yet, if done correctly and phased in over a period of a decade or more, many studies and even the Congressional Budget Office agrees a Medicare-For-All system would be a large net-benefit to the vast majority of Americans. At this point, the question isn't whether or not universal healthcare is a good idea, it's what do we need to do to get this done? It's time for us to figure it out. Our children and grandchildren will appreciate our foresight.

References:

1) https://en.wikipedia.org/wiki/History_of_health_care_reform_in_the_United_States

2) https://en.wikipedia.org/wiki/Social_Security_Act

3) https://pnhp.org/a-brief-history-universal-health-care-efforts-in-the-us/

4) https://firstquotehealth.com/health-insurance/news/non-profit-health-insurance

5) https://www.citizen.org/article/why-medicare-for-all-not-a-public-option-is-the-best-solution/

6) https://www.healthaffairs.org/do/10.1377/forefront.20200319.920962/

7) https://www.epi.org/publication/medicare-for-all-would-help-the-labor-market/

8) https://www.healthline.com/health/what-medicare-for-all-would-look-like-in-america#1

9) https://pnhp.org/news/congressional-budget-office-scores-medicare-for-all-universal-coverage-for-less-spending/