Running head: FREE HEALTH CARE

Is Free Health Care Economically Justified?

Victoria Carlson, Kenneth Newball, Sletta Mata

HCA-306A Healthcare Economics

Gregory Hutzell

Warner Pacific College

October 13, 2018

Is Free Health Care Economically Justified?

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Introduction

We start our paper off talking about free healthcare. Followed by an examination of the

Canadian healthcare system, how it is funded and how it works. Costs of both the US healthcare

system as well as the Canadian healthcare system are covered and solutions for the US

healthcare system are presented.

Next we address the current healthcare policy and reform. In this section HillaryCare is

examined followed by the Affordable Care Act. Single payer systems are examined and two

recent states that tried to implement a single payer healthcare system are addressed.

We end our paper discussing implications for the future. The positive impact free

healthcare would have on the economy is addressed, as well as the possible negative outcomes of

implementing a single payer healthcare system. The priorities that would need to be in place for

a single payer system are also covered.

Issues With Healthcare

America has a problem with their healthcare system. They spend huge amounts of money

on healthcare and yet not everyone is covered. Even with the ACA being implemented people

still can not afford insurance, copays, or deductibles. Why can't America follow in the footsteps

of other industrialized countries and offer free healthcare for all?

Free healthcare isn't really free as citizens and businesses have to pay a healthcare tax to

fund the healthcare system. Some Americans claim its too expensive to implement free

healthcare in America. There isn't such thing as free health care. However, we can have universal

healthcare coverage paid for by taxes. Say we dropped the Medicare eligibility age to zero. There

would need to be about a 2% raise in the payroll tax. There are of course other ways to finance it.
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The estimates show that for 95–99% of Americans, they would actually save money compared to

what they pay for healthcare now (Sara Erickson publish July 5th 2017).

There are several reasons why it doesn't cost as much as people think is would. First of

all, the American healthcare system currently uses 31% of its resources on administrative costs

alone. That would be reduced a great deal if there wasn't a bunch of different insurance

companies all with different requirements and different benefits that doctors’ offices and

hospitals had to deal with. Second, employer paid for health insurance is currently tax exempt. It

is considered the largest tax expenditure in the US. Most of the money currently going to health

insurance would be rerouted by businesses to salaries or other taxable investments so that would

help with the cost. Third, 60% of health care is already paid for publicly. That is because the

elderly and poor are already covered by Medicare and Medicaid and they are the people who use

the most healthcare. We only need to pay for at most 40% more than we already do. It is likely

that we wouldn't even need to cover that much because people would undoubtedly purchase

private supplemental plans like seniors do now. Finally, the evidence shows that universal

healthcare coverage costs less than the healthcare system that the US currently has (Sara

Erickson publish July 5th 2017).

The US could choose a different system of universal coverage than Medicare for all but,

any system would be cheaper than what we pay now. The Swiss system uses private health

insurance and is what the ACA was based on. Canada uses Medicare for all and has private

facilities. The UK has a more socialized system of healthcare, but their general physicians are

private, not public. There are other variations in each of those countries.It doesn't matter what the

US chooses to do, it would be cheaper if everyone had health care coverage

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The Canadian health care system was built around the principle that all citizens will

receive all “medically necessary and hospital physician services” (Sarah Kliff publish July 1st

2012). To that end, each of Canada's 10 provinces and three territories finance and run a

statewide health insurance program. There is no cost-sharing for the health care services

guaranteed under federal law. While Canadians are guaranteed access to hospital and physician

services, it is up to each province to decide whether to cover supplementary benefits, like dental

care and drug coverage. About two-thirds of Canadians take out private, supplemental insurance

policies to cover these services. While Canada is traditionally thought of as a publicly financed

system, spending on these supplemental benefits means that 30% of health spending comes from

private sources. Nearly all Canadian spending on dental care came from non-government dollars,

60 percent covered by employer-sponsored plans and 35 percent paid out of pocket. Some

Canadian legislators have made pushes to increase the scope of Canada's public health plan, to

cover more services, but have so far proved unsuccessful. While Canada's health care system is

publicly financed, many providers are not government employees. Instead, doctors are usually

reimbursed by the government at a negotiated fee-for-service rate. The average primary care

doctor in Canada earns $125,000.(Sarah Kliff publish July 1st 2012)

In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which

puts it on the slightly higher end of Organization for Economic Co-operation and Development

(OECD) countries. This probably has a lot to do with the lower unit cost of healthcare in Canada.

A MRI that costs, on average, $1,200 in the United States comes in at $824 north of the border.

It also has to do with lower administrative costs. A 2010 Health Affairs study found that doctors

in Ontario, a Canadian province, spent $22,205 each year dealing with the single-payer agency,

compared to the $82,975 American doctors spend dealing with private insurance companies,
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Medicare and Medicaid. (Sarah Kliff publish July 1st 2012) The Canadian health care system has

high marks on outcomes in its regular look at international health care systems. Canada’s

survival rates for breast and colorectal cancer are among the highest in the OECD, the

international organization noted in its 2011 report. (Sarah Kliff publish July 1st 2012) Canada

also does well in primary care, preventing costly hospital admissions from chronic conditions

such as asthma and uncontrolled diabetes. Where Canada does not do well is on wait times,

which tend to be longer than in other countries, especially to see specialists or obtain an elective

surgery. A Commonwealth Fund survey in 2010 found that 59 percent of respondents reported

waiting more than four weeks for an appointment with a specialist, more than double the number

in the United States. Canada has recently started taking steps to address this: In 2005, it had each

province set evidence-based benchmarks for wait times for various procedures. "Provinces have

made considerable progress with efforts to manage and reduce wait times, and many now meet

wait-time benchmarks for at least 75 percent of patients," the Commonwealth Fund found in a

2010 report. "Generally, when available, trend data show waits for care are decreasing in the

areas of joint replacement, sight restoration, cardiac surgery, and diagnostic imaging scans"

(Sarah Kliff publish July 1st 2012). Canadians certainly view their health care system as crucial

to national identity: 85 percent say that eliminating the public plan would result in a fundamental

change to the nature of Canada.

Solutions for Healthcare

America has the highest spending on healthcare with the poorest quality of care and

rising uninsured rates. The ACA was implemented in 2010 with the goal of lowering healthcare

costs and increasing health insurance rates. Many people worried about the economic impact it
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would have. Many feared it would increase the costs of medical care. While healthcare costs

have increased over the years the increase of the insured has helped to buffer the overall costs of

healthcare.

Is there a way to provide free insurance for all while lowering the costs of healthcare?

Let’s take a look at Canada’s healthcare system. Canada’s healthcare system is publicly financed

which means the costs of healthcare are covered by the government but the care and delivery of

healthcare is private. Providers are not government employees and are reimbursed by a fee for

service system from the government (Kliff). Each citizen is insured and covered for medically

necessary care. There is flexibility among the provinces on how to cover supplemental services

such as dental care and prescription coverage. Many use either employer insurance or

supplemental insurance to cover supplemental services. Private healthcare spending for

supplemental services accounts for 30 percent of all healthcare spending. “Some Canadian

legislators have made pushes to increase the scope of Canada's public health plan, to cover more

services, but have so far proved unsuccessful” (Kliff). Canada is able to offer lower healthcare

costs than the United States. This has to do with the reduction of administrative costs. In

America administrative costs are high as there are many insurance policies and providers that are

being handled. Canada has high rates of survival from cancer as as well as high rates of

preventative care. Preventative care reduces the costs of hospital admissions and chronic or

uncontrolled diseases, which would raise healthcare prices.

A single payer healthcare system in America would not only provide healthcare for

everyone but it would also lower healthcare costs. “Under a single-payer system, all residents of

the U.S. would be covered for all medically necessary services, including doctor, hospital,

preventive, long-term care, mental health, reproductive health care, dental, vision, prescription
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drug and medical supply costs” (What is Single Payer). It would lower healthcare costs by

reducing administrative costs by going from multiple insurance companies to one. A single payer

system would eliminate premiums, copays, and deductibles, all of which are barriers to

healthcare for those who can't afford the costs. Patients would also be able to visit the doctor,

clinic, or hospital of their choice without restrictions from their insurance.

Switching to a single payer system may seem expensive in the beginning but it offers

many savings. Funding from current government programs could be used to cover the costs of a

single payer system. California has been considering a Medicare-for-all plan, its cost is $400

billion (Cooper). With that price being more than the state budget how could California cover the

cost? The state could use the $200 billion it spends on Medicare and Medicaid and the $100 -

$150 billion employers spend on healthcare to help cover the costs. That leaves $50 -$100 billion

to have to come up with (Cooper). Would it be possible for the state to come up with such a large

amount?

California is a big, rich state, with GDP of nearly $2.5 trillion. A price of $400 billion

represents about 15 percent of their total economic output — far higher than the

developed nation average, but actually 3 percentage points of GDP less than America as a

whole. (Cooper)

With a single payer system in place healthcare prices will drop as the government gains leverage

in pricing. It will also reduce the hundreds of billions of dollars spent on administrative costs.

This would give the state more money to work with as it implemented a single payer system.

A single payer healthcare system would reduce the financial strain many face as they are

buried under medical bills. We would no longer have to worry about pre-approvals or out of

network care. We would be able to seek care when we needed it not when we could afford it or
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risk having to pay thousands of dollars for a serious illness. Single payer systems are not the cure

all and have problems too. For example, Canada is faced with long wait times for care. However,

the financial gains it offers America and the freedom over one's healthcare is worth the switch.

A single payer healthcare system is not bad as you may think. It may seem expensive in

the beginning but overall the savings and coverage are worth extra tax dollars. With the

elimination of premiums, copays, and deductibles, it would boost the economy as people would

have more money to spend. The quality of care would increase, as mentioned above, Canada has

higher rates of cancer survival and lower infant mortality rates. The single payer system can be

set up in a way that best fits the needs of the citizens and private care can be made available to

those who choose to use it. Providers are paid the same so you would no longer have to worry

about being able to afford to see them. Single payer systems offers healthcare to everyone

regardless of their financial situation their healthcare would be covered. You may even be

surprised to find that we already have a single payer system in America. Medicare and medicaid

are single health payer systems, there is a difference though because they only cover specific

groups of people. Maybe one of the best things a single payer system has to offer is the ability to

lower healthcare costs by giveing the government leverage over pricing. Implementing single

payer healthcare may have its flaws but its pros far outweigh the cons.

Current Health Policy and Reform

The United States is the only industrialized country that does not provide equal

healthcare for all (Pros and Cons of Universal Health Care). In 1993 Hillary Clinton began

working on The Health Security Act of 1993. This was a bill aimed at lowering healthcare costs

and providing universal coverage. “The government would control the costs of doctor bills and

insurance premiums. Health insurance companies would compete to provide the best and lowest
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cost packages to companies and individuals” (Amadeo). People with pre-existing conditions

could not be denied insurance and all US citizens were required to have health insurance. All

employers were required to provide health insurance to their employees and could use HMO’s or

PPO’s. Those who were unemployed could purchase insurance through the regional health

alliances, state-based health insurance purchasing groups. “ The alliances would control costs by

setting the prices for health care providers based on a fee-per-service” (Amadeo). The

government would subsidize the costs for low-income people who purchased insurance. The

National Health Board was also part of The Health Security Act of 1993. It set a cap on total

health care spending for the nation and also regulated health insurance premiums, and set limits

on maximum annual out-of-pocket costs. The National Health Board set minimum health

coverage requirements and provided free preventative care. Even though The Health Security

Act of 1993 had good intentions for the healthcare of the United States it was never

implemented. Although the bill failed there was some good that came from it, Children's Health

Insurance Program or CHIP was implemented. CHIP is a program that provides subsidized

health insurance to children in families that exceed the income limits of Medicaid, and covers 8

million children (Amadeo). The Health Security Act of 1993 was also used as a building block

for the Patient Protection and Affordable Care Act of 2010.

The ACA was implemented in 2010 with the goal of lowering healthcare spending while

providing coverage to everyone. It is able to lower healthcare spending by insuring everyone

regardless of a pre-existing condition. The ACA also provides free preventative healthcare with

no copayments or deductibles. Insurance companies are no longer allowed to drop a person if

they become ill or made a mistake on their application, and can not limit lifetime coverage.

Parents can keep their children on their health insurance plan until they turn 26 years old. All of
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this helps to lower healthcare costs by having more healthy people paying premiums but not

using services. Preventative services also help to lower costs because it reducing the number of

people being treated for chronic conditions. The ACA offers subsidies or free healthcare through

Medicaid for those who cannot afford insurance. Those who have an income level that is 138

percent or less of the federal poverty level will qualify for Medicaid. Those who have an income

level under 400 percent of the poverty level will qualify for a subsidy that can be used every

month to lower premium rates or given each year with your annual tax rebates. Although the

ACA is not a single payer system that covers everyone, it is a step closer to insuring all by

requiring that everyone have insurance and making it easier to obtain insurance. The ACA also

expanded Medicaid which offers free insurance to those who qualify.

“In the U.S., Medicare and the Veterans Health Administration are examples of single-

payer systems. Medicaid is sometimes referred to as a single-payer system, but it's actually

jointly funded by the federal government and each state government. So although it's a form of

government-funded health coverage, the funding comes from two sources rather than one”

(Montgomery). Single payer systems provide free healthcare for everyone, are financed by taxes

and run by the government. Single payer systems are organized differently in different countries

to best meet their needs and desires for healthcare. “For example, in Canada, each province has a

government program to provide healthcare. The country or provinces do not own the healthcare

providers but instead have arrangements with them to provide care. In the UK, the system is

different where the government has national healthcare providers and runs the healthcare

providers” (Araujo). In many countries with single payer healthcare systems all residents are

covered. In the US with universal healthcare only 88 percent of residents are insured as of 2017.
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There are a number of proposed benefits to a single payer system. Currently, providers

must follow different procedures with each of many insurance companies to get paid,

creating an enormous amount of administrative work. Under a single payer system,

providers might reap significant savings from reduced administrative expenses, and be

able to focus more on delivering care. As with Medicare, a single payer system may also

give the state stronger leverage to negotiate lower rates for drugs, medical devices,

payments to providers and other expenses, resulting in lower overall costs. Additionally,

a single payer system provides universal access to health insurance, which eliminates the

problem of the uninsured. (Sanghavi,Bleiberg)

Implementing a single payer system eliminates uninsured residents of the country and reduces

healthcare costs by reducing the administrative costs associated with working with multiple

health insurance companies.

In Vermont a single payer system was signed into law. “In May 2011, Governor Pete

Shumlin of Vermont signed into law “An Act Relating To A Universal And Unified Health

System,” House Bill 202 (HB 202), establishing a single payer health care system beginning in

2017” (Sanghavi,Bleiberg). This bill established Green Mountain Care or GMC and was set for

vermont to have a single payer healthcare system by 2017. Once in place everyone in vermont

would be covered by GMC, and private insurance would no longer be sold in the state. Those

who had insurance through their employers would be able to keep that insurance and use GMC

as supplemental insurance for uncovered costs of the primary insurance. The bill was passed

without a clear funding plan and ultimately failed in December 2014. Pete Shumlin stated that

the “11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of

individuals’ income” would hurt the economy (Wheaton).

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After Vermonts failed attempt to implement single payer healthcare Colorado tried to

pass amendment 69 in 2016. Amendment 69 would have been a single payer healthcare system

called ColoradoCare.

ColoradoCare was proposed to alleviate what many see as a health care crisis in the state.

Only about half of Coloradans receive health insurance from their employers, leaving

those who don’t qualify for federal programs to fend for themselves or pay a tax penalty.

As a result, 7 percent of all Coloradans are uninsured — admittedly far fewer than before

the Affordable Care Act was passed — and a much larger number face deductibles so

high that an injury or serious illness could leave them bankrupt. (Ray)

Supporters of the amendment were largely outspent by opposers of the amendment and the

amendment was defeated. Supporters still have hope that there will one day be a single payer

system in the United States. They are hopeful that the defeat of the amendment has opened up

dialogue that will increase support for a single payer system in the future.

Implications For the Future

When determining if free health care or, universal healthcare is economically justified, it

is imperative to consider future implications. In 2016, healthcare spending accounted for

approximately 17.9 percent of our nation’s Gross Domestic Product, reaching $3.3 trillion or

$10,348 per person (cms.gov). How could this be impacted by implementation of free

healthcare?

These rising healthcare costs present a strong financial burden on low and middle-class

citizens. If rates continue to rise, as they likely will, more and more middle-class citizens will be

faced with tough choices when prioritizing needs such as saving for children’s education,

personal retirement and covering their own health costs. “Furthermore, employers have
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responded to higher health care costs by scaling back wage increases and by increasing

employees’ cost sharing” (Komisar, 2013). If employers are paying employees less to cover

health premiums, that is less money in the employee’s hands to spend in other parts of our

economy.

Simply considering that rising healthcare costs are impacting where money is spent,

leads me to believe that implementing a free healthcare system in our country would help

balance the economy by freeing up citizen spending. The future implications of not

implementing free healthcare could include healthcare holding all the cards when it comes to our

economy. With healthcare spending in 2016 accounting for 17.9 percent of all spending, a 4.3

percent increase (cms.gov), imagine what the percentage would be in 2116 or even as soon as

2026. Is it possible that the citizens here in the U.S. could be facing a future where most of their

spending is on healthcare? This is a troubling thought and if that were to happen, what would

happen to the rest of our economy? Would healthcare professions be the only option for careers

as healthcare would have the greatest demand? If so, how would one become educated to do so

with no room to budget for college next to one’s own high healthcare costs? The U.S. already

faces a shortage of medical professionals and with less money in the bank for education, the

shortage is likely not going away.

While these future implications of not implementing free healthcare may seem alarming,

there are negative implications of free healthcare implementation as well. Perhaps the biggest

and most negative impact is the potential increase in government debt. “Implementing a single

payer healthcare system causes an increase in taxes, as the system needs to be paid for. The

overall cost of the system can be draining on a country and cause large debts” (Pros and cons of

universal healthcare, 2018). Though this implication seems like a deal-breaker for free
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healthcare, this was the same concern of the implementation of the Affordable Care Act (ACA).

And, while the ACA is still not a popular system and remains a topic of controversy since its

implementation in 2010 by president Barack Obama, some reports beg to differ.

Although it is impossible to state with absolute certainty the full extent to which the

ACA’s reforms have contributed to the nation’s recovery from one of the worst economic

crises of recent decades, the news has been, on balance, positive. To date, there is no

evidence that the ACA has had a negative impact on economic growth or jobs or that its

reforms have undermined full-time employment—effects that the law’s opponents had

warned about. To the contrary, evidence indicates that the ACA has likely acted as an

economic stimulus, in part by freeing up private and public resources for investment in

jobs and production capacity. (Schoen, 2016)

Is it possible that the same could be true with a system of free healthcare? After the passage of

the ACA, there is “evidence that it is possible to secure affordable coverage for all citizens,

improve health outcomes, and slow cost growth—all to the benefit of families, businesses, and

the economy” (Shoen, 2016).

A free healthcare system, or universal healthcare, would mean U.S. citizens could find

much relief from the burden of healthcare costs. The result would be fewer bankruptcies, more

money for education, travel, real estate and other hobbies that will boost the economy with

increased spending in other areas.

Let us say that the U.S. has finally decided to implement free healthcare. “Universal

healthcare has a lot of rules and regulations that people have to follow, and there is going to be a

learning curve and probably trial and error, or even some technical difficulties, just like when

Obamacare first launched” (Pros and cons of universal healthcare, 2018). Furthermore, running
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the free healthcare system will require government cuts to compensate for the needs of the

system to prevent yearly increases in taxes because, free healthcare really is not free. The

government will need to generate funds to support the program.

Additionally, our government must be diligent in paying close attention to developing

and implementing policies to incentivize providers. Countries such as Colombia and Thailand

made the mistake of incentivizing curative hospital-based care and, this proved inefficient for the

system to provide high quality and preventative care. (healthysystemsglobal.org) It is also known

that in Canada, where universal health care exists, citizens are faced with long wait times to see

providers and specialists. A survey of specialists in Canada suggests that the average wait time

for a patient to receive necessary treatment was 21 weeks in 2017.

Overlooking the need to incentivize physicians is detrimental to the cause as it is likely

that a free healthcare system would lower the high salaries of physicians. If they are not

incentivized, we risk a higher shortage of providers in the future than we have currently.

Shortages in providers can and will equal longer wait times.

Research has repeatedly indicated that wait times for medically necessary treatment are

not benign inconveniences. Wait times can, and do, have serious consequences such as

increased pain, suffering, and mental anguish. In certain instances, they can also result in

poorer medical outcomes—transforming potentially reversible illnesses or injuries into

chronic, irreversible conditions, or even permanent disabilities. In many instances,

patients may also have to forgo their wages while they wait for treatment, resulting in an

economic cost to the individuals themselves and the economy in general. (Waiting your

turn, 2017)
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As the success of this program weighs heavy on the government, financial planning,

along with changes in laws, regulations and policies will have a critical role. These regulations

will need to be monitored closely and adjusted as needs, costs and demands fluctuate. Success of

these practices can return far more to our economy, health and well being than what it costs in

tax dollars.
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