By Caroline Hsu
Although the United States is currently classified by the Human Development Index (HDI) as the 13th most developed nation on Earth, it still lacks one of the most fundamental human rights: a system for assuring that all of its residents are able to afford and receive healthcare. In fact, out of the HDI’s top 15 most developed nations, the United States is the only one that does not currently implement some sort of functioning universal healthcare system. The debate surrounding universal healthcare in the US is definitely nuanced, but ultimately, the argument for universal healthcare boils down to the notion that health is a basic human right.
This is by no means a new concept — the constitution of the World Health Organization, which was written in 1948, declared universal health coverage to be a fundamental human right. There are three crucial objectives to universal health coverage: first, that everyone receives health services, not just those who can pay for them; second, that these health services effectively improve the wellbeing of those who receive them; third, that receiving these health services does not negatively impact the financial situations of patients. In short, universal health coverage seeks to ensure that no one forgoes receiving necessary healthcare because they can’t afford it. Healthcare is a right, not a privilege.
Although universal health coverage, sometimes referred to as ‘Medicaid for All,’ might seem like a lofty goal, it is possible. According to the Organization for Economic Cooperation and Development, 18 countries have fully achieved universal health coverage, which means that 100% of their population is covered by adequate health insurance. Many other nations, including Austria, Japan, and Spain, have achieved near-universal health coverage, which means that over 98% of their population is covered by adequate health insurance. In comparison to these nations, the US is actually lagging behind — as of late 2017, less than 88% of Americans reported being covered by adequate health insurance. Although the United States prides itself on being one of the most developed and prosperous countries in the world, it cannot claim to be a frontrunner when it comes to ensuring the health of its populace.
Most Americans with health insurance are covered by employer-sponsored private coverage. Other Americans receive health insurance by qualifying for Medicare or Medicaid. Finally, a small percentage of Americans receive health insurance through the US military or Veterans Administration. However, this still leaves almost 30 million Americans who are not covered by any kind of health insurance.
For people who are just starting to research the arguments behind universal healthcare in the United States, trying to make sense of the different kinds of health insurance systems can be incredibly confusing. There are three major ways that countries can achieve the goal of universal health coverage: a single-payer system, a two-tier system, and an insurance mandate. Of the 32 nations that offer universal health coverage, 16 utilize a single-payer system, 9 utilize a two-tier system, and 7 utilize an insurance mandate.
In single-payer systems, the federal government is singlehandedly responsible for providing health insurance, which is funded by taxes. However, the actual healthcare services can either be government-run or contracted from private organizations. Nations with single-payer systems include the UK, Canada, and Norway. The US actually does have a modified single-payer healthcare system, Medicare, but not all US residents qualify for it. Most people who qualify for Medicare are retirees over the age of 65. However, you can also qualify for Medicare if you receive Social Security Disability Insurance or have been diagnosed with chronic kidney failure. If you don’t fall under any of these categories, then you cannot benefit from a single-payer health insurance system in the US.
In two-tier systems, a basic government health insurance plan is mandatory for all residents. This plan is funded using taxes and covers basic services, including hospital services and general practitioners. However, additional services that are not covered by the basic government health insurance plan are offered privately, and can be paid for out-of-pocket, or by purchasing a supplementary private insurance plan. That being said, the nuances of individual two-tier systems vary from country to country. Nations with two-tier health insurance systems include France, Australia, and Singapore.
Finally, insurance mandates require that all the residents of a country are covered by some form of health insurance, with the bare minimum policies covering hospitalizations and outpatient medical treatment. Nations with insurance mandates include Germany, South Korea, and Switzerland. The Affordable Care Act (ACA), also known as ObamaCare, is a form of insurance mandate, with the goal of ensuring that all American residents are covered by some kind of health insurance.
Many people are confused about what the ACA is actually supposed to do. One of the biggest ACA reforms is the establishment of public health insurance exchanges, which are like marketplaces that allow individuals and families to seek out and buy affordable and comprehensive health insurance plans. The ACA also provides increased government subsidies to help low and middle-income families afford health insurance. Additionally, it prohibits insurance companies from refusing service or charging higher rates to people with pre-existing conditions, making health insurance more affordable and accessible to all. The ACA also prohibits insurance companies from placing an annual or lifetime cap on how much money they’re willing to pay for an individual’s healthcare. Finally, the ACA requires all companies with at least 50 employees to offer affordable, comprehensive health insurance to all of their full-time employees.
Although the ACA has made considerable strides towards the goal of achieving universal health coverage for all Americans, it’s not a perfect system, and has faced considerable pushback, especially from Republican politicians. One of the ACA’s major flaws involves Medicaid, a program established in the 1980s to provide affordable healthcare for low-income Americans. When the ACA was first established, one of its main goals was to expand Medicaid to all 50 states in the hopes that more low-income individuals could gain access to affordable health insurance. However, in 2012, the Supreme Court declared the expansion of Medicaid unconstitutional, which means that individual states are still allowed to opt out of providing expanded Medicaid coverage to their residents. As of 2019, 37 states (including Washington DC) have adopted the ACA’s Medicaid expansion, but 14 states have chosen not to. This has created a coverage gap for low-income individuals in these 14 states, which means that about 2 million Americans still do not have affordable or accessible health coverage. Until all Americans, including those who live at or under the poverty line, are given access to affordable healthcare, we cannot claim to be a nation that values the fundamental human right of health.
In March of 2019, the Trump Administration announced that it wanted to overthrow the entire Affordable Care Act, nullifying advances in healthcare coverage for over 30 million Americans. To do this, the Trump Administration is banking on a lawsuit against the ACA, Texas v. Azar, which seeks to declare the entirety of the ACA unconstitutional. Legal scholars are divided on whether or not this lawsuit poses a serious threat to the ACA, so in the coming months, the Texas v. Azar suit is definitely something to keep your eye on if you’re interested in following the debate surrounding the ACA. To combat the Trump Administration, House Democrats recently introduced a bill to strengthen the Affordable Care Act. Provisions in this bill include increasing subsidies for low-income individuals, expanding federal assistance to include individuals at higher income levels, and fixing the ACA’s notorious “family glitch,” which currently makes it difficult for employed individuals to afford insurance plans that include their spouses and children. However, because of rampant partisanship in Congress, it’s still unclear whether this bill will make any ground.
Universal healthcare and ‘Medicaid for All’ has become the battleground of a fierce partisan debate, with Republicans and Democrats vying for political power by trying to repeal or strengthen the ACA. Although the debate swirling around universal health coverage and the ACA can be incredibly tense and confusing, it’s important to always keep in mind the core tenet of human rights that serves as the foundation of the argument for universal healthcare. Regardless of what form it ends up taking, access to quality healthcare is a fundamental human right, and every attempt to deny this healthcare is a degradation of the United States’ commitment to upholding human rights.