A Brief Argument for Universal Healthcare

The COVID pandemic has demonstrated the importance of healthcare in America. The US was ill prepared compared to other countries of similar size and wealth. 

The US has relatively few hospital beds and doctors per capita and was slow to begin mass testing. States were also forced to bid against one another and the federal government for vital supplies. No wonder it has experienced roughly 20 percent of global COVID deaths with only 4 percent of the world's population.

But even before the pandemic, the United States' healthcare system was failing.

As of 2018, the US spent nearly twice as much on healthcare as the average country in the Organisation for Economic Co-operation and Development (OECD), but had the lowest life expectancy. It also had the highest chronic disease rate, highest obesity numbers, lowest supply of available doctors, highest number of preventable hospitalizations, and highest number of preventable deaths.

The discrepancy between the US and other OECD countries can be largely ascribed to issues of access and quality. The US scores lowest among OECD countries in access to healthcare and healthcare quality-- both of which drive higher mortality rates.

One third of Americans in 2016 could not see a doctor or obtain necessary medicine because of personal cost. As of 2018, 27 million Americans have no healthcare at all-- making access to medical services prohibitively expensive. 

Why do other OECD countries have greater levels of access for lower cost? The answer, is that all other OECD countries have universal healthcare. Indeed, a systematic review of studies found that universal healthcare would save money and expand access in the US.

So why does the United States retain its neoliberal approach to healthcare? Conservatives make the argument that a universal healthcare system would increase wait times and rationing while destroying the overall quality of care. From the above data, we know the quality of care argument is simply not true: every rich country with a universal healthcare system has better quality of care than the US.

So what of wait times and rationing? 

The wait time argument is poorly constructed. A 2017 study by The Commonwealth Fund, found the US had longer wait times than several other countries with universal healthcare. While it is true there are also universal healthcare systems with longer wait times than in the US, these countries (with similar levels of wealth) still have better outcomes overall. Even within the US, publicly-run hospitals like those of the Veterans Association (VA) have "significantly shorter" wait-times than privately-run hospitals. 

The fact is, wait times are hugely variable within the US depending on one's socioeconomic status. Hence, we have fast healthcare for the upper class and slow healthcare for working-class Americans.

The rationing argument is similarly flawed. The United States is already rationing healthcare. Rather than rationing it by need, we ration it by ability to pay. Those arguing  that rationing would harm Americans ignore the 27 million without healthcare and the third of Americans who 'self-ration' by avoiding necessary medical care due to cost.

Some might say distributing goods through the market leads to the most efficient outcome. From a theoretical perspective they are right. Except when speaking about healthcare. 

If you wanted to buy a TV, you would evaluate the relative prices of a few options. You would weigh each option and find the 'equilibrium' between the most you would pay and the lowest price the firm would be willing to offer. There is a consensual transaction between rational actors. The TV and money are allocated efficiently. 

But you can always walk away. 

If the firm is charging above your equilibrium price, you can simply decide not to buy the TV or to buy it somewhere else. This ability to leave the exchange gives you power, as firms have to compete to keep you in the transaction.

Let me say this as emphatically as possible: you cannot walk away from a live-saving treatment. When you have to pay for medical expenses you have no bargaining power. This is called inelasticity in economic terms and it is what makes medical care different from TVs. 

Universal healthcare therefore, is not a radical idea. In fact, it is the most pragmatic and cost-effective of the available options. 

If we want to move from a system of exploitative pricing and rationing toward a system of equity and quality, we need to fundamentally change the way we allocate healthcare. 

We must guarantee universal health care coverage as a human right.