The US healthcare system needs reform – but the debate needs reforming first.


The United States of America is a great country: huge diversity, a global culture influence, and the world’s engine for technology innovation.

You know what isn’t so great? The healthcare system.

I am sure there are some eyes rolling at this – we’ve heard it all before.  Europeans just love to sit their drinking beer and smoking cigarettes outside cafés, discussing how glorious the healthcare on their side of the Atlantic is and how awful the American system is.

It’s important to stick to the realities. The United Kingdom’s National Health Service (NHS) is a good service, although I say good, it is not without failures. I am not here to lecture about why a single-payer system is so better-than-thou, I am here to simply highlight that the American system is exceptionally bad. Not only that, but there are several problems with the entire debate altogether.

Here are some classic arguments I have heard from the other side and why they are wrong.

“Free healthcare isn’t free, it’s paid through taxes. Why should I pay for someone who makes poor life choices and becomes ill?”

This seems somewhat reasonable at first, until you remember that you do pay ‘taxes’ for healthcare, it’s just called insurance. And when you are heavily overweight neighbour needs open heart surgery, while some Americans may sit there in glee thinking that they didn’t pay a penny towards it, they actually did – again, through their insurance.

All this also doesn’t take into account the fact that if your other neighbour needs emergency medical attention and doesn’t have insurance, thanks to the the Emergency Medical Treatment and Active Labor Act in 1986, everyone pays the bill.  It is almost impossible to stop free riders from using the system. There would need to be extremely strict rules on operating on people unless it is known they have health insurance – I shouldn’t have to address the practical and moral issues of this. I am not in denial that there are issues with the bill above, mainly due to it generally being unfunded – however this only further strengths my argument. America has tried to create more social regulation in the current system – a system which was not designed to help the most needed. The entire system needs a rethink.

 “Universal coverage is socialism”

The dirty ‘s’ word. There are really two arguments here.

The first one is a classic rebound. America has already embraced so-called ‘socialism’ in several sectors: education, military and the police. Only the most eccentric free-market libertarians would suggest we pay ‘security insurance’ for private security agencies to provide protection – it is clear that for particular public needs, government programmes can be useful. It is also important to remember the government already plays a large role in the healthcare: the youngest, the poorest and the elderly already receive healthcare through government programmes. Essentially, healthcare is paid for twice: government programmes are paid through taxes and insurance premiums are also paid.

However the next argument I’m going to make is arguably one of the major problems with the healthcare debate in the US:

The options are not binary. The choice is not between a more private-sector focused model in the US or a single player healthcare system like the UK. People on both sides of the pond are guilty of this.  I would go as far as to argue a nationwide healthcare service in the US would struggle due to sheer size of the country, not even considering cultural reasons that it might not work. The fact is though that the vast majority of countries successfully use a hybrid model: using elements of a single-payer model and private insurance relatively successfully.

Take for instance, France’s system, which provides basic coverage for all citizens, allowing people to supplement their healthcare with further private insurance (often through their employment) if they wish to do so.

Not a fan? Have a look at Singapore, which is also focused around the private sector. One of the more successful elements of their healthcare system is their government provided insurance covering ‘catastrophic events’, which citizens can opt out for to choose private providers instead.

There are hundreds of models to choose from and the fact of the matter is, they are all less expensive and provide coverage to a larger pool of people, than the US system.

A key fact is that the American system is riddled with unnecessary expenses

It is highly unlikely that America will see a single payer healthcare system in the next several decade, if ever. The ‘US system vs single payer system’ argument will not achieve much. The ultimate issue is that the US healthcare is horrifically expensive. When it is generally cheaper to pay for additional private healthcare in a country with a single payer tax system, something is not quite right. It’s important not to forget, health insurance in the US doesn’t just cover your hospital fees; it covers extortionate drug costs like no other country. People need prescriptive drugs and the state of the current the US drug market sucks peoples wallets dry. Health insurance will also indirectly fund the advertising and marketing for drugs: a cost which most people would rather see without.

Healthcare is such a hot topic because the system is broken. When healthcare is more expensive in America than anywhere else in the world, the question shouldn’t be about whether new reforms are socialist or constitutional – it should be about whether they will help reduce the costs for everyone and help create a fairer, more fiscally sensible model.

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