Top Doctors 2022

The Pandemic Cracked The Door Open To Universal Health Care. Here's How ...

Just over three years ago, New York City reported its first confirmed death from COVID-19. Many more followed, with over 20,000 New Yorkers dying in the devastating first wave alone. They were our relatives, friends, and neighbors.

As with so many other health workers, the memories of that time — the unimaginable suffering and tragedy — are seared in my brain forever. The freezer trucks used as portable morgues; the chaotic din inside the hospital, juxtaposed against the eerie silence of the streets; and the unsettling fear we felt, for our patients and our families.

As of this week, an estimated 15 million people will start to lose their health coverage, as the COVID-19 public health emergency ends.

But through the darkest days of the pandemic, one notion gave me succor: that finally, we would summon the will to change our broken health system. That seeing how your health affected mine — the revelation that we were bound up together — would shift the dialogue on universal health care. That with society shaken to its foundations, we would be shaken out of our complacency.

Needless to say, that hasn't happened. In fact, as of this week, an estimated 15 million people will start to lose their health coverage, as the COVID-19 public health emergency ends. And a U.S. District Court judge just struck down the part of the Affordable Care Act that provides no-cost preventive care for a range of services, such as cancer screenings, affecting 150 million people. We are missing the opportunity to cement the coverage gains made during the pandemic — and instead will move further away from the aspiration of universal health care.

Despite universal health care being the norm in almost every other wealthy country, it remains a distant possibility in the United States. A divided Congress means that bold health proposals are unlikely to advance this year or next. Yet this also opens up a window to craft a fresh political approach, particularly one that rises above the rhetorical ruts of socialized medicine and fearmongering over fictitious "death panels."

How can we advance the public dialogue on universal health care? As a practicing physician and the former health commissioner for New York City, I have meditated on this topic for years. And despite the aforementioned political challenges, there are some openings in the public discourse to advance the idea.

It starts with displacing some key narratives that have held us back. For instance, the notion that only some people are deserving of health care. This narrative particularly plagues the debate over Medicaid, seeking to draw distinctions between the deserving poor, who want to work, and the idle poor. Such a distinction ignores evidence from recent Medicaid expansions that policies like work requirements do not lead to higher rates of employment and that health coverage makes it easier to seek and hold a job. Or as The Economist, not a magazine known for its left-wing views on human nature, bluntly stated: "No, health insurance is not a disincentive to work."  

Even President Richard Nixon agreed that people who are unemployed or disabled warranted support in obtaining health coverage. Fifty years ago, he argued that there was "a need to assure every American financial access to high quality health care." Clearly, conservatism can be consistent with universal health care, both historically and in the present day. When Medicaid expansion is brought directly to the ballot, it wins, including in conservative states as diverse as Idaho, Maine, Missouri, Nebraska, Oklahoma, South Dakota, and Utah. The Republican legislature in North Carolina also recently agreed to Medicaid expansion, covering 600,000 additional people statewide, by pairing it with reforms meant to increase health care competition.

North Carolina's example shows how a breakthrough on coverage can help us reach other policy priorities. The amount of oxygen taken up in political debates about coverage has narrowed the dialogue from health policy to health care policy to health insurance policy. Yet the top two concerns of the public in 2022 were strengthening the economy and reducing health care costs. Universal health care offers elected officials a path to addressing both.

Indeed, there are benefits to both workers and businesses from universal healthcare. Notably, the intertwining of health insurance with employment in the United States leads to "job lock," which puts a damper on the labor market — as well as the future prospects of workers themselves, whether seeking a higher-paying position or becoming a self-employed entrepreneur. Labor unions for low-wage workers as well as companies struggling to fill job vacancies both benefit from toppling this status quo.

About two-thirds of adults already agree it is the government's responsibility to make sure all Americans have health care coverage. Given the gridlock in our political systems, an even higher proportion will need to be persuaded to make universal health care a reality. Changing minds requires a focus on the values that move people, or what Jonathan Haidt terms "moral foundations": harm, fairness, loyalty, authority, and sanctity. While the harm and fairness domains are more important to those with liberal political leanings, conservatives place more emphasis on loyalty, authority, and sanctity.

Loyalty (as a moral foundation) can be summarized as the feeling that it's "one for all, and all for one." This was the impulse that drove us to distance and don masks in the early days of the pandemic. While that notion of self-sacrifice for the group may have tapered off during COVID-19, it also points toward the right messaging for a movement around health care for all. Fundamentally it must invoke our sense of human connection, particularly to those who are currently excluded from coverage.

 The path in the United States is fraught, but it is not impossible — and there are multiple policy approaches that could start to galvanize momentum.

The faces of the uninsured, many may be surprised to learn, include veterans, family farmers, new mothers postpartum, and children. Over 6 million kids are at risk of losing coverage as the COVID-19 emergency ends, potentially doubling the uninsured rate for children. Because our identities as parents, grandparents, and caregivers are often stronger than our political identities, centering children is an important way to reset the national dialogue on universal health care.

In other countries, the path to universal health care has not always been simple. Australia adopted universal coverage, repealed it, and then re-adopted it years later — only to encounter widespread doctors' strikes lasting several months. The path in the United States is even more fraught, not least because of entrenched and politically powerful interests in the health care industry. But it is not impossible, and there are multiple policy approaches that could start to galvanize momentum: adding a public option to insurance exchanges, allowing currently ineligible individuals to buy in to Medicaid or Medicare, or radically simplifying and automating enrollment processes for individuals already eligible but not enrolled.

All of these approaches depend on enough organizing muscle to overcome political headwinds. There is latent power in tapping into the disaffection that so many clinicians feel in today's health system. Nurses' unions, for example, have already raised the issue of widespread staffing shortages successfully—and they have long been proponents of universal health care.

Martin Luther King, Jr. Titled his final book, "Where do we go from here: chaos or community?" As we reflect on the last three years — and as we consider every human being who will lose their health coverage in the coming months — the American health system must grapple with the same question. King challenged the premise that the community serves the economy, telling us that is exactly backwards; that education, housing, and health care are ends in themselves. From this vantage point, universal health care is about common dignity, the idea that each of us believes in the basic worth of another's life. We may not have lived up to that standard yet, but there is a path from here.

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What Is Universal Health Care: Pros And Cons - The Daily Dot

If anything can be understood by the Republican drive to repeal the Affordable Care Act (ACA) it's that health care is a hot-button issue in the U.S., one that's been debated for decades.

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Elsewhere in the developed world, it's a settled matter that centers around giving every citizen accessibility to health services. So, as the Senate Republican health care bill moves toward a vote, it's interesting to take a look at the alternative—universal health care.

What is universal health care?

Universal health care (UHC) is a broad term that describes the provision of quality health services to every citizen while protecting them from the financial consequences that the use of expensive treatments or medicines often incur.

The aim is to give everyone, regardless of social status or income, access to a progressive range of essential health services, including education services, as well as a full breadth of treatment and care services—although some medical interventions may not be covered. UHC often also encompasses what are called population-based services and health awareness campaigns.

What are the pros and cons of universal health care?

The sudden onset of an illness or disease can force people of lower income into poverty as they try to pay for their treatment, causing people to spend their savings and driving many into debt. So, the key to applying UHC successfully is inextricably linked to protecting people from health costs by spreading the financial risk across the population.

Many countries rate UHC as fundamental to positive health outcomes across their populations, corroborating the World Health Organisation's assessment that UHC not only improves quality of life across society but is also linked to sustained economic growth and development.

As such, UHC has generally been moved on as a key policy objective in both developed and developing nations. In fact, as part of the United Nations' Sustainable Development Goals, member states have committed to implementing and working towards UHC by 2030.

The primary arguments against switching to universal health care in the United States boil down to money, options, and trust in government.

As we've seen to a lesser extent with the ACA, the cost of insuring more people—or, in the case of a UHC system, everyone—means more people have to chip in. This often comes in the form of taxes and other payments (more on this below). This means some people might pay more than they otherwise would at certain points in their lives, while others might pay less. Some Americans are opposed to the idea that their money might go toward keeping a stranger healthy or alive. Others want the option to spend their money on something other than health insurance, even if that puts them at higher risk.

Another factor is choice. Under a UHC system, everyone is effectively treated equally and options for treatments may be limited. This is great for people who are at a financial disadvantage, but people with the funds to spend more for better (or simply different) treatments may balk at the idea of relying on UHC.

Finally, there's the question of whether the federal government can effectively and efficiently run a health care system for hundreds of millions of Americans in all 50 states. One only need explore the problems with the Department of Veteran Affairs—inadequate care, long wait times for patients, and more—to see how a government-run health care system for everyone could potentially devolve into a nightmare.

How are universal health care programs paid for?

The health care models and financing systems vary from country to country, but most countries provide total coverage through a blend of publicly owned and private systems. On occasion, however, a government may directly and solely manage health care provision on behalf of the citizenry.

UHC is often paid for by several sources. In most countries, funding is secured through taxation, often supplemented by private and compulsory contributions made on behalf of an employee by an employer or company.

Is UHC common around the world?

Many economically developed countries in the world implement universal health care in one form or another. The countries of Europe and Scandinavia almost all deliver UHC, apart from a couple of troubled countries.

The United Kingdom has offered its citizens a National Health Service since 1948, alongside a market for private insurers. Other wealthy countries like Australia, Russia, Saudi Arabia, New Zealand, Brazil, Japan, and South Korea have provided UHC for more than half a century.

Developing countries like China, which supports the world's largest health care system already, is working toward UHC for its colossal population of 1.37 billion people.

In North America, Canada has successfully implemented health care provision for every citizen since the 1960s, in stark contrast to its southerly neighbor.

Why does the U.S. Not have universal health care?

There is no real consensus on how health care should be implemented in the U.S., and there are many reasons for this. When it comes to UHC, the strongest opposition in the U.S. From players in both the political and business spheres.

On one hand, interest groups spend big money lobbying on behalf of the powerful private health insurers industry. In 2009, when Obamacare legislation was being drafted, health-sector lobbyists doubled in number and spending hit more than $1.2 billion. Meanwhile, ultra-conservatives with limited government ideologies believe that UHC stands in contradiction with American values. Groups like the House Freedom Caucus have worked to restrict both government subsidizing of health services and what those essential services include.

Money and ideology aside, a January poll from Pew Research shows that a 60 percent majority of Americans say the government should be responsible for ensuring health care coverage for all Americans—effectively backing UHC.

Perhaps the loudest vocal political force for American UHC is Sen. Bernie Sanders (I-Vt.), who ran for the Democratic presidential nomination last year. Providing health care for all Americans became one of his key campaign pitches in his race against Democratic rival Hillary Clinton.

"There is one major country that does not guarantee health care to all people," he said during a February 2016 PBS debate between Sanders and Clinton. "There is one major country—the United States—which ends up spending almost three times per capita what they do in the U.K. Guaranteeing health care to all people, 50 percent more than they do in France guaranteeing health care to all people, far more than our Canadian neighbors, who guarantee health care to all people."

In just one decade, the country has moved from establishing the Affordable Care Act, known as Obamacare, which enfranchised over 24 million citizens using government subsidies and funding.

For social democrats like Sanders, the Affordable Care Act was good, but it didn't go far enough.

The U.S. Is now retreating further from UHC. Senate Republicans recently unveiled their plan to repeal and replace Obamacare, which greatly cuts funding for Medicaid—a government-run insurance plan that serves over 60 million Americans—among many other provisions. 

Still, many Americans are not sold on the ideas Republicans have offered for replacing Obamacare. Even if it passes as Obamacare did, the debate is clearly far from settled.

Column: The Need For Universal Health Care - CBS News

This story was written by Ben Rowley, Daily Mississippian

Data from the U.S. Census Bureau indicates the number of Americans without health insurance has reached 47 million. That means that 15.8 percent of the residents of the self-proclaimed "best" country in the world do not have access to adequate health care.

It is true that America is home to some of the world's best doctors and hospitals; however, many Americans receive inadequate care or no care at all. The uninsured are forced to turn to emergency rooms for treatment for ailments routinely treated by a simple visit to the doctor's office. This results in long waits for patients with more severe injuries and higher costs for the insured as hospitals attempt to recover the cost of treating those unable to pay.

Health care is going to be a pivotal issue in the coming presidential election. The U.S. Health care system is broken. Both Sen. John McCain and Sen. Barrack Obama acknowledge serious problems, including the use of "gate keepers" and the difficulties faced by those with pre-existing conditions in getting health coverage.

Even as the health care debate in the U.S. Takes center stage in the public's eye, both candidates tiptoe around the topic of reform. McCain risks alienating the Republican base by promising universal coverage, and Obama must communicate his plans for universal health care without sounding like a "socialist".

Though a universal health care is desired by many, it remains a touchy subject. Typically, talk of universal plans stirs images of socialized medicine like that found in England. And while it is true there are big problems with the health service in the United Kingdom, there are many universal health care systems that offer much better care than the American system and at a much lower cost.

The American health care system is said to be market-based. This means (whether admitted or not) health care decisions are often influenced more by the financial outcome for the provider and insurance company than the health of the patient.

This profit seeking is ruining the health of far too many Americans. In the quest for increased profits, insurers and hospitals have resorted to practices that lead one to question whether any sense of ethics remains in corporate America.

Countries all over the world have taken aggressive steps to provide for the health of all of their citizens. In fact, several notable democracies have implemented universal health care. Care is widely accessible to everyone under these programs. Life expectancies are higher and infant mortality rates are lower in these countries than in the U.S. All of these things are achieved at a much lower cost than in America.

Opponents of universal care can argue that "socialized," "single-payer" systems -- both terms are often misused -- are inefficient and offer worse care than the American system. However, medical indicators such as life expectancy, infant mortality rates, wait times and cost do not lie. If people are living longer in countries like Japan, France, England, Germany, Cuba (yes, Cuba) and Taiwan, then maybe they are doing something better than us: providing very good health care to everyone.

Spending on health care in the United Statesequals more than 15 percent of GDP. The GDP of the United State is nearly four times larger than that of Japan, the second-largest economy. Japan, however, spends only 8 percent of its GDP on health care, but provides a high level of care to everyone.

The U.S. Spends about $6,500 on health care per capita, while France spends only about $3,500. However, France has a higher life expectancy and lower infant mortality rate than the United States.

There are a few basic steps that must be taken to ensure that all Americns have access to the best health care in the world.

First, insurance companies should be prohibited from denying anyone coverage.

Second, everyone must purchase insurance and subsidies should be provided for the poor.

Third, insurance companies must become nonprofit.

Fourth, the price paid for medical procedures, doctor visits and medicine should all be negotiated in advance and should be standardized throughout the country.

While many may call these steps "socialist," "big government," "liberal" or "un-American," they are vital if the U.S. Is to remain a healthy nation. As it stands now, America is still "the land of the free and the home of the brave," but we are also home to the uninsured, underinsured, sick, obese and hopeless. Small-market reforms in health care in this country could improve our quality of life and secure our place as the "best" country for a long time to come.

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