The privatized system of healthcare within the United States, has left forty million (plus) people uninsured, and uncared for in times of sickness and distress; thus, a nationalized healthcare institution should replace the current private system. The arguments for and against national healthcare services vary on a number of specific issues regarding nationalization vs. privatization. It’s not just a question of economics or viability, but also morality. Do we have a moral obligation to provide healthcare as a right to all citizens, not just those who can afford it? While it is my understanding that we do have this moral and material obligation, the question of national healthcare needs to be addressed considering all viewpoints, so that a logical, rational, and moral solution may be determined.
The first issue of the question is a thorough assessment of the current healthcare situation in the United States. First and foremost, the statistical evidence of over forty million U.S. citizens living without any form of health coverage or benefit is in fact true; which accounts for mostly working class men and women and their children. We as a nation spend roughly 14% of it’s GDP on health care; yet we are the only industrialized nation without a serious, comprehensive health care institution to take care of the working people (Navarro). There is often times a misunderstanding that these people are unemployed, or welfare recipients. However, this assertion bears no validity whatsoever, considering these people get the benefit of government services such as Medicaid and Medicare.
Most of the people who do not have health insurance work for small businesses that simply cannot afford (or simply will not) provide health coverage for them. This creates a significant disparity in health coverage which ultimately results in 100,000 deaths per year due to lack of needed health care. The study done by Professors David Himmelstein and Steffie Woolhandler concluded that this statistic not only outweighs the number of people (in the United States) that die of AIDS, but it is also a scarce statistic that is rarely heard outside of closed medical circles (Navarro).
Unfortunately, this is not the extent of the problem by any means. For those of whom are fortunate enough to have health insurance, many of them are underinsured with inadequate coverage for their needs. This includes the recipients of welfare programs such as Medicaid and Medicare. Patients with inadequate insurance policies are forced to cut back on other necessary expenditures in order to meet the increasing costs of medical care, even if it means going hungry or cold. Amongst the elderly alone, it is estimated that 35% are forced to cut-back on food expenditures along simply to pay for medicine. 39% of terminally ill patients claim to have “moderate to severe” problems paying their medical bills.
The notion that the United States is predominantly middle-class has created a delusion that privatized healthcare actually works. This misconception has arrived at attempts to squander the real numbers of actual working Americans, those whom make up approximately 60% of the population. While the media and others like to portray the American population as one big “middle-class,” it’s a bit more complicated than that. Of course, on top you have the full upper-class; the bourgeoisie. These are the large business owners, the capitalists, and others. The next class down is what is known as the petite-bourgeoisie, or upper middle-class. This class includes smaller entrepreneurs and professional elites (lawyers and doctors). Below this tier lies the actual middle class, made mostly of self-employees, technical personnel, craftsmen, and artisans. The bottom is comprised of the largest class, and subsequently the one in which suffers the most from a lack of sufficient medical care, the proletariat (working class). It’s important to know these numbers because the class structure of modern American society plays a particular role in the inadequate distribution of medical care to those in the lower echelons of society (Navarro).
It’s the working class that suffers the most from the private sector health coverage. When a member of the working class gets fired, he finds himself uninsured until he can find another job, and that’s assuming he will get one that covers his insurance. This is a highly dependent factor as well: not all jobs offer comprehensive health coverage. With the passing of the Taft-Hartley Act, workers have been forced to depend on receiving coverage through the laborious processes of collective bargaining (Navarro). This only benefits those workers whom are in a union, and can utilize collective bargaining for health insurance. What about those who have no union? The fact remains, the number of American workers actually in unions has decreased steadily since the 1950’s. So not only are we seeing less and less union membership, but also more jobs where workers have no choice of representation and have no say in matters regarding their benefits or health coverage.
Another weak point to the privatized healthcare argument is the maldistribution of resources. The areas and persons with the greatest needs for health care are not the areas and persons with the greatest access to care. Hospitals, nursing homes, clinics, doctors, dentists, and other health care professionals disproportionately locate in well-to-do urban and suburban areas because the highest income can be generated there. The residents of these areas have better access to care than do the poor in rural and urban areas. This phenomenon is particularly true for access to specialized institutions and personnel, but it is also true for general practioners and basic care institutions as well.
This maldistribution of resources continues to play a significant role in the shorter-life expectance of poor working class individuals compared to their upper-class counterparts. It has severely affected the African-American working class more so than anyone else. Statistically, the infant and maternal mortality rates are nearly twice those of whites and comparable to many countries in the Third World. The average life expectancy of an African American is still seven years lower than for a white American. This inequity in distribution has resulted in one third of Hispanics rendered uninsured, and one-quarter of African Americans; while compared to the 13% of whites whom are uninsured (Cochran et. al. 243).
Worse yet, 16% of African Americans and 10% of Hispanics rely on emergency rooms for their primary care, compared to 5% of whites. Poor children tend to be inadequately immunized and suffer more than other children from chronic and acute conditions, such as visual problems, low-hemoglobin counts, elevated blood lead levels, severe dental problems, and pneumonia (amongst others). Other disparities amongst the poor include the higher rates of mental illness; thousands of communities that have no health care professionals at all. The fact that half of all hospital closures since 1983 have been in poor rural areas, and one-quarter of all current existing rural hospitals are in danger of closing(Cochran et. al 245).
The high cost of medical care has been a constant since the 1940’s. Aggregate and per capita costs in terms of national health expenditures have significantly increased from roughly 4% of the GDP in 1940; to approximately 14% of the current GDP (Cochran et. al. 244).
The rate of health care inflation continues to remain well above the rate of inflation in the economy in general, and the only slowdown represented by the rising number of uninsured going without health care. Key aspects that can be blamed on private ownership have represented a continuously growing uncertainty regarding the future of privatized health care. The growth in costs continue to remain unexplained, while pharmaceutical and health insurance companies have recorded record-setting profits for the last several fiscal quarters (Tucker 699).
The United States government has attempted to respond to the growing discontent with private health insurance through a series of programs, most notably Medicare and Medicaid. These programs have seen marginal success in addressing some of the inherent problems, they have utterly and ultimately failed to create any real substantial benefit for those whom are in need their services (Cochran et. al. 256). The largest problem facing Medicaid and Medicare is the decentralized manner in which they are operated. Because administration of these programs is so loose, states have been able to manipulate stipulations for which applicants may or may not meet a new standard of qualifications in order to receive Medicaid/Medicare benefits. Medicaid/Medicare are short-term solutions to a long-standing problem, the disparities cannot be fixed by mere reformism (Tucker 704).
The contradictions that exists between competing interests of private and public sectors of the economy represent the inherent question of what direction an economy must undertake, and answers to the predominant economic questions of what governs the economy: the ‘invisible hand of the market’ or the government. In a national healthcare institution, marked by government ownership of the healthcare industry, prices remain fixed; resources are no longer implemented to the notion of generating the highest profit, but rather, the achievement of equitable distribution of income. Government ownership of capital and other resources prevents a few individuals or groups from acquiring a disproportionate share of the nation’s wealth. If the questions of production and distribution of medical supplies and services were dictated by centralized planners, rapid growth and technological advancements go towards the welfare of all citizens, not just those who can afford it. A healthcare industry that operates under public interest rather than profit motive will meet the demands and needs of the people without disparity (Tucker 722).
Proponents of privatized medical care often cite arguments that try to negate the severity of being uninsured. One argument for privatized health care states that many of the uninsured are simply made up of a temporary bracket; mostly those between jobs or students making their way into the workforce. Statistical evidence has shown that a number of uninsured remains so only for about 6 months or less; while only 15% remain uninsured for a prolonged amount of time (two years or over). These statistics, when spun into subjective context, equate to only 5.5 million individuals who would constitute a chronic uninsured population (Stelzer).
Another argument against the nationalization of healthcare is based upon the grounds that ‘supposedly’ anybody can receive medical attention in this country. 88% of the hospitals in the United States are nonprofit, thus they cannot legally turn anybody away who is in need of medical care (Stelzer). This doesn’t mean only for the duration of the emergency either, in fact, the hospital must provide care until treatment is complete. This is a ‘straw man’ argument that is highly dependent on the reasonable availability of hospitals in poor/working class communities-a variable which was addressed above.
For the 5.5 million (chronic uninsured) a number of them are not forced into such a position, and 40% of this group amass an income of $20,000 or more (can this cover medical costs?); while 10% reported an income greater than $50,000 per year. So what do these numbers mean; well, they refute the financial disparity of those uninsured individuals. This distorts the perception that all those whom are uninsured are in fact in need of government assistance. Further studies show that only 29% of the uninsured are below the poverty line, and that this group in particular willingly spends more money on entertainment, tobacco products, and other ‘luxury’ goods than on medical care. Finally, in dealing with the demographics of the uninsured statistics, 37% are under the age of 25-an age group that is typically known to be healthy, and less prone to disease than other age groups (Stelzer).
Critics of national healthcare often cite excessive costs and limited resources for unlimited needs as a means of countering the argument for a nationalized health care system. It is erroneous to believe that a nation can provide equitable care of all citizens; but rather, it is a much more feasible solution to provide some care for all, and the best care for a few (Lamm 8). This argument rests on the belief that there isn’t going to be enough resources to provide services for all, therefore those with the most wealth should be able to expect the best health care provided.
The skeptics of national health care question whether or not the provision of medical care to all citizens (whether equitable or not) is not a question of rights, but rather of charity. The notion of what constitutes a right is an abstract argument with no grounds in empirical data, but rather a societal and cultural priority of values. Proponents of privatized health care see the issue of health care as a human right as an exhaustion of what actually constitutes as a ‘right.’ What exactly does this mean? The ambiguities of such arguments don’t necessarily constitute a meaningful and convincing policy debate (Lamm 11).
Perhaps the most pertinent argument against a nationalized health care system is the apparent problems and fears that people tend to have towards the system in general. Prohibitive fears of insufficient funding of nationalized health, waiting in excessive lines, shortages, and other problematic attributions to nationalized health have stalled many from initiating such policies. While the U.S. spends nearly 14% of its GDP on health care expenditures, it also is home to some of the most advanced medical technological advancements in the world (Lamm 11). Many of these advancements have been spurred by private investment through corporations that have yielded much of the technology we use in to save millions of lives every year.
Another line of criticism of national healthcare states that we should look to reform, not completely altering the system. Reform plans such as health insurance purchasing cooperatives have been laid out to help control a structured competition in which the market would be able to still drive itself, while making it possible for small employers to pool their employees together into larger groups for more purchasing power and lower rates. These initiatives have been exceedingly popular amongst investors and particularly those who are against the issuing of government subsidies to small businesses.
Other proposals that look to simply reform the current system also include a notion quite popular with economic conservatives; health insurance vouchers. This alternative relies more on relatively unregulated markets that would propose using the income tax system to provide health insurance vouchers in the form of refundable tax credits or tax deductions to low-income persons who purchase health insurance policies. The system of private health insurance companies would remain in place, employers would not be required to provide or purchase insurance for workers, but rather join voluntary health insurance purchasing cooperatives (HIPCs) if they choose (Cochran et. al. 272).
Through our assessment of the solutions to the problems facing the current health care system in America, I am a staunch supporter of a strictly centralized national health care system. On the side of nationalized health care, there are yet more distinctions to be made amongst public health coverage. For instance, there is a notion of the single-payer plan. The single-payer plan basically equates to the liberal solution of the health care problem. The single-payer plan would restructure the system in such a way that health insurance would be provided publicly to every person as a right of citizenship. Health providers would still be private; government would not take over private hospitals or physician practices. However, such a plan would eliminate all private insurance, as well as Medicaid, in favor of a national or state-administered single health insurance programs.
My solution for the national health care question is that of which addresses the inequity in the distribution of services and wealth; thus equating to equal distribution of the same health care for all citizens. In the realm of efficiency, it is of the utmost concern that government operates on public interest to meet the demands and needs in terms of medical treatment and supplies. The backlash that has resulted from private medical coverage is that of an entire class of individuals whom cannot afford to take care of themselves. The degree to which a person feels secure in their health care is a fundamental concern that we all must go through. It affects our job, income, education, and sense of worth. Therefore, to distribute health care unequally on the basis of income is to commit a grave injustice. All must have an equal right to the most extensive health services available. It would be wrong to allow the wealthy to extend their lives by buying access to superior medical treatment at the cost of working class citizens.
One of the concerns with this proposal regards the provision of equal access to the most expensive services available would drive up the demand for them, imposing an enormous burden on society. However, these tentative concerns can be addressed through governmental initiatives that can simply negate supply and demand economic theories. Through a nationalized commanded health program, in which market incentives (capital, profit) can be simply ignored, and supply and demand can be manipulated in a manner in which health costs become too prohibitive for the working class (majority) to afford. If the production goals of medical supplies are directly related to the theoretical production limits, an accurate quota for the production of medical supplies will meet their essential demand in the public.
By nationalizing the pharmaceutical industry, governments would no longer have to subsidize private interests, but rather dictate them itself. A centralized economy could potentially establish medical supplies at or below equilibrium. For example, planners would set the price for aspirin below the market-determined equilibrium price of $5. At the set price, speculation predicts that this new below-equilibrium price will drive up demand for aspirin. When this is not taken into consideration by the planners, there will ultimately be a shortage in aspirin. However, using statistical data and consumption records, we can make a logical estimate as to what level production of aspirin could be made so that shortages do not occur; while completely meeting the set demands of the public (for aspirin).
In conclusion, the privatized system of healthcare has acted as a wrecking ball that has devastated the working class of this country for long enough. It’s time for serious considerations into what can be done not to salvage the current system, but to completely overturn it, and in its place resurrect a system of equitable treatment of all citizens on the basis of health care. The problems that exist are not only that of the uninsured, but the underinsured as well, as they continue to face exceedingly high medical costs that equate to higher profits for private insurance and pharmaceutical companies. The failure of the government’s attempts to address the maldistribution problem has only solidified the solution in the form of nationalized healthcare. The only viable solution to the rising problems facing the current system is nationalization and an end to health care disparity.
Cochran, Clarke E., Mayer, Lawrence C., Carr, T.R., and Cayer, N. Joseph. American Public Policy. United States: Wadsworth/Thomson, 2003.
Lamm, Richard D. “Health Care is Not a Human Right.” Human Rights 25 (2003): 8-11.
Navarro, Vicente. “America’s Class Structure Has Created an Unfair Health Care System.” Medical Ethics. September 2003. Opposing Viewpoints Resource Center. Broome Community Coll. Lib., Binghamton, NY. 20 November 2005 http://webster.sunybroome.edu:2104/servlet/OVRC?vrsn=228&slb=SU&locID=sunybroome&srchtp=basic&c=3&ste=17&tbst=ts_basic&tab=1&txb=%2522Medical+Care%2522&docNum=X3010053233&fail=8192&bConts=8319
Stelzer, Irwin M. “America’s Health Care System is Not in Crisis.” Health and Fitness Journal. February 1996. Opposing Viewpoint Resource Center. Broome Community Coll. Lib., Binghamton, NY. 20 November 2005 http://webster.sunybroome.edu:2104/servlet/OVRC?vrsn=228&slb=SU&locID=sunybroome&srchtp=basic&c=5&ste=17&tbst=ts_basic&tab=1&txb=%2522Medical+Care%2522&docNum=X3010141224&fail=8192&bConts=8319#SourceCitation.
Tucker, Irvin. Economics for Today. United States: South-western/Thomson, 2003.