Healthcare: Should It Be A Privilege Or A Right In Us

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A country where people would rather take an Uber to the hospital, as opposed to calling emergency services, signifies something severely wrong in the healthcare system. Studying in America has made me aware of not just political tensions within the country, but also structural problems, one of them being the healthcare system.It is one thing reading horror stories about medical care bills in the United States and another thing to be put in a position where you are reliant on the system. This paper will cover the notion of healthcare as a right, and why America needs to employ structural reforms to shift towards universal healthcare.

We must first understand what health and healthcare is before we can talk about the current system. The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being (Preamble to the Constitution of WHO…) whereas healthcare is defined by the Merriam-Webster dictionary as efforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals. When examining the question of healthcare as a human right, it is important to look at frameworks that support it as a right in the perspective of both philosophy and politics.

In fact, it is possible to derive philosophical support of healthcare through Thomas Hobbes in Leviathan. Within the Laws of Nature, Hobbes says that “A law of nature (lex naturalis) is a precept or general rule, found out by reason, by which a man is forbidden to do that which is destructive of his life or taketh away the means of preserving the same, and to omit that by which he thinketh it may be best preserved” (Hobbes 210), which implies there is inherent worth in the value of human life. In relation to Hobbes’ third law in particular, it’s important for “men [to] performe their covenants made: without which, covenants are in vain, and but empty words, and the right of all men to all things remaining, we are still in the condition of war” (Hobbes 214), which leads to the fact that there exists political evidence and covenants that America has signed that confer healthcare as a right, which means the government is bound to uphold it for the American society.

On a global political level, the Universal Declaration of Human Rights published by the United Nations, whose goal is to preserve international peace and security as well as social welfare and cooperation, under which healthcare falls, states that everyone has the right to a standard of living adequate for the health and well-being…including…medical care (Maruthappu, Mahiben, et al.). The International Covenant on Economic, Social and Cultural rights also states that it is the “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” in addition to: “the creation of conditions which would assure to all medical service”, and this was signed by America in 1977 (Maruthappu, Mahiben, et al.). On a more national level, President Roosevelt proposed a ‘Second Bill of Rights’ in 1943 that included the right to adequate medical care and the opportunity to achieve and enjoy good health (Maruthappu, Mahiben, et al.).

With establishing the frameworks that support healthcare as a right, we can now look at what the concept of universal healthcare actually is. The WHO defines universal health care, or universal health coverage, as all people receiving quality health services they require without having to be burdened by financial hardship. They [the WHO] go on to say that universal health care is a combination of two key elements, namely people’s usage of the health services they require and the economic consequences of doing so. As previously established, health care services should be considered a right and not a privilege and therefore, everybody should be able to access a range of health services from treatment to prevention to rehabilitation. This is not an exhaustive spectrum, but rather, the very basic premise of health services that should be accessible to individuals. The services must then be carried out by qualified individuals and set to a national standard. The second aspect of universal health care, relating to economic consequences, is that universal health care should negate the financial risk with seeking care. In fact, an academic study found that 66.5% of all personal bankruptcies were tied to medical issues, which is an estimated 530,000 families because of medical issues and bills (Konish 2019), which is actually detrimental to the overall economy of the country, which I will elaborate on further later in the paper. Subsidies should exist for the poor and vulnerable, as the current access to healthcare is a class barrier in the United States, but it is not enough to have subsidized healthcare for vulnerable groups alone, because there are multiple problems within the American healthcare system.

There are three main problems with healthcare in the United States, namely increasing health insurance premiums, the inefficiency in the Medicare and Medicaid systems and monopolies over the pharmaceutical industry. Let us first examine the problem with increasing health insurance premiums. One of the biggest problems with having multiple private healthcare insurance policies is that premiums are rising but the quality of the policies are falling. Between 2005 and 2015, premiums have increased 5% per year and single coverage deductibles have rising 67% between 2010 and 2015, growing faster than the average income (Long 2016). There are also problems with employer provided insurance plans, as coverage within these plans differ between wage levels. Companies with a high proportion of low-wage workers are less likely to provide health insurance to their workers, and small firms are less likely to provide health benefits. Among small firms (3-199 workers) in 2015, only 56 percent offered health coverage, compared to 98 percent of large firms (“Employer Health Benefits 2015 Annual Survey”). There also exists a racial disparity in insurance within minorities, with 7.6 percent of non-Hispanic Whites, 11.8 percent of Blacks, 9.3 percent of Asians, and 19.9 percent of people of Hispanic origin going uninsured in 2014 (Medalia and Smith, 2014). Women also pay a higher insurance premium compared to men, and from this alone, we can see that there exists a structural barrier in access to healthcare not only in class, but also in gender and race.

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Secondly, despite the existence of Medicare and Medicaid, the system is not one without flaws. Medicare is a system that provides health insurance to persons aged 65 and older or to those with disabilities without regards to income (“What’s Medicare?”). There lies two issues with this approach, the first one being that there is a rapidly aging population in America so the number of individuals who benefit from the system is rapidly increasing as well, which leads to the second problem. Medicare employs a “fee-for-service” model, which means the more services you use, the more you pay. Physicians and facilities are allowed to manipulate this system by doing anything that can be justified as beneficial for a patient, so costs rocket each time a health procedure is carried out, and individuals can be charged for say, three consultants being involved in their care on top of the procedures they are undergoing.

Medicaid, on the other hand, is a program that provides health coverage for low income Americans who fall into three general groups, namely families with children, elderly individuals and individuals with mental or physical disability (“Medicaid”). To qualify for Medicaid, one must be near or at the Federal poverty level, as long as other criteria such as age and overall health status. The problem with this system is that there are many Americans who live at slightly above Federal poverty levels and therefore do not gain access to the system and cannot afford private health insurance either, which is why when they seek treatment for illnesses, they often end up with debilitating costs that they cannot recover from, because they were close to being in the poverty level to begin with. Not to mention that because Medicaid is state administered, a family that falls below poverty levels in California might not meet the same qualifications in say, Utah, and will have to forfeit health insurance but cannot necessarily afford private health insurance due to high premiums.

Another flaw of the American healthcare system is that there exists a monopoly within the pharmaceutical industry, which is mostly due to public policy changes, that allows companies to exploit patients and charge premiums for necessary medication. In 1958, the Federal Trade Commission authored a report on the antibiotics industry in which it found that a handful of companies had cornered the market and kept prices high for tetracycline, a broadly useful antibiotic (“High Drug Prices & Monopoly.”). Though the FTC could never prove price-fixing in court, they forced the companies to license out tetracycline at a low price, mostly due to government policies in the 1960s encouraging competition by limiting the length of patent monopolies or forced drug companies to license their patents when they gained high market share (“High Drug Prices & Monopoly.”).

However, in the 1980s, America began moving away from policies that encouraged open competition, which led to 60 pharmaceutical companies merging into just 10 between 1995 and 2015 (“High Drug Prices & Monopoly.”). One such policy is the Bayh-Dole Act, which allowed non-profit institutions to claim patents on discoveries funded by government research, translating into more drugs and research tools being covered by patents today, which makes it difficult for small companies to break into the markets (“High Drug Prices & Monopoly.”). The best example is the market for insulin is the best example, with three American manufacturers of insulin, a key drug in treating diabetes, raised their prices by 168 percent, 169 percent, and 325 percent, respectively (“High Drug Prices & Monopoly.”). Between 2010 and 2015, for instance, nearly a quarter of all generic drugs saw at least one price increase of 100 percent or more, and some saw increases of 1,000 percent or more (“High Drug Prices & Monopoly.”). Because of this, Americans are facing the brunt by having to pay high healthcare costs with necessary medication such as insulin is being sold at a premium on top of already high insurance premiums.

The biggest argument against universal healthcare is that healthy people should not be made to pay for the healthcare costs incurred by those who are unhealthy, and that Medicare and Medicaid already incur high costs on the federal budget. The true issue is that the inefficiency of the system combined with the privatization of healthcare and big pharma monopolies on medication means that healthcare costs are higher than they have to be. The approach to this should be a structural change within the healthcare systems as well as the regulation of monopolies on the government. For structural change, there exists many countries with universal healthcare system that the United States can model themselves after. One of the best examples of healthcare systems is the National Health Service in the United Kingdom, which is a single-payer socialized healthcare system with the government paying 80% of costs through general taxes, which private insurance available for elective medical procedures, but the NHS is not the only option (Amadeo 2019). Singapore, for example, has a two-tier system and is one of the best healthcare models in the world. It is split one-third public spending and two-thirds of private spending, where the government manages hospitals that provide free to low-cost healthcare alongside regulations that control the overall cost of the entire healthcare system (Amadeo 2019). They also maintain a system of automatic deductions from their salary and employers, where a mandatory healthcare savings account collects 7% to 9.5% of their income, employers pay another 5% and earns interest, which helps pay for medical procedures, as opposed to employer purchased health insurance in the US (Amadeo 2019). In 2016, the US healthcare costs came in at 17.07% (“Current Health Expenditure (% of GDP)”)of the nation’s GDP, whereas the United Kingdom and Singapore, for comparison, came in at 9.76% (“Current Health Expenditure (% of GDP)”) and 4.47% (“Current Health Expenditure (% of GDP)”) respectively. The reason America pays almost double comes back to the fact that there exists a lack of regulation, in general and that medical expenditure will continue to rise under the Medicare system as the baby boomer generation age.

Should America move towards universal healthcare, the country would be looking at a gain in benefits, namely health benefits as well as economic benefits. It’s undeniable that a nation’s prosperity is tied to the wellbeing of its citizens. A study published in The Lancet found that higher health coverage leads to better access to necessary care, which in turn, meant more of the population sought out health care, which lead to improved population health. For example, in 1988, Brazil introduced extensive health reforms to increase coverage of health services. Prior to 1988, roughly 30 million  

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