Universal Health Care Pros and Cons – Introduction
A health care insurance coverage allows a person to avail of medical care and treatment at a time when he or she needs need. Health care systems are included in government policies in order to improve the health of the people and prevent them from succumbing to diseases (Drouin). Thus, various combinations of fund sources, together with the delivery infrastructures, payment schemes, and health care providers must be considered in order to make the system effective. The end goal of a health program is to keep the people healthy and live a quality life, that ultimately leads to a productive country.
What is Universal Health Care
The system considered ideal by many governments and individuals is universal health care because at any time and from any health care provider a person can seek medical assistance. Everyone would have a good health status and quality of life in this way. It is managed by a single health care administrator rather than multiple health insurance companies (Lohman). All paper works will be handled by the administrator. While hospitals and physicians will be independent under this scheme, patients will be free to select the physician or health care facility to seek medical assistance. In addition, under universal health care, other services that Medicare does not cover may be used by the patient. It provides coverage of many medically necessary care services such as hospital care, mental health services, medical prescription, physician visits, home care and rehabilitation, and eye and dental care. (Field).
It would make people healthier and more productive to provide a holistic health care coverage. Therefore, this scheme is applied by many developed countries, such as Canada, Russia, Germany, Britain, and part of South America (Hu and Hsieh). The United States and South Africa are the only two industrialized nations with no universal health care system. (Lohman).
List of Health Care Systems in Selected Countries, Challenges and Costs
One important component in the implementation of a universal health plan is the source of funds which is the backbone of any health care plan (Drouin). The funds can come from the tax revenues collected (allocated for the health care system) and private health insurance schemes. It is quite difficult to implement a universal health plan because of the cost it would require (Rodriguez). Funding a universal health care system would be a challenge, as the money needed to manage and operate the scheme is enormous. The International Labor Organisation, with funding from various sources, encourages the implementation of universal health coverage for the effective delivery of services (Drouin). According to Lebow (2003 26, qtd. in Rodriguez), other developed countries provide all their citizens with coverage, but still spend less on healthcare than the US.
The United States has a complex health care system and is poorly rated compared to other developed countries (Rodriguez). Despite the trillions of money spent on health care (Tooker 2003, qtd. in Rodriguez 43), 40 million people are still without coverage (Rodriguez). In countries where universal health care is carried out, the government spends less money to cover all people because it can save money from high administrative costs in the US (Rodriguez). In the current US setup, with its billing system and more than 1,000 private-sector healthcare providers, it is not surprising that the costs would shoot up. (Rodriguez). The insurance premiums currently in the United States are very high (Some Advantages par. 5).
The U.S. government runs Medicare to provide coverage for people under the age of 65 with certain disabilities, those over the age of 65 and those with permanent renal failure. (Hogberg par. 6). It is financed through taxes and income, premium and out-of-pocket expenses (par. 7). If Medicare is made available to all, taxes will increase (par. 11). Since everyone will benefit, everyone must share the responsibility, according to Senator Ted Kennedy (Senator Ted Kennedy 2005, par. qtd. in par. 11).
Also Study: American Healthcare System Explained
Although the US struggles to adopt universal health care plan, its present economic condition would not allow it with its huge deficit and debts (Tulchinsky and Varavikova). At the local level, even New York is incapable of implementing a universal coverage (Some Advantages par. 1). The World Health Organization data reveals that only the US has been struggling to adopt the system out of the 29 developed countries (Shi, Singh, and Shi). Due to lack of health care service provided by this scheme, many Americans are deprived of medical and health care. The US system has not been updated for many years, thus, it is incapable of meeting the current situations encountered by patients and doctors (Edelman and Mandle).
Although many Americans avail of private insurance coverage, the financially incapable are left with no coverage, which leaves the country’s general health condition in a downward trend (Gupta). The US presently practices the “managed care” system wherein people avail a health care services that suit their capacity to pay. This leaves the poor and those living below the middle class status to be without a health care coverage,
The universal health care efficiency and benefits can be seen when the US health system and Canada’s are compared. For instance, despite the 15 percent (of GDP) spending of the US on health care, only 85 percent of the citizens are covered (Lohman). Canada, on the other hand, only spends 10 percent of its GDP for the same purpose but 100 percent of the people are covered. At a time when the US spending was 14 percent of GDP (1994), Germany was spending less than 10 percent of its GDP (Reinhardt). Although the covered individuals pay 50 percent higher, it is ranked 37th on overall performance and effectiveness by the World Trade Organization (WTO). More than 45 million citizens have not health care plan, while 50 million more are under-insured.
Implementing a universal health system would be confronted by challenges such as: non-partisan health coverage for everyone, ability to determine a formula for reducing drug wastes, abuse by both doctors and patients, and adopting a procedure that would protect patients from fraud (Hu and Hsieh).
Canada’s health care, called Medicare, provides universal coverage and free at the point of use (Irvine). Universal health coverage started in Canada in 1944 with Saskatchewan as the first. The federal government shared the funding with the provinces on a fifty-fifty sharing (WHO, 1996, qtd. in Irvine). All provinces were implementing universal hospital coverage in 1958 (Irvine). The federal government again offered a fifty-fifty sharing if the provinces give coverage that complies with four criteria: comprehensiveness, public administration, portability, and universality (Irvine). Kraker (2002, qtd. in Irvine) said that in 1971, all Canadian citizens had access to the basic health care services “regardless of employment, income, or health”.
Medicare is financed by public sources but operated by the private sector. The five characteristics of Canada’s system are: a) universal, b) portable, c) comprehensive, d) accessible and e) public administration (Irvine). The health insurance is controlled locally, gives autonomy to doctors, and allows the patients freedom of choice (Kraker 2002, qtd. in Irvine). The provincial governments are the main providers of health care (Irvine). The local governments also a) plan, evaluate and provide hospital care; b) negotiate the salaries of health care providers, and c) negotiate the fees for doctor’s services. With planning made on the local level, the insurance plans of each province differs from each other and extends to the most possible “medically necessary hospital and physician services,” and may even include optometry, dental services, chiropractic and prescription drug.
The simplicity of Germany’s health care is intentionally designed by the parliament, thus, making administration and regulation easy (Reinhardt). It also utilizes a top-down global budgeting during the Physician Payment Review Commission (PPRC) public deliberations. Its universal health scheme followed the trail of the voluntary mutual aid fund that had been in place for centuries (Gleick). However, when the universal health plan was introduced, it was accepted together with the effects, advantages and disadvantages of the voluntary mutual aid that was in place by then. Through the benefits achieved from the scheme, the German government decided to involve all the people to contribute to the scheme, which is better, and an improved version prevalent in developing countries.
Health bonds the people together, thus, the government places it high in the priority list (Reinhardt). All people, regardless of social class, use the same health care system. Around 90 percent of the population is supported by 1,000 independent and semi-private sickness funds, with only around 10 percent availing of the commercial insurance. Through the socialized payment scheme, premium is based on one’s ablity to pay.
The French Health Care system is ranked first by the World Health Organization (WHO) in 2000 (World Health Report 2000, qtd. in Rodwin). France, just like Germany and other countries in Europe, started with the introduction of a series of mutual aid funds which were later integrated into a universal health scheme that targets every citizen (Tulchinsky and Varavikova). France health care does not allow freedom of patient to choose, competition among insurance companies, and to contract between the funding sources and health care providers unlike Britain, Germany and the Netherlands (Rodwin). This is a big departure from the mutual aid and cooperation concept from which the health care system has evolved. The French National Health Insurance (NHI) is funded by payroll taxes, revenue funds, and consumer co-insurance. Unlike Medicare, NHI coverage increases when the patient’s costs also increase. When the patient is suffering from chronic or serious illness, he or she is exempted from paying co-insurance when his or her attending physician accepts reimbursement from NHI as payment in full. If the physician does not accept such reimbursement, the patient’s co-insurance will be reimbursed by a complementary health insurer. So, the presence of many co-insurances does not restrict the patients from enjoying various health care services equivalent to those offered in the US and other European countries.
The National Health Service (NHS) of United Kingdom is said to be the biggest health care funded system which provides most of the services in England, Wales, Scotland and Northern Ireland (United Kingdom). Although the systems in these areas are managed locally, the funds come from the centralized NHS which is about $2,950 annually for every citizen. UK allots 9.4 percent of the GDP for health care, with 82 percent of the funds coming from the general taxes and the rest from user fees and private insurance. The health care system is managed by the Department of Health through the 10 Strategic Health Advisories.
The NHS operates based on three criteria: comprehensiveness, equity and clinical need. No charges are required at the point of service except for specified prescription, dental services and eye care charges. Health care providers are hired by NHS, the fourth biggest employer worldwide. Majority of the physicians and nurses work for NHS, while most of the general practitioners (GPs), dentists and the rest of the self-employed health providers have a contract to render service with the NHS. Budgetary allocations of hospitals and doctors are based on the need and population of the area. Around 11 percent still avails of private insurance which is allowed in UK, but this tantamount to paying double for the same service. At present, the budget is already strained with the increase in demand, thus, the political pressure for increase in funding is applied on the government.
Pros of Universal Health Care
According to Hsiao, Shaw and Fraker, the scheme can provide equal medical services to all citizens regardless of the economic situation of the individuals. From the studies conducted on universal health plan, it was shown that it could provide the health care services to all members of the community, and the people in turn can access the needed health care services in time, which reduces the health risks people usually experience in a particular country. In turn, such affordable health care services will increase the productivity of the people (Gupta).
Physicians will benefit from this type of plan since their services will be fully compensated. They can also provide the same services to people with lower income. Patients on the other hand will have the option of consulting a doctor of their choice (Tulchinsky and Varavikova). This would assure that they could have the treatment needed and the services and medical equipment that would provide the cure to their illness. The elderly, children and disabled will also be covered.
Physicians will also have more time in treating the patients which would otherwise be used in attending to the different procedures of the various insurance companies, identifying each patient coverage, or splitting the payments from co-payors (Some Advantages par. 8). This would simplify the accounting procedure of the doctors since payments would only come from one source (par. 8). With a standardized system, all patients would be able to avail of the “same services, medications, and right to doctors not just the selective few who can afford it” (par. 9). The doctors can then accept any patient and provide the services needed by the latter (par. 9). Many patients who cannot afford to pay for health care and treatment such as surgery or preventive diagnosis would have their conditions worsened (par. 12). A universal health plan would avert this situation since the patient can immediately avail of health care services before the condition becomes worst, or even before it becomes more expensive to treat (par. 12).
A universal health plan is seen to be an ideal system. It would cost less, portable, effective and allows freedom to select the service (Lohman). Through portability of the plan, the coverage remains even if the worker transfers from one company to another, and at the time of the transfer, there is already an existing illness. The effectiveness of the system as reflected in Canada is the low mortality rate (35 percent lower than the US) among infants since the expectant mothers can go to the doctor for pre-natal care. The life expectancy of Canadians is longer by two years. The patient is not restricted in selecting which medical professional or hospital to consult or undergo treatment.
In the present setup, US companies choose the type of insurance coverage they would provide to employees as part of the benefits given to them (Some Advantages par. 5). Employers are provided with additional burden on what health coverage to provide, in addition to the other perks, such as trainings, vacation, etc. (par. 5). It is believed that one administering agency would definitely lower the costs of health care since competition is removed (par. 7). Duplicate claims and procedures imposed by many health plan providers would be eliminated, thus saving time and money in processing the claim (par. 7). High premium payment from the members will be replaced by funding from taxes (par. 7). Related costs would also decrease since purchasing the services will be done in bulk (par. 7).
Cons of Universal Health Care
Many people have no access to health services and they die without even seeing a doctor. For those who are covered by health insurance, they can avail of medical services depending on their level of income. Patients in the low-income group would find health insurance coverage as very expensive and unaffordable (Shi, Singh, and Shi).
A universal health care system is said to unfair for the contributors, especially the working class, since they are paying for the health services of people who have no share in the insurance pool (Tulchinsky and Varavikova). It would be unfair for a company to shoulder the health care expense of people who get sick due to an imbalanced diet or poor eating habits that leads to obesity, and unhealthy lifestyle such as smoking and alcohol addiction.
The universal health plan is made to answer for the health care expense of people who got sick due to smoking. Since it would provide coverage for all persons, it would constrain the budget of the government and may affect the allocations for education, defense, environmental programs and several others (Some Advantages par. 4). It would affect the competitiveness of the private insurance companies (par. 6). A monopoly is likely to occur if only one entity will handle the health care program (par. 6). Competition among the health insurers would ensure that they would be able to provide the best packages for the insured. Without competition, the administrator of the health care system will become lax that may affect the delivery and the type of services, and improvement in the products and services would cease (par. 6). It would also not cover all services, such as fertility treatment, mental health, drug rehabilitation, dentistry, among others (par. 11).
According to Rodriguez, health care should be regarded as a right; otherwise, the deaths of people resulting from lack of medical care due to insurance or financial problems would be blamed upon the government. This right is embodied in Article 25 of the Universal Declaration of Human Rights of the United Nations which states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including . . . medical care and necessary social services” (Universal Declaration of Human Rights 1948, qtd. in Rodriguez). The government then has the obligation to provide coverage for all citizens even for those without premium contribution and those unemployed. In the case of the unemployed, the coverage should be shouldered by the government as part of its social welfare obligation to its people. The government can defray the costs of such coverage from the taxes it collected from business firms and premium collected from working members of the health care system. However, in majority of the countries, their income from revenues would not be able to provide for such a holistic coverage since many of them are developing countries.
To implement a universal health plan, the government has to consider all the stakeholders in the program such as doctors, specialists, other health care providers; the administrative and operating costs, the insurers, health care facilities and institutions, and the current policies of the government (United Nations). But in reality, there are sectors in society that do not want such a system to be implemented on a societal level. For instance, the influential medical organization the American Medical Association (AMA) is opposing “most reform measures that would result in an equitable, affordable system for everyone” (McCanne 2004, qtd. in Rodriguez). This opposition has a big negative impact on its implementation although other sectors are in favor of such a scheme (Rodriguez). But on the individual level, there are many doctors in the US who support the move that the current funding system should be modified to maximize allocation of resources that primarily benefit the patients (McCanne 2004, qtd. in Rodriguez).
Implementing the universal health plan would benefit more the sectors of society which are not capable of paying for insurance coverage, the unemployed, low-income workers, the young and the elderly. They are the people who are mostly likely not to seek medical attention although suffering from illness since they have no means to pay for medical care. And if they have coverage but with low premium payment, they will queue in a long line or bear the long waiting period. If the illness is already in a terminal or critical stage, long waiting periods might result to the death of the patient.
Having a universal health plan then would avert such a condition since the patient, no matter what the condition in life, can avail of medical care as the need arises, anytime and anywhere. Since the condition in each country differ from each other, each country must study its own unique conditions so that the plan can be workable in their specific settings. There may be hindrances in its implementation, but the government must be proactive in finding solutions and pass laws that would remedy the situation. In the end, the government and the people, as well as business firms will benefit from such a scheme since people will become or remain healthy, productivity will increase, and the profits of companies and income of the government will likewise expand. To end, the health care system is dynamic, so the all the health risks factors must be considered and updated in order to provide the best health care coverage for the people, and the doctors and health institutions are fully compensated for their services and facilities (Tulchinsky and Varavikova).
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