Written by: Soh Iwin (20-E5)
Designed by: Poh En Xi (20-E3)
Healthcare Reform in the United States
The 25th Article of the Universal Declaration of Human Rights states that “Everyone has the right to a standard of living adequate for the health and well-being of himself … [and this] includ[es] medical care.” While healthcare is deemed as an essential human right by the United Nations, some people are still deprived of it. This is especially so in the United States, where some inequitably lack healthcare access due to their skin colour or income level. Why is this so, and what can be done to ameliorate America’s healthcare system?
What’s wrong with the United States’ Healthcare System?
Over the years, healthcare in the United States has been largely reliant on free market forces. In simple words, the price of healthcare and its insurance lies in the hands of the producers and consumers, who affect the demand and supply of healthcare. Ask any Economics student and they would chime in with ecstasy on the devastating effects of utilising the free market approach – market failure. This entails exorbitant prices for healthcare insurance, leaving many who are unable to afford healthcare insurance uninsured.
Another issue with the current healthcare system is the skyrocketing government expenditure invested. For one, in 2017, the United States devoted 17.1% of its GDP to healthcare, while Germany and the United Kingdom only spent 11.2% and 9.6% respectively. What’s more, racial discrimination in healthcare is still apparent. Such abhorrence is evident in how 13.6% of blacks are uninsured in 2019 compared to the 9.8% of whites.
Consequently, the government intervened through various schemes, of which two will be discussed in further detail below.
Measure #1: Single Payer System
Dubbed as the “Medicare-for-all” Act, a Single Payer System ensures universal healthcare coverage, where healthcare services are funded by governmental expenditure. This makes healthcare affordable, as the government can set lower prices for medical practitioners to charge for health services. Consequently, the number of Americans having access to healthcare services increases, increasing the demand for healthcare services while bolstering national economic growth.
While the merits of a Single Payer System appear promising, there are cons as well. This includes the lower quality of healthcare, such as longer waiting times for treatment, which potentially affects the critically ill in dire need of healthcare support, and the lack of diversity in the types of healthcare services offered. For instance, sex reassignment surgeries or cosmetic procedures are prohibited under this system. Another bleak con is the higher government expenditure, which may translate to surging taxes that are proportional to a citizen’s income, depending on the government’s decision. While equitable on the surface, this unfairly burdens the middle class citizens who may not be wealthy enough to sustain their lives or purchase health insurance.
In essence, a Single Payer System advocates for an egalitarian society by endorsing healthcare as a human right with universal coverage. However, the hefty nature of this system makes its economic sustainability questionable, with another chief concern being universal healthcare affecting the business models of profit driven, big pharma companies.
Measure #2: Affordable Care Act (ACA)
Brought forward by former-president Barack Obama in 2010, the ACA is not federally funded; rather, it expands the private insurance market by making it mandatory for everyone to purchase health insurance. This prevents individuals from purchasing insurance only when they are unwell. Consequently, insurance fees dip, enabling more to be able to afford for it.
The number of insured citizens surge when racial discrimination is curbed via this scheme, enabling more people of color to be insured. Under this scheme, insurers are prohibited from cherry-picking their customers and are required to provide insurance for those with pre-existing conditions, This ensures coverage for all citizens regardless of their race, age, gender or pre-existing conditions. While this scheme sounds good to consumers, it is dreaded by many companies. This is because under ACA, employers are mandated to ensure that every employee is insured, otherwise they will incur a hefty fine. Thus, the ACA was lambasted to aggravate the economic activity of businesses. What do the Democrats and Republicans think of these systems then?
What do the Republicans and Democrats Think About These Measures?
Generally, the Republicans are on a mantra of “repealing and replacing” the ACA, and have decried the single payer system for a few reasons Firstly, they detest the increased federal involvement from these two schemes, as they prefer individual states to be granted the autonomy to decide how or if their citizens are insured. Secondly, they deplore the financial burden that these schemes have caused.
As for the Democrats, they advocate for universal healthcare coverage, the expansion or reintroduction of ACA, as it insures the poor and ethnic minority groups. On the contrary, only a fraction of Democrats support the enactment of a single payer system, as it decreases the prices and drugs, thus affecting the profits of Big Pharma companies.
With such a clash in beliefs and values, it is not surprising that none of the aforementioned proposed measures have been successful. How then, do we proceed?
A 17-year-old Eunoian’s View
When I was first presented with the disparities of the two parties’ beliefs regarding the aforementioned schemes, the first thing that came into my mind was the notion of a compromise. In this case, since the Democrat’s main concern is ensuring that every sick person is insured while the Republicans vy for autonomy, a compromise can be brokered where the country conducts a national screening for all citizens to identify the ones who do not have healthcare insurance, but require medical support. From there on, each state has the freedom to implement their measures on how they wish to insure these identified individuals. This allows the Republicans to have autonomy, while safeguarding the Democrats’ interests when everyone is healthy. Further expounding on the Republicans’ interests, this approach is economically friendly as it saves governmental expenditure from funding healthcare schemes for universal coverage, thereby decreasing the need for cumulative taxes passed to its citizens. Devising a solution that considers the interests of both parties makes it easier for such measures to be passed in the Congress and Senate.
Alternatively, America can consider emulating the healthcare systems of other countries, such as Singapore. Singapore’s healthcare system is the epitome of success and efficiency. By striking a balance between the United States’ market based approach towards healthcare and the Single Payer System proposed, Singapore ensures universal healthcare access which is not fully federally funded. This is done through maintaining the presence of polyclinics and private general practitioners, where consumers (Singaporeans) can continue to consume healthcare services to induce a demand for healthcare.
At the same time, while the Singaporean government does not fund the whole populace’s healthcare expenses, there is still some degree of federal intervention which makes it partially similar to the Single Payer System. This is evident in the multifarious schemes adopted by the government to make healthcare affordable for all Singaporeans, such as governmental subsidies, healthcare insurance and compulsory saving schemes like Medisave. As for those who still find healthcare services extortionate despite the aforementioned schemes, the Singaporean government did not leave them alone to fend for themselves too, as seen in the set-up of the Medifund scheme. Medifund is a scheme where the government endows funds to help pay for the medical bills of the needy, depending on a set of criteria.
With such a neat combination of the Single Payer System and market based approach, it is no surprise that Singapore has the second most efficacious healthcare system globally, where the degree of efficiency is determined by the nation’s cost of healthcare, average life expectancy and ill-health rate.
Of course, Singapore’s healthcare system should not be fully rehashed in the context of the United States; extrapolation will only be futile. This is because the American populace may have a different set of healthcare needs as compared to Singaporeans; thus, Singapore’s healthcare system should be modified before it can be used in the United States.
With this, I hope that one day, America’s healthcare system will improve. This is especially important in the dire healthcare crisis that the United States is currently facing amidst the current pandemic. But for now, all the best, Americans!