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Universal health care is not a novel or even a new concept. The idea that a centralised health care system should provide health care and financial protection to all citizens of a country has its roots in Germany, in the 1880s after a string of medical discoveries by German scientists that, became the basis of modern science based medicine. In 1883, the earliest form of a national healthcare system was implemented, in the form of the Sickness Insurance Law. This allowed low wage industrial workers to enjoy injury and illness insurance with funds drawn from contributions by both employee and employer. The years that followed saw the United Kingdom follow with a similar scheme; The National Insurance Act 1911. Then came the Russians in the following year. By the 1930s, almost every country in Western and Central Europe had a similar health care system. However, this age-old debate still rages on in the senate of the USA.
The Affordable Healthcare Act aka Obamacare was only the USA’s first step towards Universal Health Care and was only enacted in 2010. Yet, barely into the first hundred days of his the succeeding president, steps have been taken to dismantle it and enact Trump’s American Health care Act. The consequences could be dire. 26 million people stand to lose health care insurance by 2020 if this comes to pass.
Downsides to Every Upside
Equality sounds very enticing and magnanimous – a quality most would like to associate with a developed and humane society. However, there remains some concerns that prevent a unified consensus on the issue. To this we can look towards those countries that have had such an institution for decades; onward to Europe!
The pharmaceutical and biotechnological industries are important ones to the USA. In this industry, profits drive competition, which in turn, fosters innovation. Government initiated universal healthcare plans will chip away at pharmaceutical company profits as they will insist that these medical breakthroughs are made available, at the expense of the levels of profit they would otherwise enjoy. With less profits to be made, companies will simply relocate or cease investments altogether. This is a serious implication as this industry makes up 2% of the US GDP, and it contributed 5% to Singapore’s.
In countries with universal healthcare, an overstretched health care system can sometimes result in long wait times for treatment. In Canada which has a much prided public healthcare system, many Canadians have reported travelling to the USA for quicker treatment. In an often quoted case, Canadian Sharon Shamlaw failed to obtain timely treatment for stem cell treatment and ultimately succumbed from cancer when it was readily available across the border in the nearby city of Buffalo, New York, in the USA. For decades, Canadian doctors had repeatedly warned the health ministry about an inevitable shortage of resources and “unprecedented demand” for stem-cell transplants, but the issues went unaddressed.
There is also a fear that in a single-payer universal healthcare system, the government is decides what treatment a patient receives, thereby removing the doctor and patient from that process. In a system where the individual is responsible for his or her own medical insurance, the patient can decide which insurer is making unreasonable restrictions and decide to use another insurer or physician. In a single-payer system, the government takes over that decision making process as they are the paymaster and are more subject to benchmarks such as budget and spending instead of healthcare quality.
The free market has been called the most efficient allocator of resources. In a capitalistic society, we tend to give more credence to a laissez faire system. The criticism of a centrally administered healthcare system is that government bureaucracy will lead to inefficient programs that ultimately misallocates resources; leading to higher costs.
Society Benefits as a Whole
It is unarguable that moving from an individual-paid medical insurance system to a universal healthcare system will result in some people being slightly worse off. The chief complaint is higher taxes and a free rider problem of dutiful taxpayers supporting the uninsured. Contrary to this popular belief, though, is Kellogg School assistant professor, Craig Garthwaithe’s research based on previously confidential data, that it is public hospitals that bear the costs of treating the uninsured by providing uncompensated care.
Regardless of who bears the cost, it is the positive net effect that is behind the impetus to implement universal healthcare. A study by the Department of Economics, Eastern Michigan University revealed that if the USA adopted universal healthcare, mortality is reduced by1.69-1.92%. It was also calculated that by extending medical insurance coverage to the entire uninsured population, over 75 000 lives would be saved annually and may yield annual net benefits to the nation in excess of $US400 billion.
Expressed in dollars and cents, citing the USA as an example, it was determined that the cost of universal healthcare would be between $34-$69 billion assuming a range of coverage options. The cost of not implementing universal healthcare leading to the diminished health and shorter life spans of Americans without insurance is $65-$130 billion.
No One Size Fits All
When looking for a working model that the USA can put in place, prominent Harvard Medical School professor, William Haseltine, lauded Singapore’s healthcare system for its emphasis on valuing a free market system as well as recognizing the value of a strong government role in the marketplace to ensure a well-functioning health care system. This has resulted in an efficient system that spends 3% of its GDP on health care in contrast to the United States’ nearly 18%.
Singapore has in place a non-modified universal healthcare system. What this means is that the government ensures everyone has access to affordable healthcare within the public health system, through a combination of compulsory savings, subsidies, and price controls. Paying for one’s own medical treatment has resulted in an efficient use of health care services to the maximum with a minimum burden to encumber the taxpayer. Singapore has “one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes,” according to an analysis by global consulting firm Towers Watson. It is a system that works in Singapore but requires an implicitly high level of trust in the government, as it is a policy heavy solution.
Haseltine advised that the right government policy canmake a positive impact. “We have this whole suspicion of government, but that’s a really big mistake,” he said. “Trusting the government to set enlightened policy is a big lesson the U.S. can learn from Singapore”, he said.