A Prescription for the Future: Healthcare as an Investment for the Future Generations
Over the past decades, the healthcare industry has risen to become one of the largest industries in the United States. In 2020 alone, healthcare spending in the U.S. increased 9.7 percent with national healthcare expenditures rising to $4.1 trillion, accounting for 19.7% of Gross Domestic Product, GDP. Despite the rapid rise in a span of a year, healthcare spending is expected to continually increase in future years (“NHE Fact Sheet”). Accounting for such a large portion of the economy, healthcare’s emergence as a tense topic in politics is no surprise. Although the substantial growth of healthcare spending has become normalized due to the coronavirus, COVID-19, pandemic that took the world by storm, the pandemic also raised fundamental issues regarding the industry and the inequalities present in the current healthcare system. One particular issue is seen in the healthcare sector: the lack of access to healthcare within marginalized groups. While the definition of access to healthcare varies, this paper narrows the term “access” to mean the ability to obtain healthcare services. To increase access to healthcare, the implementation of adequate universal health coverage poses a means to diminish the cost barrier, decreasing the risk of poor health outcomes and mitigating the health disparities in a variety of different groups that can be seen today.
Healthcare should be interpreted as a right to all individuals and should not be perceived as a luxury good alone. But there is no doubt that universal healthcare is a divisive issue even within the healthcare sector. One contender opposing the prospect of universal healthcare is UCSF emergency medicine physician Dr. Lance Montauk. In one publication, Dr. Montauk references the Bill of Rights — or rather the absence of rights — concerning comprehensive healthcare. He depicts health insurance as a commodity due to the Bill of Rights’ not explicitly mentioning the “right” for accessing healthcare (Montauk). While Dr. Montauk’s perception is not necessarily incorrect, the Bill of Rights alone does not sufficiently present the idea of national rights. This can be seen in another key doctrine the U.S. Constitution, which mentions other rights that are to be secured by the government: “Life, Liberty, and the pursuit of Happiness” (“Const., Preamble”). Granted, the interpretation of these words varies between individuals, but access to healthcare correlates with health, and health status is viewed as a key predictor of happiness among adults. Medical conditions, regardless of severity, can contribute to debility. Without healthcare, individuals facing physical illness are challenged with maintaining or improving their quality of life. Instead, these individuals may become dependent on others and unable to partake in activities that once brought joy. As daily tasks become more difficult, so does the pursuit of happiness — depriving not one, but two of the three big rights listed in the Constitution.
Previous literature also supports this thought where health insurance, in association with appropriate uses of healthcare services, contributes to better health outcomes for adults. Health insurance allows financial barriers to be reduced, effectively increasing the likelihood of better health outcomes when people regularly utilize health services. Additionally, a study by Angner et al. demonstrated that there were no instances in which access to health insurance decreased one’s health outcome (Angner, et al.). Thus, creating a universal healthcare system would not physically harm or reduce the health of any individuals who choose to partake in utilizing the service. On the other hand, the contrapositive has also been demonstrated where a lack of healthcare attributed to diminished happiness in adults (Blanchflower). As a result, healthcare is not only a commodity but a duty of the government to ensure the inalienable rights of its citizens, even when its initial implementation presents additional costs.
There is no denying that providing healthcare to the millions of citizens in the U.S. would incur high initial costs, but the costs should be perceived as a financial investment for the future economy. The creation of universal healthcare functions as an investment because the effects will be more prominent in the future than at the time of implementation. From an economic perspective, productivity is viewed as a key component of economic growth. By improving access to healthcare through the means of universal healthcare, theoretically, citizens should be able to seek care with lesser financial constraints when faced with maladies or injuries that would otherwise inhibit productivity. Diminishing these health consequences would lead to a more productive population as healthier employees are less likely to miss work. Healthier workers also contribute to healthier families, meaning that employees may be less likely to miss work to care for ill family members as well, as viral transmissions within the workplace diminish (Center for Disease Control and Prevention). Though not identical, the Affordable Care Act (ACA) had similar goals in expanding healthcare accessibility to a sizeable population and demonstrated significant increases in health. One study demonstrated that increased insurance coverage through the expansion of the ACA “improved[…] timely care for 5 common surgical conditions.” The study also observed that people with Medicaid were more likely to obtain aid during earlier stages of the disease, increasing the likelihood of receiving optimal care after admission (Livingston, et al.). One of the five common surgical conditions included appendicitis. The cost of an appendectomy, the procedure to remove the appendix, has an upwards cost of $35,000, and approximately 280,000 procedures are performed a year. However, not only were Medicaid patients able to receive care, but the patients typically responded to their health issues in a timely fashion and were less likely to delay their care. Early detection can alleviate the millions of dollars that are spent on this one procedure alone. The resolution of such diseases allows individuals to return to their normal activities and return to previous, if not greater, levels of productivity, leading to higher incomes whilst saving costs on medical procedures. Considering the other high-priority, high-cost procedures performed in the medical field, the economic results will become more apparent with the introduction of national healthcare.
Admittedly, with a sizeable portion of the population being uninsured, incorporating universal healthcare may introduce a considerable amount of patients to the health industry. In 2019, 28.9 million nonelderly Americans were reported to be uninsured. Even with the ACA and Medicare, the uninsured rate continues to gradually increase since 2016 (Tolbert and Orgera). This also demonstrates that the ACA and Medicare are not equivalent to universal healthcare as there are groups that remain disproportionately uninsured. While it appears unlikely that every individual will make use of their insurance immediately after receiving it, it is reasonable to believe the volume of patients at specific periods, including flu season or a during a pandemic, will be sufficiently increased. No answers can be provided with certainty, but in preparation for such events, other policies or measurements may have to be used to counter the aforementioned implication. The concern for increased wait times that accompany the incorporation of universal healthcare is a valid concern and a possible outcome; however, universal healthcare may become an extraordinary public investment beyond these concerns in the foreseeable future.
In addition to responsive care, universal healthcare contributes to preventative measures, leading to an overall healthier populace. By reducing the cost barrier to access health services, people can partake in medical visits to sooner detect health problems. By detecting health issues earlier, universal healthcare demonstrates cost-effectiveness by decreasing future health expenditures. When considering health-preventative measures such as vaccinations, there are positive externalities that affect not only the vaccinated individuals but also the neighboring people, whether they are vaccinated or not. Prevention of chronic conditions can offer high savings due to the high-cost treatments for such conditions; one estimate suggests up to $45 billion per year in savings as a result of preventative interventions for chronic conditions (Yong, Saunders, and Olsen). So universal healthcare creates opportunities for more health-related positive externalities to take place while also potentially leading to savings for more chronic conditions. Though not all individuals are prone to chronic conditions, the U.S. populace as a whole becomes healthier, meaning that people in the labor force also experience increased productivity, giving rise to both a healthier and wealthier economy. And even disregarding the economic outcomes of early detection, deaths from health-related conditions would be holistically reduced.
Among people that are most affected by mortality are those of lower socioeconomic status (SES), and the creation of a universal healthcare system may help to ameliorate socioeconomic differences seen both in quality of health and health services. Mortality is a key indicator for assessing the health of a population. Whether contributed by or being a contributor to socioeconomic status, poor health and mortality are more prevalent in those of lower SES. In other words, although financial inequalities are present, health inequalities also exist within the country. In Canada, universal healthcare demonstrated a reduction in health inequalities for people of lower SES with lower rates of mortality (Veugelers). Unfortunately, in the U.S. healthcare system, patients may experience discrimination based on the type of insurance that they hold. Those who were uninsured or insured through public insurance were more likely to experience discrimination than those who were privately insured (Han, et al.). Here, the benefit of universal insurance can be seen; as universal healthcare provides access for all citizens, regardless of socioeconomic status, public health insurance may become widely accepted and no longer perceived as “inferior” insurance. With the implementation of universal healthcare, private healthcare options should still be available, allowing individuals to decide on an insurance plan that caters to their personal needs. Choice and competition within the insurance market can be preserved while people can be treated with dignity and respect once the notion of fair treatment becomes highlighted. But with the wide acceptance of public insurance, providers would be less likely to associate public insurance with lower SES, decreasing discrimination solely based on the insurance held by a patient.
Furthermore, universal health coverage helps to address racial inequalities that are seen in healthcare. In the context of COVID-19, essential workers are less likely to have insurance than non-essential workers, and Black essential workers are demonstrated to be less insured than white essential workers. With rises in medical costs — and debt by association — medical debt creates disproportionate concerns for Black families in the absence of insurance to assist in payment (Perry). If the debt is viewed as “negative income” and Black families are more likely to accrue medical debt than non-Black families, then the implementation of a universal health care system may help to reduce healthcare-related financial burdens for these families. Here, less medical debt means more disposable income for these families, and less medical debt may even contribute to an upwards movement in a family’s SES. Though this system alone can not alleviate the systemic inequalities, universal healthcare introduces a method for partially reducing race-based financial inequality for minority groups.
The high costs prevalent in the healthcare industry create barriers in terms of accessibility on top of the health disparities that can be seen today. Individuals from lower socioeconomic backgrounds or traditionally marginalized groups are most affected by these inequalities, but universal healthcare would be inclusive to all individuals, regardless of class, race, or gender. Yet universal healthcare is also a divisive issue that is often met with opposition. Concerns with universal healthcare are often financially motivated, but the issue is more than the costs; it is a way for the United States to become healthier, happier, and more suitable as a place that people can proudly call home. While advocates and policymakers need to carefully consider whether the transition is favorable, the fact that health inequalities remain widespread is a key issue to consider. Medicare and the ACA have helped to shrink certain disparities, but perhaps it is time for the remaining disparities need to be addressed. Embracing universal healthcare allows the nation to move forward as a unit, so let’s move forward together as one healthy body.
References
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