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Nothing quite exposes the inequalities that exist in American society more than the health care system. It’s a complex combination of private insurance, public programs and politics that drives up costs, creating significant barriers to lifesaving medical treatment for large segments of the population. In America, access to quality health care often depends on income, employment and status.
Robert Hughes, professor of business ethics and legal studies at Wharton, is an advocate for universal health care coverage. Drawing deeply on his research in philosophy, Hughes believes that equal access to medical care is beneficial for both liberty and social stability. Health, he says, should not be tied to wealth.
“I think it’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance,” he said, referring to the crowdsourcing platform used to help raise money for patient bills. “That’s why I say that truly universal health care would be good for people’s liberty. Because you’re not really free if you’re depending on charity, especially discretionary charity like the kind you see on GoFundMe, for a basic need like health care.”
Hughes recently joined the Wharton Business Daily radio show on SiriusXM to discuss universal health care in the context of the presidential election. (Listen to the podcast at the top of this page.) President-elect Joe Biden has said he will protect and rebuild the Affordable Care Act, which has been under attack since it was enacted in 2010 under President Barack Obama.
The ACA, commonly referred to as Obamacare, brought the U.S. closer to providing universal health care through subsidized private health insurance, but Hughes said there’s still a wide gap. He believes policymakers should ensure that everyone has coverage and access to the same needed treatments.
“It’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance.”
“I think it’s totally feasible for us to change the health care system, if we all were willing to do the right thing. But we’re not all willing to do the right thing,” Hughes said.
The professor argued the case for universal health care in a paper titled “Egalitarian Provision of Necessary Medical Treatment,” which was published last year in the Journal of Ethics. (The author-accepted version is here.) He examined the health care systems of the U.K., Australia and Canada, concluding that Canada’s single-payer system is the most advantageous for the U.S.
Private insurance would still exist under such a setup, but it could not be used to pay for treatments already covered under universal health care. This provision would eliminate wealth as the controlling factor in health.
“I don’t understand why there’s so much resistance to the idea of truly universal health insurance in the United States, given that this is something that other industrial countries just do,” Hughes said.
He acknowledged that the U.S. doesn’t have the “political will” to change a system that’s been entrenched since the end of World War II, when employers began offering health insurance to their workers instead of higher wages.
“We can’t wave a magic wand and go back to 1946,” he said. “I don’t see the United States completely uprooting all these insurances. And that means we might need to create a model that keeps a lot of what we have, making it more accessible to more people, rather than creating all new institutions from scratch.”
Knowledge@Wharton interviewed Hughes last year about his paper. For an in-depth look into his research and advocacy, read the interview here.
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5 Comments So Far
Joseph Weiss
The resistance is due to the US being very capitalistic and less ready to turn over anything to the Government. Moreover, since we have seen how Medicare (and Medicaid) is run, and how other countries deal with how the system is rationed out for new treatments etc then it gives one pause. Just look at how the Federal Government pays practitioners for Medicare. Your article just basically says wouldn’t it be nice if we were all treated fairly and equally in everything. Nice idea but not practical with humans to get the best results for all for the long term.
Al Lehmann
It’s obvious from comparative costs and aggregate outcomes that single payer universal healthcare is superior overall. While no system is perfect, simply comparing the results in dealing with the COVID epidemic between Canada and the US, the US has roughly 2 1/2 times the per 1000 mortality rate that Canada has. Lower American life expectancy and higher perinatal mortality are further reflections of this distinction.
Private health care as currently practiced supports a huge, unwieldy insurance apparatus that syphons off huge sums that could be spent on actual care.
Health care costs for American corporations are a drain on economic competitiveness, when a less expensive single-payer system can enhance both costs and efficiencies.
Single payer health care is a no-brainer.
Brian Beaulieu
Earnest conversation and analysis is foundational to making decisions that work. Having someone declare they know what is “right” and that a fundamental change is a “no brainer” is not conducive to engaged, learned discourse and change.
Barbara McCreary
There are studies that calculated the amount spent by employers to provide health insurance to their employees. One reported an average of $15,000 per employee. If employees, who say they prefer their employer insurance, considered universal health care and an additional $15,000 a year income; would they reconsider? How much does your physician spend to file and collect insurance claims? Would that money be better spent to hire more healthcare professionals? Would there be an impact on the quality of care if the physician’s office was only focused on healthcare? How would we fund the universal program, well employees with extra $15,000 could pay extra ?$$ in taxes; doctors and medical facilities could pay ?$$ in taxes from the enormous savings from the enormous claims costs cuts.
Günther Rückl
What is the author’s main concern? The immorality of how access to high-quality healthcare in the US depends on the power to pay. I think we can all agree that is a indisputable fact.
How can we achieve access to necessary high-quality care for all regardless of the capacity to pay? Most importantly, all social strata of the US citizenry ideally need to participate in that discussion. That is, for a multitude of reasons, far from being the case. Therefore the discussion is head-heavy dominated by the money of corporations, special interests and rich individuals through their easy access to subservient media (manufacturing consent). The result: There is no balance of interest representation in this discussion. Add to that the corruption of our political ‘representatives’, speak Congress, in their majority representing the powers with money (ending up in their pockets in the form of campaign funds drowning out the whispers of socially conscientious individuals and organizations ) we must admit there will likely never be justice in US healthcare without a tsunami of popular discontent resulting in the overthrow of the status quo. The issue is incredibly straight forward: self-interest, the obsession with bein power and the need of the US variety of Capitalism to make profit by any means rules out even the slightest progress toward a truly egalitarian healthcare system. Much talk about morality that the financial powers successfully bypass with little critique by the mainstream media. The fatal ideological design underlying US healthcare applies just as well to other areas such as education. Those of us who have been raised in, and experienced, a different variety of Capitalism, i.e. a socially fairer and inclusive Capitalism, seem to have sharper eyes when it comes to identify the cause of the perennial healthcare quagmire in the US.