Improving the United States Health Care System

with Free Universal Health Care

By Amulya Bandari

Putting the issue into Perspective

According to a study done by the RAND corporation, a nonprofit global policy think tank, the

average American household can spend anywhere from 16 percent to 33.9 percent of their income on

health care.i To put that into perspective, Americans are spending roughly $5,000 per person per year

on health care, a $2,000 spike from a decade ago, according to an analysis done by big data company

Clever on the Bureau of Labor Statistics Consumer Expenditures Survey.ii Households with lower income,

tend to spend more of their income on healthcare. However, many tend to underestimate or neglect the

issue. Instead, Americans are forced to spend an immense amount of their income on healthcare.

People in the United States tend to regard this situation as the normal. They do not question why the

costs are so high, and rather comply to the status quo. If this continued, health care prices will continue

to skyrocket. Although the issue has been brought to light, especially do to the Covid-19 outbreak and

the current presidential election, it is important to find a concrete solution to the issue. It is important

for all Americans to have access to proper health care without having to worry about the costs, with

Free Universal Health Care.

What is Healthcare and Free Universal Healthcare?

 Healthcare is defined by the Oxford Dictionary as “the organized provision of medical care to

individuals or a community.”iii It might be a relatively simple definition; however, it encompasses many

subcategories. Medical care consists of both mental well-being as well as physical well-being. There are

different levels and aspects of health care. It encompasses simple medications and routine medical

checkups to complex state of the art medical procedures. It also includes mental health, skin care,

dental care, eye care and much more. These medications and procedures can cost individuals thousands

of dollars. Free Universal Healthcare is a healthcare system where all residence of a region free of

charge. That means that all doctor appointments, medications and procedures will be paid by the

government instead of individuals. This system has been adopted by countries all around the world,

however, the situation in the United States is a bit different.

Insurance in America

The United States operates with a different system. Due to the United States being a capitalistic

society, mostly everything is owned by the private sector. This means that individual corporations and

businesses oversee hospitals and other aspects of medical care, unlike countries that practice free

universal healthcare, where the government operates it. To compensate for this, insurance companies

were created, which reduce the burden of medical expenses. First, an individual pays a premium, which

is a monthly bill that various depending on person. Then, if a medical expense arises, such as a sudden

lifesaving surgery that could cost hundreds of thousands, the health insurance company will pay part of

the bill, reducing the burden. In countries with free universal health care, the companies that individuals

pay premiums for is the government. This could also come in the form of a tax. The funds from the

population are taken by the government and are given back to the people through free medical care.

This also gives countries the lowest possible price for certain medical necessities, since an entire country
is demanding lower prices compared to a small insurance company, which has relatively few people

underneath it. The United States on the other hand primarily relies on the private sector for health

insurance, leading to high costs in healthcare. During recent years, the healthcare system has shifted to

a hybrid system rather than a purely private system. This has been due to events and demands

throughout history.

History of Healthcare and Insurance in America

The notion of the government providing medical care for its people had been around for

centuries. In the United States, the first ever prepaid medical care plan was established in July 16 th, 1798

by President John Adams, which provided aid for sick and disabled seamen. It led to the creation of

many hospitals in Boston, Charleston and other ports.

The movement for free health really picked up during the mid 19 th and 20th century, due to a

number of events. Activist Dorthea Dix revolutionized the medical field. She fought for the proper

treatment of those with mental illness and part of her campaign was to have the government fund the

rehabilitation of the mentally ill.iv Her activism was the spark for the Progressive movement, which

revolutionized the healthcare system in America.

The early 20th century was marked with the Progressive movement, which fought against

problems caused by industrialization, urbanization and political corruption. The main goal of the

movement was for social reform and advancement for the people. This encompassed healthcare and

medical reform. The movement led to employers providing for insurance rather than all the burden be

on the workers. Throughout the great depression universal health care was proposed, however, the

federal government decided to allow third party insurance companies to take over.
 It was not until the 1960s and 70s that the healthcare system started to take shape into the

current system. With the rise in the elderly and uninsured led to increase in support for health care

reform. President Lyndon B. Johnson used the support built up to pass Medicare and Medicaid, which

provided aid for those over 65, those with certain disabilities and certain low-income groups. v This was a

huge step forward and a major accomplishment for those who supported free universal healthcare.

After that major stride, many ideas were brought to the table, especially during Clinton and

Bush’s presidency. However, none of them were passed. It was not until the Obama administration that

another major stride was taken. On March 23, 2010, President Barack Obama signed into effect The

Affordable Care Act, also known as Obama care, which is the largest healthcare reform act since

Medicare.vi This act increased the number of people insured by around 20 to 24 million, creating the

current healthcare system.vii

The Current System

All the reforms and policies stated above have created the current established health care

system. The United States uses a mixed system of private and public insurance. As of 2019, of the 330

million individuals living in the United States, the 59 million that are 65 or older fall under Medicare, so

they are insured. Of the 273 million that are under 65, 159 million have employer-based insurance, 84

million have some other form of coverage and 30 million people are still uninsured. More than 20

million people gained healthcare coverage after the Affirmative care act was passed, so the number of

uninsured went down to 30 million. To put this into perspective, the number of non-elderly uninsured

went from 17% in 2012 to 10.4% in 2018, so nearly 7% decrease in just six years. viii
Figure 1 This is the current distribution of health insurance coverage in the United States. There are still roughly 30 million
individuals uninsured, and the number will only continue to rise if things continue as they are. Credit to CBO gov
https://www.cbo.gov/publication/51385.

This is a major stride in the right direction, however, there are still more than 30 million people

who are completely uninsured. Furthermore, those who are insured still might not be able to afford

their costs even after insurance has covered them. This has led to many people fearing for the future

and some even skip necessary health screenings due to the cost. According a survey done by the Kaiser

Family Foundation (KFF), a health policy analytic group and journal, of those who have insurance, 24%

were worried about if they could afford their co-pay payments, 28% were worried about the cost per

month for health insurance and 34% were worried about the cost of deductibles.ix If these percentages

are applied to the whole United States population, of the 314 million Americans insured, at least 75

million are worried about costs.x

This high cost and lack of insurance can be detrimental to people. Due to high costs, some

individuals decide not to get certain treatments done or take certain medications. This often leads to

worsening symptoms and even death. According to a pole done by Gallup, 58 million people have been
unable to afford prescribed medication at least once in the past 12 months.xi This has become a

common theme, and some even decide to not undergo life saving treatments due to high costs.

Throughout the decades, health care costs have also been on the rise. Even though the United

States does not offer free universal health care, its health care expenditure per capita is higher than all

countries that offer free health care. The United States spent $10,586 per capita on health care

compared to Italy, which even though offers free universal healthcare, spent much less than the United

States at $3,428 per capita.xii With such high costs and increasing problems, there needs to be change.

Figure 2 This graph shows the rise in health care expenditure over the years. The costs continue to rise, even though the United
States does not offer Free Universal Health Care. A new system must be implemented to not only reduce costs, but also provide
better care. Credits to KFF https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-
nhe-trends_year-over-year-growth-in-health-services-spending-by-quarter-2010-2019.

Time For Action

With the increase in prices, the burden on the people of the United States has increased. Even

those with health insurance are struggling to deal with the costs of health care and worry about

affording basic medical necessities. If the situation continues like this, soon more people will suffer, and
more people will die to the lack of proper health care. Especially right now, the topic of health care has

taken the limelight, due to the Covid-19 epidemic taking the country by storm, which has left more than

1.8 million people infected and nearly 120,000 people dead. The number of infected and dead is only

speculated to increase as time goes on.xiii Many experts agree that the spread of Covid-19 would be

minimized and treatment would be more effectively administered if the United States had adopted a

Free Universal Health care system. It would also prevent future pandemics and epidemics from

becoming too severe. So, it is important, now more than ever, to give everyone access to proper health

care through free universal healthcare.

Implementation

Single Payer System

There are a multitude of methods to implement free universal healthcare. One option is through

the single payer system. This option eliminates privately owned services. Instead, all services are

government owned and operated. Physicians work under the government instead of private hospitals,

and hospitals are government owned. Insurance companies are also eliminated in this option, and all

medical care is free. Instead of individuals paying, the costs are paid for by the government with tax

revenue. This option would significantly reduce costs, since the government would have all the

purchasing power for medication, employment and other medical supplies. Basically, in this option all

third parties are replaced by the government.

One common argument against this system is that the cost for healthcare would increase

drastically, however, that is not the case. The shift to a one payer system would actually save money. It

is estimated that the if the United States shifts to a single payer system, it will save more than $150

billion dollars annually just in administrative costs.xiv Including all other factors and costs, the United
States could save nearly $500 billion annually. Many countries around the world have adopted this idea,

such as the United Kingdom, Spain and New Zealand. The United Kingdom is a prime example of the

effectiveness of the single payer system. The United Kingdom spends only 9.5% of its GDP on health

care, whereas the United States, which many expect would have lower costs since it does not offer free

universal health care, spends nearly double at 17.2% of GDP on health care.xv

Another major counter argument to this policy is that the quality of health care would decrease,

since the government would have to manage everything rather than individual specialized companies.

However, this has not been a huge problem in countries that have implemented this system. For

instance, In the United Kingdom, quality is consistent, and if one hospital is lacking, it is easy to transfer

a patient to a larger hospital. The government operating hospitals also removes many bureaucratic

hurdles, so hospitals can focus on their patients. The government also does not have to worry about

profits compared to privately owned hospitals. They system has been extremely effective, with

countries saving billions in health care costs.

Furthermore, this concept is not unknown territory for The United States. The United States

uses the single payer system for military personnel. Military personnel receive free treatment and have

designated military hospitals, with state-of-the-art procedures. Since this system is already implemented

for a portion of the population, it is not impossible to make it nationwide.

Figure 3 This is a graph that shows the GDP per capita spent on Health Care per country. Countries like Japan, Germany and the
United Kingdom, who all have Universal Health Care implemented, still have lower costs compared to the United States. If the
United States adopts a Free Universal Health Care System, costs can be reduced. Credits to Forbes
https://www.forbes.com/sites/niallmccarthy/2019/08/08/how-us-healthcare-spending-per-capita-compares-with-other-
countries-infographic/#480fac49575d.

Social Health Insurance System

Another way to implement universal health care in the United States is by implementing the

social health insurance system. In this system, it would be mandatory for individuals to have insurance,

which is obtained through an employer or the government. The taxes and revenue collected by the

insurance will then go into a government fund, which will then be distributed back into medical costs.

One major benefit of this system is that hospitals are still privately owned, and physicians still

work for privately owned hospitals. Individuals can receive care from any hospital in the country, and

they would receive affordable care since everyone has insurance. This would also make the transition to

this system much easier, since hospitals are still privately owned. In the single payer system, hospitals

are owned by the government, so in the United States, all hospitals would have to be purchased by the
government, which could take decades. This problem is eliminated with the social health insurance

system.

This system is also beneficial because the government can control insurance prices. Since the

government controls the insurance, it also controls rates and copays. This means that the government

could implement a progressive insurance rate. This means that those of lower incomes will pay less in

copays compared to those who can afford treatment, or the government could implement a standard

insurance rate. Furthermore, this system allows copays to be tailored to an individual. For instance, on

average a copay for a normal visit in Germany is on average $10 for the lower middle class, whereas in

the United States it can cost more than $100 for the same treatment.xvi

This system has also been implemented and has been gaining popularity in the United States.

Medicare is the United States’ implementation of the social health insurance system. Like previously

states, the government provides insurance for those who qualify. However due to the thousands of

loopholes, thousands of individuals have been left uninsured. Since the United States already has

implemented this system on part of the population, it will be easy to apply it to the entire country and

remove its loopholes. This has led to the rise in the Medicare-For-All movement, which popular

Democratic Presidential Candidate Bernie Sanders advocates for.

One common counter argument to this option is that the cost would outweigh the benefits,

however, just like the one payer system, the social health insurance system will also save money. It is

estimated that if Medicare-for-all in implemented, the United States would save 13% in national health-

care expenditure, which is equivalent to $450 billion annually and 68,000 lives would be saved

annually.xvii This system in not only beneficial, but highly feasible, since it has gained popularity, and the

idea is already partially being implemented.

Conclusion

As of now, the United States still does not offer Free Universal Healthcare, however, recent

legislative has been pushing the United States healthcare system to a free universal healthcare system.

Due to the Covid-19 pandemic, the government has offered free testing as well as significant reduction

in costs for treating Covid-19. This action is one of the most recent steps towards free universal

healthcare in the United States. As of now, more than 70% of Americans are in favor of universal

healthcare.xviii With the gaining popularity through politics and the Covid-19 pandemic showcasing the

importance of healthcare, the movement will continue to increase in popularity. Soon more steps will be

taken to reach a free universal health care system, and thousands of lives will be saved.

i
Carman, Katherine Grace, Jodi Liu, and Chapin White. “Accounting for the Burden and Redistribution of Health
Care Costs: Who Uses Care and Who Pays for It.” Wiley Online Library. John Wiley & Sons, Ltd, January 27, 2020.
https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13258
ii
Carman, Katherine Grace, Jodi Liu, and Chapin White. “Accounting for the Burden and Redistribution of Health
Care Costs: Who Uses Care and Who Pays for It.” Wiley Online Library. John Wiley & Sons, Ltd, January 27, 2020.
https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13258.
iii
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Dictionary at OxfordLearnersDictionaries.com. Accessed April 12, 2020.
https://www.oxfordlearnersdictionaries.com/us/definition/english/healthcare?q=health+care.
iv
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com.ezaccess.libraries.psu.edu/cqresearcher/document.php?id=cqr_ht_health_care_2019.
v
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vi
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vii
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viii
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ix
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Population.” The Henry J. Kaiser Family Foundation, February 10, 2020. https://www.kff.org/uninsured/issue-
brief/key-facts-about-the-uninsured-population/.
x
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xi
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https://news.gallup.com/poll/268094/millions-lost-someone-couldn-afford-treatment.aspx.
xii
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Forbes. Forbes Magazine, August 8, 2019. https://www.forbes.com/sites/niallmccarthy/2019/08/08/how-us-
healthcare-spending-per-capita-compares-with-other-countries-infographic/#480fac49575d.
xiii
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xiv
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Health Program. Accessed April 12, 2020. http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php.
xv
Galvani, Alison P, Alyssa S Parpia, Eric M Foster, Burton H Singer, and Meagan C Fitzpatrick. “Improving the
Prognosis of Health Care in the USA.” The Lancet. Elsevier, February 13, 2020.
https://www.sciencedirect.com/science/article/pii/S0140673619330193.
xvi
Underwood, Anne. “Health Care Abroad: Germany.” The New York Times. The New York Times, September 29,
2009. https://prescriptions.blogs.nytimes.com/2009/09/29/health-care-abroad-
germany/?_php=true&_type=blogs&_r=0.
xvii
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xviii
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