Abstract
The single-payer healthcare system aims to enhance equality in the United States, primarily through improved health insurance availability. The proponents view that the proposal will boost preventive care while the opponents feel that it will propagate inefficiencies. Regardless, the single-payer method has benefits, which outweigh its disadvantages, especially concerning accountability, justice, cost, and healthcare quality. Exorbitant medical bills are among the leading causes of bankruptcy in the US since treatment expenses have hiked, whereas the medical covers are expensive and unreliable. Consequently, the single-payer structure will ease the health-associated economic burdens among Americans.
Introduction
The single-payer framework will boost healthcare management through centralization, thus, raising the accessibility of quality clinical services among all individuals who need them. Furthermore, the new scheme will facilitate medical administration efficiency, flexibility, and affordability, leading to a decreased disparity. The single-payer methodology supports adequate infection protection since it heightens access to preventive care, mainly screening services. Nonetheless, critics claim that the single-payer technique is ineffectual due to the possibility of lengthening the waiting time and triggering adverse economic and political outcomes such as job losses and political divisions. However, most of the perceived limitations are the current principal setbacks in realizing excellent and productive healthcare. Notably, the single-payer system will incorporate all the existing medical securities and streamline healthcare operations to increase the Americans’ realization of superior services despite their diverse socioeconomic backgrounds, ultimately reducing bankruptcies, fatalities, and upgrading disease prevention.
The United States’ health care system is primarily based on the philosophy of profit over the provision of high-quality medical care. The forces that drive it largely encompass private health insurance companies that engage in fierce competition for a share of the market. The assumption is that the cost of care would decline as there are numerous players in the market. However, that has not been the case. Between the years 2000 and 2004, the earnings of insurance companies rose by 114%, premiums increased by 60%, and the number of uninsured Americans grew by 6 million (Patel & Rushefsky, 2015, p. 34). Contrary to popular belief, the majority of individuals who did not have insurance cover included American citizens, and not immigrants as alluded to. The aforementioned statistics show that insurance companies have an incentive to make more money while cutting people out of insurance covers. The maximization of profit over the improvement of public health is a core reason why a single-payer health care system would be good for America. In many instances, these companies deny insurance to Americans with pre-existing conditions and charge higher premiums to those with chronic illnesses. This situation is unacceptable because of the importance of having equitable and universal health care that every citizen can have access to. The American health care system provides insurance covers to people who can afford it while denying access to those from poor economic backgrounds. Patients with high health care costs suffer because many private insurance companies are unwilling to insure them. After all, by doing so, profits would dwindle considerably. America needs to implement a system that provides equal and universal health care. Therefore, the current system is inadequate and should be replaced with a single-payer system.
The implementation of a single-payer health care system in the United States has been discussed for several years. It is a hotly-debated issue that aims at addressing the problem of inequity. The US healthcare system is flawed as it does not offer universal healthcare. The Affordable Care Act has played a key role in the improvement of the health insurance industry. However, it excludes more than 30 million Americans. A single-payer healthcare system involves the provision of insurance services for everyone by a single entity. This means that every citizen receives health coverage under a common insurance plan. All the necessary services, including doctor visits, prescription drugs, and vision care, are provided. Opponents of the system have argued that it will increase wait time and lead to massive job losses. On the contrary, proponents argue that it will provide preventive care to all, decrease health care spending, and enhance positive health outcomes as observed in countries like Norway, Sweden, France, and Denmark. America should switch to universal single-payer healthcare because it will stop medical bankruptcies, guarantee better and more affordable care to everyone, and improve the overall health of the entire nation.
Benefits
Statistics have shown that the number one cause for bankruptcies in the United States is medical bills, accounting for about 62.1% of all cases. Additionally, more than 2 million people are under severe financial pressure owing to their huge medical expenses (Levitt, 2018, p.1). A 2019 study conducted by the Kaiser Family Foundation (KFF) revealed that 9% of the participants had declared bankruptcy because of their medical expenses while 20% had disputes with collection agencies (Sainato, 2019, p.1). The researchers also found out that, even though wages were increasing, people were unable to keep up with the rising costs of health care. Medical insurance premiums have doubled while wages have increased by a paltry 26%. A 2019 study showed that approximately 530,000 cases of bankruptcy emanating from accrued medical debt are reported annually (Schumaker, 2020, p.1). The Affordable Care Act has been insufficient in mitigating the problem because of poor health insurance. The most effective way of addressing the issue is the adoption of a single-payer system.
Several studies have been conducted to evaluate the contribution of medical bills on the increasing rate of bankruptcies across America. As mentioned earlier, two-thirds of bankruptcy cases have been linked to illness and medical bills, as health care has become costly over the past decade (Casull, 2019, p. 10). The situation has not improved in the past four years since Donald Trump became president. For instance, more than 2 million Americans have lost health coverage and as a result, they have succumbed to various diseases. This statistic was revealed in an analysis conducted by Harvard University. The situation has been worsened by the emergence of the Coronavirus pandemic. The majority of those suffering include people with disproportionately low income, uninsured, and minorities. The study revealed that 40.6 million American adults have medical conditions that put at risk the health of the children they work with daily. The increasing cost of health care due to COVID-19 means that more families will go bankrupt as a result. A study published in the American Journal of Public Health revealed that approximately 530,000 families declare bankruptcy annually, owing to the burden of medical bills or illness (Casull, 2019, p. 15). Medical expenses cause hardships that deplete the finances of many homesteads, leading to the buildup of debt.
The aforementioned Harvard study involved a sample of 910 individuals who went bankrupt between 2013 and 2016, and whose court records are publicly available. The study was a component of the Consumer Bankruptcy Project (CBP) research on bankruptcy cases across America, which aims to find out the main causes. The research mainly focused on cases that were filed after the implementation of the ACA in 2010. According to the findings, 58.5% of bankruptcies were caused by medical bills while 44.3% of the cases originated from income losses due to illness (Casull, 2019, p. 19). These findings were similar to those from surveys conducted in 2001 and 2007. Many debtors cited medical bills and income loss due to illness as two of the main causes of their bankruptcies. The study also found out that the ACA did not mitigate the situation because there was a 2% increase in medical-related bankruptcies after the legislation’s implementation (Casull, 2019, p. 19). Moreover, the responses were similar for participants who lived in states that had either accepted or rejected the ACA’s Medicaid expansion. The cases were higher in middle-income homesteads, primarily due to higher copayments and deductibles, even though the ACA is in effect. People from poor economic backgrounds have few assets. Therefore, they are less likely to seek formal bankruptcy relief. The researchers also noted that medical bills were the main cause of unpaid debts that were sent to collection agencies for recovery.
The widening economic gap between the rich and the poor in the United States is contributing to disparities in health outcomes. The healthcare system is expected to lower income-based disparities in health outcomes. However, research has shown that it exacerbates them. Poor people have less access to medical care than rich people, despite the passage of the ACA as many of them remain uninsured. The situation is not much better for individuals with private insurance because the rise in insurance premiums overshadows any income increases, thus leading to financial debt (Patel & Rushefsky, 2015, p. 38). Meanwhile, the percentage of health resources dedicated to the service of the rich has increased considerably. It is important to implement additional reforms to the ACA so that inequality in the health care system can be eradicated and more Americans can have access to health insurance. Before the passage of the ACA, about 20% of Americans lacked health insurance coverage (Patel & Rushefsky, 2015, p. 38). In that regard, approximately 45,000 deaths were reported annually as people succumbed to illness due to the high costs of health care.
Health care inequality in the US is evident from government statistics. For instance, between 2011 and 2013, almost 40% of households with an annual income of $22,500 described their health as fair or poor (Patel & Rushefsky, 2015, p. 47). Additionally, 12% of households that had an annual income above $47,700 gave similar responses. Insurance coverage did not change the health outcomes for both groups. Adults from poor socioeconomic backgrounds are more likely to find difficulty doing daily chores because of the adverse effects of chronic illness. Moreover, their children are at a higher risk of high blood pressure and obesity than children from wealthy families. The situation is projected to worsen because of differences in income increases. For instance, between 1979 and 2007, the wealthy reported a 275% increase in earnings while the poor reported an 18% increase, even with the inclusion of government payments (Patel & Rushefsky, 2015, p. 49). The worsening of economic mobility over the years has led to an increase in care disparities among different socioeconomic groups. This challenge can be mitigated by the implementation of a single-payer health care system.
One of the major challenges of the current health care system is the pervasive inequality with regard to access to quality health care. More than 30 million Americans lack access to health insurance because they cannot afford it (Levitt, 2018, p.1). The system is comprised of a complex network of both public and private insurance providers that take advantage of applicable laws to deny coverage to individuals from poor socioeconomic backgrounds. The US spends more on funding the healthcare system compared to other developed countries. However, the World Health Organization (WHO) has noted that it has the lowest life expectancy (Donnelly et al., 2019, p.1). Surveys conducted by the Centers for Disease Control and Prevention (CDC) have shown that there is a 10-15 year gap in life expectancy between the rich and poor. It performs poorly with regard to the attainment of specific health outcomes. In that regard, the current system is ineffective due to a lack of centralized administration.
Moreover, the implementation of a single-payer healthcare system would mitigate the challenge of inequity. As mentioned earlier, the Affordable Care Act plays a significant role in enhancing health insurance coverage (Liu & Brook, 2017, p.1). However, millions of Americans have little to no access to quality health care. A single insurance provider will promote the provision of health coverage to everyone because of the elimination of the competition that exists between public and private insurance agencies (Donnelly et al., 2019, p.1). In that regard, administrative costs will decrease, and the cost of medical services will be easily regulated. It would also curtail wasteful spending and lower expenses (Glassman et al., 2017, p.204). Case studies from other developed countries have shown that the system is effective. Experts have argued that the system would encourage more spending to enhance positive outcomes with regard to public health (Levitt, 2018, p.1). For instance, funding obesity prevention programs would be cheaper and more effective than paying for visits to physicians. Increasing access to preventive care services would promote the overall health of the public, keep people productive, and lower medical costs. The prevention of diseases through measures such as screening and vaccination could be possible through a single-payer system.
Additionally, an important argument in support of a single-payer system is the reduction of the cost of medical care. The program would be operated by merging the current sources of funding, such as Medicaid and Medicare, with affordable taxes predicated on an individual’s economic status (Schumaker, 2020, p.1). Surveys have projected that more than $500 billion in administrative costs would be avoided because the operations of the single provider would be streamlined (Gee., 2019, p.1). Moreover, premiums would be eliminated, and all individuals would save money. Barriers to quality medical care, such as deductibles and co-pays, would disappear, and patients would enjoy the freedom to choose their doctor and hospital (Donnelly et al., 2019, p.1). The system would allow doctors to take full control over patient care, and, as a result, provide the best care possible.
The rising cost of health care is one of the reasons why many American households live in poverty. For instance, a 2018 study cited expensive medical care as the reason for the 7 million people who lived below the poverty line as defined by the federal government (Casull, 2019, p. 23). Poor people do not have access to Medicaid, even though they might be working. The ACA offers a subsidy but covers specific services that might not be needed. The amounts of deductibles have been on the rise between the years 2007 and 2017. As a result, many Americans have remained uncovered. Consequently, employers pay less and the employees are required to pay the larger portion. A single-payer system should be implemented to enhance affordability at points of service. The system would lower the overall costs of medical care because the associated expenses would be spread across taxpayers. Therefore, premiums would be eliminated, out-of-pocket costs would be non-existent, and numerous medical benefits would be covered (Patel & Rushefsky, 2015, p. 58). Currently, people with serious health conditions, shoulder the financial burdens of insurance cover disproportionately. A new system would ensure that the burden is evenly distributed and that the segmentation of health care risks is eradicated.
Individuals who cannot afford health insurance coverage usually encounter the challenge of choosing between taking care of their health and accruing medical debts. A 2017 survey conducted by Bankrate, a financial services company, revealed that about 31%, 25%, and 23% of Millennial Americans, Gen X, and Baby Boomers, respectively, had declined medical treatment because they could not afford to pay for the services. These findings are an indication of how ineffective the current healthcare system is, and this could be mitigated by implementing a single-payer system. Obamacare has several limitations that can be addressed by creating a single health insurance provider. The law renders the control of costs impossible and supports the imbalanced funding of health care (Glassman et al., 2017, p.32). Insurance providers will continue the unethical practices of increasing deductibles and co-pays, limiting care and maintaining restrictive networks to their advantage and at the expense of patients.
Disadvantages
There are three main disadvantages of implementing a single-payer healthcare system in the US: it could increase wait time, cause political divisions, and lead to job losses among private health insurance firms. A single-payer system could be ineffective because, in the US, health care is a political issue that is hotly debated (Krahn, 2016, p.42). Current surveys have shown that more than 50 % of Americans support a shift to a single-payer system. However, the percentages are different among members of political parties as 39% and 64% of Republicans and Democrats support the shift, respectively (Levitt, 2018, p.1).
The abolishment of the private health care system would lead to massive loss of jobs and the uncertainty of careers rooted in health care. Health care providers would be the least affected individuals. However, employees who work in privately-owned entities would either encounter destabilization or the outright loss of their jobs. An increase in wait time is one of the main reasons presented by opponents of the proposed system (Levitt, 2018, p.1). They argue that the program will overwhelm the health care system, and increase the number of days that a patient would wait before seeing a doctor (Krahn, 2016, p.48). Moreover, the restricted availability of core healthcare services renders the system a poor fit that could replace the current system. Opponents argue that despite its numerous benefits, the system will not mitigate the challenge of balancing access, cost, and quality in healthcare.
In a single-payer system, the responsibility of funding health care is given to the government and it competes with other priorities. Therefore, there is a risk of being used as a tool for campaigns by politicians for tax cuts. Moreover, physicians would be subjected to unnecessary government oversight with regard to health care decisions. The power to regulate payments and monitor health care providers would probably be misused by the government (Patel & Rushefsky, 2015, p. 76). For instance, it could limit the application of certain therapies and pay differently for the various services offered based on quality. The result would be unwanted consequences such as increases in disparities in health outcomes. Additionally, the lack of competition would be detrimental as the government would pay whatever it wants, though it could be inadequate to cover all costs of care. Under the current system, physicians are inadequately paid for the services they offer under the Medicaid program. Reductions in reimbursements have been linked to decreased access to, and a lower quality of health care (Patel & Rushefsky, 2015, p. 73). In that regard, reduced settlements under a single-payer system would compel physicians to halt their services, thus decreasing access to medical care. Giving the government the power to determine health care prices is a risky move that could destabilize the entire system.
Proponents of a single-payer system base their arguments on the results reported by states that have attempted to use government programs to expand coverage. For example, TennCare was a Medicaid program implemented by the state of Tennessee in 1994 (Casull, 2019, p. 33). Its objective was twofold: to increase health coverage among uninsured people and to regulate costs. The program collapsed due to impractical financial planning and mismanagement. In 2006, Massachusetts implemented a law that was aimed at promoting universal health coverage in the state. Two years after the law’s enactment, about 165,000 residents had received coverage through a combination of avenues, and approximately 93% of the state’s population was covered by the end of 2007 (Patel & Rushefsky, 2015, p. 352. However, poor planning led to adverse outcomes. The provider workforce was not expanded to deal with the increasing number of care seekers. Therefore, many patients did not have access to care and costs increased significantly. Without proper planning and management, a single-payer system will introduce massive inefficiencies in the health care system, increase the cost of care, and limit access to key medical services.
Rebuttal
The arguments presented by opponents of the single-payer system are baseless as surveys conducted in countries that have adopted the program reveal otherwise results. For example, the aforementioned issues are much smaller in France, Norway, and Denmark when compared to the current American system. The main hindrance to adopting the proposed system is political interference rather than challenges within the program’s structure (Levitt, 2018, p.1). Stakeholders who will be affected the most, including health insurers and pharmaceutical companies, are the major obstacles. The argument that the transition from the old to the new system is costly is informed by unsubstantiated ideologies because, in the long term, it would save billions of dollars. As mentioned, the government would save $500 billion in administrative costs if a single-payer healthcare system were to be adopted. The losses that would be incurred as a result of job instability or losses are negligible when compared to the amount of money that would be saved and the improvements in public health that would be achieved. The single-payer system has been successful in many nations, including Canada, Norway, Sweden, and Taiwan.
Conclusion
The current healthcare system is characterized by dependence on employer-based, for-profit health insurance that has left millions of Americans without coverage. Although Obamacare was implemented to mitigate the problem, the premiums are still high, and more than 30 million individuals lack access to quality medical care. The prevalence of expensive and unequal insurance plans has resulted in numerous negative outcomes that include bankruptcies, death, and an increase in cases of preventable diseases. In that regard, America should switch to universal single-payer healthcare because it will stop medical bankruptcies, guarantee better and more affordable care to everyone, and improve the overall health of the entire nation. A single-payer system would enhance the health of everyone because people would seek medical care early enough before diseases progress to more critical stages. People who lack insurance are less productive because they suffer more from injuries and report higher cases of illnesses than people with insurance coverage. The possibility of having a wider choice of doctors would ensure continuity of care in case an individual changes employers or careers.
The Trump government has worked tirelessly to repeal the ACA and reintroduce capped insurance. This move has elicited heated debates because even though the ACA does not provide the best form of insurance, repealing it without a better option is detrimental to the health care system. The COVID-19 pandemic has led to massive loss of jobs and insurance among Americans. If the government does not implement mitigation measures, the situation will worsen. This is the most opportune moment for the US to take a step forward and provide single-payer health insurance that will cater to the needs of all citizens. The lack of universal health care in America is acceptable because an illness should not an individual to file for bankruptcy. A government-sponsored system would encourage the reduction of wasteful administrative costs, promote public health, and increase access to quality medical care. The current system is ineffective. Therefore, a shift toward a system that would increase access and reduce health care costs is a move in the positive direction.
References
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