Elysse Mendoza
This upcoming January, California will be expanding Medi-Cal’s eligibility requirements, allowing any low-income adult aged 26-49 to enroll in full-scope coverage, regardless of immigration status. This is a monumental step in improving access to care for all Californians, with an estimated 520,000 residents now gaining eligibility for health coverage. Moreover, it’s an additional advancement in the prospect of universal healthcare in the United States, being one of the biggest expansions of coverage since the Affordable Care Act (ACA).
“Free healthcare” has been a topic of intense debate, especially in recent years, within the US, one of the only first-world countries in the world to not guarantee healthcare for all. Crying socialism, most right-winged individuals are opposed to the implementation of a single-payer healthcare system, in which the government pays for citizens’ healthcare via tax money.
Currently in the US, private healthcare is what dominates the health system landscape. Individuals and families may purchase plans via various health insurance companies or may qualify for government-sponsored programs like Medicare or Medicaid, which are age and need-based. While some services may come free of charge, such as preventative care, courtesy of the ACA, many services and medications still boast hefty prices to the consumer. Traditionally, those who can afford more comprehensive and less restrictive plans will have access to better care and are more likely to seek out care when they need it. This presents a severe inequity between socioeconomic levels and racial backgrounds, and results in millions of individuals not receiving healthcare. While the uninsured rate has been on a relatively steady decline since the advent of the ACA, an estimated 26 million people are without insurance as of 2022. Even so, just because individuals have insurance, that does not translate into them seeking regular health services due to many other barriers. This may include financial and geographic barriers, but also poor health and health insurance literacy due to the complexity of our health system and the inability to access important health information. In fact, a poll by the NORC Center for Public Affairs Research found nearly 8 in 10 Americans are concerned about accessing quality care when they need it, which was magnified among Black and Hispanic adults.
In 2017, Senator Bernie Sanders introduced his own Medicare for All Act, which proposes the consolidation of all government health programs and essentially wiping out the need for private health insurance. An ambitious attempt to bring the concept of universal healthcare to light in Congress, the bill was unsurprisingly not passed, but has been reintroduced numerous times since. It is still being referred to and discussed within different congressional committees, yet is still unlikely to be passed anytime soon.
The thing is, for many of the countries that already utilize a single-payer system, private health institutions are still available to consumers. While the government serves as the baseline insurer and all citizens are enrolled in some sort of national healthcare system, individuals may elect to add on private insurance if they can afford it. The purpose is to cover gaps in the national system for services not traditionally covered, such as to see doctors under private practice (instead of the government) or to simply reduce copayment costs.
While this system ensures all citizens can receive free healthcare, it still propagates social inequities in access to care, since it entails that those who can afford it can pay for “better” health. Some European countries have tried to tackle this issue, with French law requiring employers to split the cost of employer-sponsored insurance 50-50 with employees, and German policy requiring individuals earning under a certain amount to be enrolled in their government plan and giving those who make above the threshold the choice between public and private. These sound very similar to the US’s Medicare and Medicaid systems, however, most essential and preventative services under their government programs are free, unlike the US.
The list of issues cited by those opposed to a single-payer system is long and hefty, and their concerns are not unfounded. The major and most referenced barrier would be the economic implications of such. Sanders’ Medicare for All Act is estimated to cause of net increase in healthcare spending by $6.6 trillion and raise income and payroll taxes for citizens, something undoubtedly not very favorable. At the same time, however, it would increase overall government savings by an estimated $2.2 trillion, with additional tax revenue, increased purchasing power, and reduced hospital and health administrative costs. Additional complaints include reduced efficiency in the system, with many countries that have implemented universal health systems experiencing very long wait times to see providers, as well as less incentive for medical innovation. It’s also important to consider that relative to its global peers, the US is significantly larger both in terms of land and population, posing a large issue in the feasibility of implementing this system that counterparts have not seen.
Regardless, one principle remains unchanged - healthcare is a human right. While there is a long road ahead in figuring out what will work for the US and what will not, it is evident that universal healthcare works in alleviating health inequities. Moreover, as controversial of a topic as this is in the political realm, about 40% of Americans have stated their support for a single-payer system and 63% say that it is the government’s responsibility to ensure all citizens have health coverage, as discovered in a Pew Research Survey in 2020. No health system is going to be perfect, but the US needs to recognize that critical disparities lie in our current systems that could be fixed with a single-payer plan. It’s time to keep up with our peers and provide quality, affordable, and accessible care for all .
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