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A common aspiration among children is to become a doctor, or at least pursue some sort of medical practice. While it’s inspiring to see dreams of medical careers unfold for bright individuals, there is a sinister side to U.S. healthcare: in the United States, medical costs are so high that certain marginalized or economically disadvantaged groups are unable to afford good health. Compared with other developed countries, America’s healthcare services are lagging behind, and this does not bode well for the economy and the people alike. However, our healthcare system (that can be found in Forest Hills walk in clinic) is a long-standing institution that has provided generations of Americans with appropriate treatment. Would it be beneficial to replace, or at least tweak the system using universal healthcare?

To begin, universal healthcare concerns itself with how people pay for healthcare. Put simply, the government ensures that everyone, regardless of how they pay for healthcare, receives services. Historically, the idea of medical care being available to all people is not new. The question has been how to implement it. Obviously, several countries have figured that out; Otto von Bismarck introduced his own system to Germany in 1883, and most of the Nordic countries hopped on the bandwagon in the 1950s. However, unlike most of the world, the United States has yet to adopt universal healthcare. Why is that, exactly?

The United States is unique because it has a network of private insurance companies – companies that purchase healthcare services on behalf of consumers – which account for approximately 18% of its GDP. These companies derive the bulk of their revenue from premiums, which are yearly negotiated fees paid by their consumers. To keep their consumers in line, private insurance companies offer deductibles, which are the amount of money the consumer must pay out of pocket before insurance pays for the rest of the bill. These deductibles come with copays, which are a specific and relatively small amount of money paid to insurance companies by consumers for each medical transaction.

Numerous presidents in the past have attempted to pass healthcare legislation, but have been impeded by lobbying from giant health insurance businesses. President Franklin Roosevelt, drafting his New Deal program, considered adding a universal healthcare program. However, Roosevelt was hesitant, and the bill was passed without the measure. Before he or other Democrats could return to the subject, the GOP had already branded it as a socialist agenda.

What is Health Insurance?

The main problem with American healthcare today is not only that not all citizens are covered, but also that even covered citizens face overwhelming costs. This is because money, not health, is the bottom line of private insurance companies. These companies negotiate with hospitals and other healthcare providers – which sell to insurance companies that are willing to pay the most – and exorbitant costs are passed on to customers in the form of high copays and generous premiums. In some cases, private insurance companies and healthcare providers are unable to reach an agreement. Deductibles then become null and void, and the consumer has to pay the medical bill in full. The result is a system that drains money from public purses, favoring big healthcare businesses and affecting people of different socioeconomic statuses disproportionately.

Universal healthcare is a concept that seeks to address this problem. In countries that have implemented universal healthcare, three similar systems come to mind: the private-public insurance hybrid, socialized healthcare, and single-payer healthcare. Though some nations have blended these systems or used similar ones, these three remain the largest general models within universal healthcare.

Systems of Universal Healthcare

The first of these three systems was loosely implemented by the 2010 Affordable Care Act, passed under the Obama administration. This system allows private insurance companies to provide services, but the government fiercely regulates their activity. In some cases, the government will also provide its own state health insurance. That way, a variety of healthcare choices are available to the public, every individual has access to either private or state insurance, and universal coverage is achieved.

The main problem with this system is that private businesses are far richer and have more significant influence than the government – at least within the healthcare system – making the former a much more attractive client than the latter to a healthcare provider (i.e. a hospital). The result is much the same as a healthcare system controlled solely by unregulated private businesses, as healthcare institutions would often refuse to negotiate with state insurance or provide for state-insured individuals.

Socialized health care (also known as the Beveridge model) has been heavily implemented, most notably in the Nordic nations and the United Kingdom (the National Health Service). Under this model, the people pay for hospitals, pharmacies, and other medical institutions with income tax. In return, the government would provide the services publicly: national healthcare would be funded just like the post office, the roads, or the police. Medical staff, like nurses and doctors, would therefore work for the state, not a private entity.

Such a system effectively covers every individual but faces fierce opposition from those who claim that socialized healthcare binds individuals to state decisions. Socialized healthcare is also bad for private businesses: with universal state coverage, the need for private insurance companies – which are significant contributors to GDP – is eliminated. Americans, throughout history, have heavily resented taxes; unfortunately, this system would require a moderate increase in income tax rates. Also, people who do not require substantial medical attention might oppose the system, since they have to pay for something they don’t need. However, the price for the government to use universal healthcare has proven to be lower than the traditional system.

Lastly, single-payer healthcare – used in neighboring Canada – is a system in which the government is the sole buyer, or insurer, of healthcare services. Instead of paying premiums, citizens would contribute a higher percentage of tax. Private healthcare institutions would still exist (i.e. businesses run the show), but private insurance companies would be cut from the picture.

Single-payer healthcare faces many of the same challenges of socialized healthcare: private healthcare businesses frown, and certain individuals become frustrated with state involvement. However, since the government has no interest in exploiting consumers for monetary purposes, single-payer healthcare provides consumers with one reliable and affordable choice of insurance while maintaining the vigor of private healthcare. Single-payer thereby serves as a bridge between the two previous approaches, incorporating private and state entities alike.

Supporters and Proponents

Support for universal healthcare has risen in recent years, especially following the ratification of the Affordable Care Act. In the 2016 election, the idea was nascent and growing, but now it is a central talking point among the Democrats. The most notable pioneers, Bernie Sanders and Elizabeth Warren, support free medical access for all citizens regardless of income. Sanders’ plan shows significant influence from other countries’ implementations; he seeks to “cut prescription drug prices in half…by pegging prices to the median drug price in five major countries.” On the other hand, Warren hopes to expand Medicare so that doctors are paid by the government “instead of fighting with an insurance company.” Numerous other candidates, like Julián Castro, have provided skeletons for a universal-esque system, while the rest (like Pete Buttigieg and Joe Biden) merely offered vague options to implement the system in the future.

According to PBS, 69% of American youth (between ages 15 and 34) support some sort of universal healthcare program. That percentage is much smaller for older Americans, who grew up with the traditional system. The old method may have worked in prior years, when the debt wasn’t as massive, the economy was booming, and private insurance didn’t have such a stranglehold on the nation. As a result of the baby boomer generation, which is still the largest age group in the country, the younger generations have had less access to medical services than their elders.

Difficulties with Change

Implementing nationwide programs has always been challenging in the United States. Many members of Congress, though they will try to hide it, are supported and manipulated by insurance lobbyists behind the scenes. Medical products and services can remain unnecessarily expensive, enabling insurance companies to siphon off money from Americans. Getting Congress to try to take down their own ally would be extremely difficult. Additionally, certain states have repeatedly objected to Medicare and universal healthcare, and have paid more in medical costs as a result.

Regardless of political stance and economic values, almost everyone can agree that serious flaws exist in the American healthcare system. In a country in which society is driven by monetary goals, incentives are misaligned, and healthcare is provided for all the wrong reasons. So the next time a child says that he or she wants to become a doctor, inform them of the convoluted healthcare system in the United States, and they just might reconsider.