Should the Government Provide Free Universal Health Care for All Americans?

In a Nutshell

Yes

No

  1. The number of uninsured U.S. residents has grown to over 45 million (although this number includes illegal immigrants, etc.).
  2. Health care has become increasingly unaffordable for businesses and individuals.
  3. We can eliminate wasteful inefficiencies such as duplicate paper work, claim approval, insurance submission, etc.
  4. We can develop a centralized national database which makes diagnosis and treatment easier for doctors.
  5. Medical professionals can concentrate on healing the patient rather than on insurance procedures, malpractice liability, etc.
  6. Free medical services would encourage patients to practice preventive medicine and inquire about problems early when treatment will be light; currently, patients often avoid physicals and other preventive measures because of the costs.
  7. People will have an easier time starting their own business or working part-time if health insurance is covered.
  8. Patients with pre-existing conditions can still get health coverage.
  1. There isn't a single government agency or division that runs efficiently; do we really want an organization that developed the U.S. Tax Code handling something as complex as health care?
  2. "Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc.
  3. Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.
  4. Government-controlled health care would lead to a decrease in patient flexibility.
  5. The health-care industry likely will become infused with the same kind of corruption, back-room dealing, and special-interest-dominated sleaze that is already prevalent in other areas of government.
  6. Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.
  7. Just because Americans are uninsured doesn't mean they can't receive health care; nonprofits and government-run hospitals provide services to those who don't have insurance, and it is illegal to refuse emergency medical service because of a lack of insurance.
  8. Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care.
  9. Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc.
  10. In an effort to cut costs, price & salary controls on drugs, medical equipment, and medical services are likely to be put in place, meaning there is less incentive to pursue medical-related research, development, and investment, nor pursue medical careers in general.
  11. A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation.
  12. Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession.
  13. Malpractice lawsuit costs, which are already sky-high, could further explode since universal care may expose the government to legal liability, and the possibility to sue someone with deep pockets usually invites more lawsuits.
  14. Government is more likely to pass additional restrictions or increase taxes on smoking, fast food, etc., leading to a further loss of personal freedoms.
  15. Patient confidentiality is likely to be compromised since centralized health information will likely be maintained by the government.
  16. Health care equipment, drugs, and services may end up being rationed by the government. In other words, politics, lifestyle of patients, and philosophical differences of those in power, could determine who gets what.
  17. Patients may be subjected to extremely long waits for treatment.
  18. Like social security, any government benefit eventually is taken as a "right" by the public, meaning that it's politically near impossible to remove or curtail it later on when costs get out of control.

Related Links

Overview/Background

It's no secret that health care costs are spiraling out of control in this country. On average, we now spend more per person on health care than both food and housing. Insurance premiums are multiplying much faster than inflation, which prevents economic growth and leaves businesses with less money to give raises or hire more workers. While the quality and availability of medical care in the United States remains among the best in the world, many wonder whether we'd be better off adopting a universal government-controlled health care system like the one used in Canada. The Obama administration passed a health care bill that takes the U.S. part of the way towards a government-controlled system. How far it takes us is up for dispute. The new law is sure to be debated and modified for years to come. This debate discusses whether a complete government takeover of health care should be undertaken.

Yes

  1. The number of uninsured U.S. residents has grown to over 45 million (although this number includes illegal immigrants, etc.). Since health care premiums continue to grow at several times the rate of inflation, many businesses are simply choosing to not offer a health plan, or if they do, to pass on more of the cost to employees. Employees facing higher costs themselves are often choosing to go without health coverage. No health insurance doesn't necessarily mean no health care since there are many clinics and services that are free to indigent individuals. However, any costs not covered by insurance must be absorbed by all the rest of us, which means even higher premiums. In all fairness, the 45 million uninsured number has been called into question since in includes illegal immigrants, people making over $75K who choose not to buy coverage, and others who have options for coverage but choose not to get it. The true number of people without options is closer to 15 million.

  2. Health care has become increasingly unaffordable for businesses and individuals. Businesses and individuals that choose to keep their health plans still must pay a much higher amount. Remember, businesses only have a certain amount of money they can spend on labor. If they must spend more on health insurance premiums, they will have less money to spend on raises, new hires, investment, and so on. Individuals who must pay more for premiums have less money to spend on rent, food, and consumer goods; in other words, less money is pumped back into the economy. Thus, health care prevents the country from making a robust economic recovery. A simpler government-controlled system that reduces costs would go a long way in helping that recovery.

  3. We can eliminate wasteful inefficiencies such as duplicate paper work, claim approval, insurance submission, etc. Think back to all the times in your life you've had to fill out a medical history, answering the same questions over and over. Think about all the insurance paperwork you've had to fill out and submit. Our current health care system generates an enormous amount of overhead. Every time we go to the doctor, a claim must be submitted, an approval department has to go over the claim, checks have to be mailed, patients are sent co-pay bills, and so on. The thing that's especially wasteful is that each doctor's office usually maintains their own record-keeping system. A universal healthcare plan would allow us to build one centralized system. There would be no need for maintaining insurance information or wasting time submitting claims. The work savings in the banking and postal areas alone would be worth billions every year.

  4. We can develop a centralized national database which makes diagnosis and treatment easier for doctors. Most doctor's offices maintain a separate record-keeping system. This is why you always have to fill out a lengthy health history whenever you go to a new physician. This is a problem for several reasons. First of all, it's wasteful of both time and money. Second of all, patients may lie, forget, or do a poor job of explaining past medical problems. Doctors need accurate information to make a proper diagnosis. Last of all, separate systems means we have a tougher time analyzing data at a national level. For example, are incidents of a certain disease dropping? How often is a certain illness associated with a specific set of symptoms? A centralized national system would allow us to do data analysis that we never dreamed possible, leading to medical advances and increased diagnosis efficiency. The main argument against a centralized database is that certain insurance providers may deny coverage if they find certain past medical problems. However, if the government is paying for everything, that should never be a problem.

  5. Medical professionals can concentrate on healing the patient rather than on insurance procedures, malpractice liability, etc. Doctors have to take classes now simply to understand all the insurance plans out there; they are often restricted by insurance practices, such as what tests can be ordered. Doctors must practice defensive medicine to avoid getting sued. Some physicians are even leaving the profession rather than deal with all these non-medical headaches. A simplified universal health system would allow doctors, nurses, and other medical professions to simply focus on doing what's best for the patient. Medicine is a complex enough subject as it is. Our current system just adds to an already mentally-draining profession.

  6. Free medical services would encourage patients to practice preventive medicine and inquire about problems early when treatment will be light; currently, patients often avoid physicals and other preventive measures because of the costs. Because many people are uninsured and those that do have insurance face high deductibles, Americans often forego doctor visits for minor health problems or for preventive medicine. Thus, health problems that could be caught at an early stage or prevented altogether become major illnesses. Things like routine physicals, mammograms, and HIV tests could prevent major problems. This not only affects the health of the patient but the overall cost of the system, since preventive medicine costs only a small fraction of a full blown disease. A government-provided system would remove the disincentive patients have for visiting a medical professional.

  7. People will have an easier time starting their own business or working part-time if health insurance is covered. One of the things that keeps Americans tied indefinitely to their current, full-time positions is the fear of losing health insurance, or the fear of paying some outrageous amount per month for a new individual/family policy. This amounts to a bit of modern day slavery, since people with kids or some potentially expensive health condition can't easily leave their jobs. Many Americans would like to work part-time so they can spend more time with kids, pursue a new degree, or spend time do the fun things they love before they die. Others have a great business idea but can't afford the startup costs & risks when health care is added in. Universal health care provides these opportunities.

  8. Patients with pre-existing conditions can still get health coverage. One of the biggest weaknesses of our current health care systems is that patients with a past or current medical condition such as cancer or asthma often cannot obtain affordable health coverage. Some insurance companies won't even give a policy to such individuals, or if they do, they will cover everything BUT their past diagnosed conditions. Anyone with an expensive illness or disease must then often face one of two choices: use up all their own money, or leave the condition untreated. In a universal system, no one with a pre-existing condition would be denied coverage. People could change jobs without fearing the loss of health insurance.

No

  1. There isn't a single government agency or division that runs efficiently; do we really want an organization that developed the U.S. Tax Code handling something as complex as health care? Quick, try to think of one government office that runs efficiently. Fannie Mae and Freddie Mac? The Department of Transportation? Social Security Administration? Department of Education? There isn't a single government office that squeezes efficiency out of every dollar the way the private sector can. We've all heard stories of government waste such as million-dollar cow flatulence studies or the Pentagon's 14 billion dollar Bradley design project that resulted in a transport vehicle which when struck by a mortar produced a gas that killed every man inside. How about the U.S. income tax system? When originally implemented, it collected 1 percent from the highest income citizens. Look at it today. A few years back to government published a "Tax Simplification Guide", and the guide itself was over 1,000 pages long! This is what happens when politicians mess with something that should be simple. Think about the Department of Motor Vehicles. This isn't rocket science--they have to keep track of licenses and basic database information for state residents. However, the costs to support the department are enormous, and when was the last time you went to the DMV and didn't have to stand in line? If it can't handle things this simple, how can we expect the government to handle all the complex nuances of the medical system? If any private business failed year after year to achieve its objectives and satisfy its customers, it would go out of business or be passed up by competitors. Consider the health care bill passed by the Obama administration in 2009--it's over 2000 pages and barely scratches the surface for how the law will be implemented!

  2. "Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc. There's an entitlement mentality in this country that believes the government should give us a number of benefits such as "free" health care. But the government must pay for this somehow. What good would it do to wipe out a few hundred dollars of monthly health insurance premiums if our taxes go up by that much or more? If we have to cut AIDS research or education spending, is it worth it?

  3. Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness. Government workers have fewer incentives to do well. They have a set hourly schedule, cost-of-living raises, and few promotion opportunities. Compare this to private sector workers who can receive large raises, earn promotions, and work overtime. Government workers have iron-clad job security; private sector workers must always worry about keeping their jobs, and private businesses must always worry about cutting costs enough to survive.

  4. Government-controlled health care would lead to a decrease in patient flexibility. At first glance, it would appear universal health care would increase flexibility. After all, if government paid for everything under one plan, you could in theory go to any doctor. However, some controls are going to have to be put in to keep costs from exploding. For example, would "elective" surgeries such as breast implants, wart removal, hair restoration, and lasik eye surgery be covered? Then you may say, that's easy, make patients pay for elective surgery. Although some procedures are obviously not needed, who decides what is elective and what is required? What about a breast reduction for back problems? What about a hysterectomy for fibroid problems? What about a nose job to fix a septum problem caused in an accident? Whenever you have government control of something, you have one item added to the equation that will most definitely screw things up--politics. Suddenly, every medical procedure and situation is going to come down to a political battle. The compromises that result will put in controls that limit patient options. The universal system in Canada forces patients to wait over 6 months for a routine pap smear. Canada residents will often go to the U.S. or offer additional money to get their health care needs taken care of.

  5. The health-care industry likely will become infused with the same kind of corruption, back-room dealing, and special-interest-dominated sleaze that is already prevalent in other areas of government. In President Obama's push for health insurance "reform", we saw firsthand how politics rears its ugly head. In order to secure 60 votes in the Senate, the Democrats put in special payoffs for Nebraska (the "Cornhusker kickback"), Louisiana (the "Louisiana Purchase"), and Florida in order to secure votes from reluctant senators. In other words, the merits of the bill and the good of the nation took a backseat to politics as usual. Another example was the proposed tax on "Cadillac Health Plans", which was one of the few things in the 2000+ page bill that economists predicted would actually help reduce overall costs. Unfortunately, Obama's biggest political supporters--big unions--were set to be hit. So of course, a deal was struck to exempt his union supporters, whereas non-union members in the same boat still faced the tax hikes. With something as important as health care, can we really have politicians and special interests taking power? How long before funding/regulatory decisions on certain drugs, treatments, research, etc. are decided based on those who give the most political support, as opposed to which will save lives and improve quality of life?

  6. Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now. Co-pays and deductibles were put in place because there are medical problems that are more minor annoyances than anything else. Sure, it would be nice if we had the medical staff and resources to treat every ache and pain experienced by an American, but we don't. For example, what if a patient is having trouble sleeping? What if a patient has a minor cold, flu, or headache? There are scores of problems that we wouldn't go to a doctor to solve if we had to pay for it; however, if everything is free, why not go? The result is that doctors must spend more time on non-critical care, and the patients that really need immediate help must wait. In fact, for a number of problems, it's better if no medical care is given whatsoever. The body's immune system is designed to fight off infections and other illnesses. It becomes stronger when it can fight things off on its own. Treating the symptoms can prolong the underlying problem, in addition to the societal side effects such as the growing antibiotic resistance of certain infections.

  7. Just because Americans are uninsured doesn't mean they can't receive health care; nonprofits and government-run hospitals provide services to those who don't have insurance, and it is illegal to refuse emergency medical service because of a lack of insurance. While uninsured Americans are a problem in regards to total system cost, it doesn't mean health care isn't available. This issue shouldn't be as emotional since there are plenty of government and private medical practices designed to help the uninsured. It is illegal to refuse emergency treatment, even if the patient is an illegal immigrant.

  8. Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care. When government controls things, politics always seep into the decision-making. Steps will have to be taken to keep costs under control. Rules will be put in place as to when doctors can perform certain expensive tests or when drugs can be given. Insurance companies are already tying the hands of doctors somewhat. Government influence will only make things worse, leading to decreased doctor flexibility and poor patient care.

  9. Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc. Universal health care means the costs will be spread to all Americans, regardless of your health or your need for medical care, which is fundamentally unfair. Your health is greatly determined by your lifestyle. Those who exercise, eat right, don't smoke, don't drink, etc. have far fewer health problems than the smoking couch potatoes. Some healthy people don't even feel the need for health insurance since they never go to the doctor. Why should we punish those that live a healthy lifestyle and reward the ones who don't?

  10. In an effort to cut costs, price & salary controls on drugs, medical equipment, and medical services are likely to be put in place, meaning there is less incentive to pursue medical-related research, development, and investment. Regardless of whether medical costs are paid for publicly or privately, the costs are extremely expensive and going higher every year. Rising costs of drugs, diagnostic tests, advanced treatments, physician & nurses' salaries, and so on all contribute to the skyrocketing overall cost. Politicians are likely to jump in and try to limit costs by putting in price caps on various items they deem "excessively profitable." This de-incentivizes businesses from investing in new drugs or medical advances. As an example, new drugs often take over a decade to develop, test, and pass FDA standards. That means companies must spend sometimes millions of dollars over the development period without grossing dollar one! The only thing that keeps companies in the market at all is the potentially lucrative payout of that patent along with the ability to sell their new drugs at whatever cost the market will bear. Drug price controls, or even the mere threat of price controls, will likely dissuade many companies from taking on the new investment. Consequently, medical advances are likely to curtail.

  11. A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation. A universal health plan means the entire health insurance industry would be unnecessary. All companies in that area would have to go out of business, meaning all people employed in the industry would be out of work. A number of hospital record clerks that dealt with insurance would also be out of work. A number of these unemployed would be able to get jobs in the new government bureaucracy, but it would still be a long, painful transition. We'd also have to once again go through a whole new round of patient record creation and database construction, which would cost huge amounts of both time and money.

  12. Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession. Government jobs currently have statute-mandated salaries and civil service tests required for getting hired. There isn't a lot of flexibility built in to reward the best performing workers. Imagine how this would limit the options of medical professionals. Doctors who attract scores of patients and do the best work would likely be paid the same as those that perform poorly and drive patients away. The private practice options and flexibility of specialties is one of things that attracts students to the profession. If you take that away, you may discourage would-be students from putting themselves through the torture of medical school and residency. A recent study showed that nearly 1/3 of doctors would leave the profession if the Obama health care bill was put into law.

  13. Malpractice lawsuit costs, which are already sky-high, could further explode since universal care may expose the government to legal liability, and the possibility to sue someone with deep pockets usually invites more lawsuits. When you're dealing with any business, for example a privately-funded hospital, if an employee negligently causes an injury, the employer is ultimately liable in a lawsuit. If government funds all health care, that would mean the U.S. government, an organization with enormous amounts of cash at its disposal, would be ultimately responsible for the mistakes of health care workers. Whether or not a doctor has made a mistake, he or she is always a target for frivolous lawsuits by money-hungry lawyers & clients that smell deep pockets. Even if the health care quality is the same as in a government-funded system, the level of lawsuits is likely to increase simply because attorneys know the government has the money to make settlements and massive payouts. Try to imagine potential punitive damages alone. When the government has the ability to spend several trillion dollars per year, how much will a jury be willing to give a wronged individual who is feeble, disfigured, or dying?

  14. Government is more likely to pass additional restrictions or increase taxes on smoking, fast food, etc., leading to a further loss of personal freedoms. With government-paid health care, any risky or unhealthy lifestyle will raise the dollar cost to society. Thus, politicians will be in a strong position to pass more "sin" taxes on things like alcohol, high-fat food, smoking, etc. They could ban trans fat, limit MSG, eliminate high-fructose corn syrup, and so on. For some health nuts, this may sound like a good thing. But pretty soon, people will find they no longer have the option to enjoy their favorite foods, even in moderation, or alternatively, the cost of the items will be sky high. Also, it just gives the government yet another method of controlling our lives, further eroding the very definition of America, Land of the Free.

  15. Patient confidentiality is likely to be compromised since centralized health information will likely be maintained by the government. While a centralized computer health information system may reduce some costs of record keeping, protecting the privacy of patients will likely become very difficult. The government would have yet another way to access information about citizens that should be private. Any doctor or other health professional would be able to access your entire health history. What if hackers get into the data?

  16. Health care equipment, drugs, and services may end up being rationed by the government. In other words, politics, lifestyle of patients, and philosophical differences of those in power, could determine who gets what. Any time you have politicians making health care decisions instead of medical or economics professions, you open a whole group of potential rationing issues. As costs inevitably get out of control and have to be curtailed, some ways will be needed to cut costs. Care will have to be rationed. How do you determine what to do with limited resources? How much of "experimental" treatments will have to be eliminated? If you're over 80, will the government pay for the same services as people under 30? Would you be able to get something as expensive as a pacemaker or an organ transplant if you're old? Would your political party affiliation or group membership determine if you received certain treatments? What if you acquire AIDS through drug use or homosexual activity, would you still receive medical services? What if you get liver disease through alcoholism, or diabetes from being overweight, or lung cancer from smoking--will the government still help you? Just think of the whole can of worms opened by the abortion & birth control issue?  You may or may not trust the current president & Congress to make reasonable decisions, but what about future presidents and congressional members?

  17. Patients may be subjected to extremely long waits for treatment. Stories constantly come out of universal health care programs in Britain and Canada about patients forced to wait months or years for treatments that we can currently receive immediately in America. With limited financial and human resources, the government will have to make tough choices about who can treatment first, and who must wait. Patients will like be forced to suffer longer or possibly die waiting for treatment.

  18. Like social security, any government benefit eventually is taken as a "right" by the public, meaning that it's politically near impossible to remove or curtail it later on when costs get out of control. Social security was originally put in place to help seniors live the last few years of their lives; however, the retirement age of 65 was set when average life spans were dramatically shorter. Now that people are regular living into their 90s or longer, costs are skyrocketing out of control, making the program unsustainable. Despite the fact that all politicians know the system is heading for bankruptcy in a couple decades, no one is rushing to fix it. When President Bush tried to re-structure it with private accounts, the Democrats ran a scare campaign about Bush's intention to "take away your social security". Even though he promised no change in benefits, the fact that he was proposing change at all was enough to kill the effort, despite the fact that Democrats offered zero alternative plan to fix it. Despite Republican control of the presidency and both houses, Bush was not even close to having the political support to fix something that has to be fixed ASAP; politicians simply didn't want to risk their re-elections. The same pattern is true with virtually all government spending programs. Do you think politicians will ever be able to cut education spending or unemployment insurance?...Only if they have a political death wish. In time, the same would be true of universal health care spending. As costs skyrocket because of government inefficiency and an aging population, politicians will never be able to re-structure the system, remove benefits, or put private practice options back in the system....that is, unless they want to give up hope of re-election. With record debt levels already in place, we can't afford to put in another "untouchable" spending program, especially one with the capacity to easily pass defense and social security in cost.


Related Links

Reader Comments
A 20-Point Solution to Health Care Crisis
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ProCon.org - Right to Health Care
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Americans for Free Choice in Medicine
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Wikipedia: Universal Health Care Debate
The Individual Medical Investment Account
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Is anything missing? Is any of the material inaccurate? Please let me know.

Written by:
Joe Messerli
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