What is Universal Health Care, and why doesn’t America already have it?
The United States health care system is made up of > 60% employment-based private insurance, Medicare, Medicaid, and the Veterans Administration system. Our health care costs twice that of other developed countries while leaving many uninsured. Universal Health Care is a catch-all term which describes how many other developed countries cover all their residents through a variety of approaches. There are three types of universal health care: single payer, mandatory insurance, and national health insurance. High-income nations besides the U.S. manage to insure all their residents through a regulated system of health plans, while others have a single public plan for everyone. These countries do differ in how health care is financed. They all use a combination of taxes, premium contributions, and cost-sharing. Surprisingly, all plans feature some amount of private insurance.
In the Netherlands and Switzerland, universal coverage is achieved through a system of competing health plans. These systems resemble the marketplaces offered by the Affordable Care Act (ACA). Employers share insurance cost in the Netherlands, while in Switzerland, residents pay 100% of health plan costs. 40% of the Dutch receive tax subsidies to purchase insurance similar to that offered by the ACA. Out of pocket costs vary among these plans. (Read more at https://www.commonweathfund.org/blog/2019/universal-health-coverage-eight-countries)
Great Britain, Canada and Norway utilize single payer plans funded through either local, regional, or national taxes. Interestingly, in all countries with universal coverage, some part of the population has secondary health insurance which may cover uninsured services such as dental, vision, physiotherapy, and elective care. Germany mandates residents either select coverage from among 110 nonprofit private insurers or choose private coverage.
Universal Health Care Comparison Chart (2018)
| Country | Type | % of GDP | Per Capita | Wait to see specialist 4+wks | Infant Mortality Rate (2017) |
| Australia | 2-tier | 9.6% | $4,798 | 22% | 3.0 |
| Canada | Single | 10.6% | $4,752 | 56.3% | 4.5 |
| France | 2-tier | 11.0% | $4,600 | 49.3% | 3.5 |
| Germany | Mandate | 11.3% | $5,550 | 11.9% | 3.0 |
| Singapore | 2-tier | 4.9% | $2,000 | 2.2 | |
| Switzerland | Mandate | 12.4% | $7,919 | 20.2% | 3.7 |
| United Kingdom | Single | 9.7% | $4,193 | 29.9% | 3.7 |
| United States | Private | 18.0% | $9,892 | 4.9% | 5.7 |
Why doesn’t the U.S. have universal health care? We do, for select residents. Medicare, Medicaid, and the Department of Veterans Affairs provide universal health care to specific populations. The demand for universal health care started post WWII when the World Health Organization declared health care to be a basic human right. In the U.S., health insurance has traditionally been tied to employment, which made sense when jobs were plentiful and health care costs were low. A fear of the country succumbing to socialism has been a recurring theme in the inability to pass universal health care legislation. https://qz.com/1805692/bernie-sanders-isnt-a-democratic-socialist-he-is-a-social-democrat/ Nearly 21% of Americans think socialism is a threat to the country. Trump has accused Democrats of pushing a socialist takeover of the health care system but has not offered his health plan. https://www.businessinsider.com/difference-between-socialist-and-democratic-socialist-2018-6
Universal health care was first proposed in the nineties. Obama proposed a Medicare for All plan in 2009. Both initiatives were defeated. Instead, the Affordable Care Act passed in 2010 which required mandatory health insurance, with exemptions. Trump’s tax plan removed the ACA mandate in 2019. Read more at https://www.thebalance.com/universal-health-care-4156211
For universal health care to work, everyone must pay premiums or additional taxes to cover the costs. Such a system under governmental regulation allows everyone to have access to quality treatment at low costs. The final installment of Health Care Reform will discuss the differences between Trump’s health care proposals and Biden’s plan.
