Why a Universal Basic Income (UBI) or Universal Social Security (USS) requires single-payor universal public healthcare.
January 14th 2013 Douglas Johnson experienced one of the worst days of anyone’s life. He received a diagnosis for cancer. Luckily (if there is ever a luckily with cancer) he had developed a form of cancer in his right eye called intraocular melanoma, and this specific form of cancer has a relatively good prognosis, and a futuristic, non-invasive treatment. His doctors recommend Transpupillary Thermotherapy (TTT), essentially burning the cancer with a thermal laser.
Douglas felt like he had simultaneously both lost and won the lottery.
Now let’s imagine that Douglas lives in a society with a Universal Basic Income or Universal Social Security — a system that replaces means-tested welfare programs like food stamps, housing support, and university grants, with a direct cash deposit to all citizens ages 16 and above. Like Social Security for the elderly, but for everyone.
Now we have to decide, should a society that adopts a UBI/USS, must it also have universal health insurance?
Let’s imagine that there is no public health insurance and 20% of people are uninsured, and Douglas is one of those uninsured people when his diagnosis comes down. Although Douglas receives ~$1,400 per month, the cost of his cancer treatment is in the hundreds of thousands of dollars. Even with the basic income, the same negative outcomes of lack of insurance would still plague him. He could go personally bankrupt, he might have avoided paying out of pocket for regular checkups which could have caught his cancer sooner, he might become a financial burden to his family leading to strains and risks to his children’s college fund, his wife’s work, their marriage, etc.
However, if Douglas’ society does have universally secured health insurance, then his care is covered and he and his wife and children avoid a financial shock. Douglas goes back to work. His children attend college. His wife stays at work.
Walking through Douglas’ example, it is clear that a UBI/USS cannot fulfill it’s promise of eliminating poverty if it isn’t partnered up with a form of universal health insurance.