Universal Healthcare as a Basic Human Right

The World Health Organization (WHO) recognizes health as a basic human right. Most developed nations have supported the efforts of this organization to ensure that as many people as possible have access to affordable and quality care. For many developing nations, quality and affordable care remains an elusive dream. Crumbling infrastructure, poverty and mismanagement are among the factors that have hampered the effort of these countries to safeguard the health of their people. It is worth noting that challenges in delivering quality care are not confined to the developing world. Despite being an industrialized nation, the United States has struggled to offer affordable, equal and high quality care. The enactment of the Affordable Care Act (Obamacare) is the nation’s best attempt at achieving universal healthcare. Complex ethical questions and the lack of political commitment are some of the issues that have complicated the introduction of universal healthcare in the country. For the US to join other industrialized nations in providing universal healthcare, concerted political action and an overhaul of the private health insurance marketplace are needed.

The Issue and its Evolution 

To gain a full understanding of the question of universal healthcare in the US, it is important to explore how this issue has developed. Essentially, universal healthcare is concerned with the provision of medical services to all members of a country. When a nation has successfully adopted universal healthcare, all its citizens gain access to quality services regardless of their ability to pay for these services. In the US, universal healthcare has been both elusive and divisive. The US spends huge amounts on healthcare every year. For example, for 2018, it is projected that the country will spend as much as $3.5 trillion on healthcare (Abutaleb, 2018). Given the amounts set aside for healthcare, one would expect that Americans enjoy medical services of high quality. This is not the case. According to Prof. Christopher Murray (2016) who performed a comparison of the quality of care in different countries, the US ranks 28 th . In addition to being unable to deliver quality care to its citizens, the US has failed to provide insurance coverage to millions. As of 2016, the size of the uninsured population in the country stood at 26 million (“Key Facts about” 2017). This high number is despite such initiatives as the Affordable Care Act which was designed to provide medical insurance to many more Americans.

The high cost of care in the US, the large uninsured population and the failure of the US to offer quality medical services are the main issues that have made universal coverage an issue, an opportunity and a need. With the adoption of universal healthcare, the US will be able to address all these challenges. Universal healthcare has gained the attention of decision makers in the US. It has achieved this because it holds the key to an enhanced healthcare delivery system. The fact that the US lags behind other industrialized nations is another factor that has caused universal healthcare to become the focus of the attention of decision makers (Jones & Kantarjian, 2015). One should note that the absence of universal healthcare in the US is not the result of inaction. Political leaders have led calls for the US to reform its healthcare system so as to deliver care to all its citizens. The efforts of these leaders have been sabotaged by political divisions and strong opposition from businesses and the insurance industry. For example, the full implementation of Obamacare has been hampered by political opposition and campaigns by the business community. The challenges that the Obama administration faced in its quest to deliver coverage to the millions of uninsured Americans underscores the complex history and evolution of universal healthcare. Obama’s efforts are part of a protracted campaign to introduce universal healthcare in the country. Even in the year following the First World War, various governments unsuccessfully attempted to deliver universal healthcare.

Policy Makers and their Positions 

The issue of universal healthcare has sparked reactions from different policy makers and stakeholders. Lobby groups, the government and legislators are among the parties who have made their positions on universal healthcare clear. Members of Congress are sharply divided on this issue. On the one hand, Democrats support efforts to provide universal coverage. For example, in 2017, led by Bernie Sanders, these leaders backed a bill which sought to expand Medicare, thereby inching the country closer to universal coverage (Weigel, 2015). On the other hand, Republican Congressmen appear opposed to any and all efforts to introduce universal coverage. In the recent past, these leaders have been trying to replace Obamacare, arguing that this policy is responsible for an increase in premiums, while ignoring the fact that thanks to this policy, millions of Americans now have coverage (Oberlander, 2017). Given the sharp divisions in Congress, it is unlikely that the introduction of universal healthcare will be led by legislators. These divisions are usually reflected in the healthcare policies that the government of the day pursues. For example, being a Democrat, Barack Obama spearheaded a campaign to deliver universal coverage. Under the leadership of President Donald Trump, Republican Congressmen are striving to replace Obama’s policy.

As noted above, lobby groups are among the stakeholders who have expressed their positions on the question of universal coverage. These groups represent the interests a wide range of communities which include ordinary families, businesses and medical practitioners. Given their diverse composition, these groups do not speak with the same voice. For example, the lobby groups representing business interests are opposed to universal coverage. Their opposition is based on the fear that when universal healthcare is introduced, businesses and employers will be mandated to pay for the health insurance of their employees. The groups which speak for American families and the medical community are largely in support of universal coverage. The position of these groups reflects the views of a majority of Americans who desperately desire universal coverage (Kiley, 2017).

Nursing Involvement 

Nursing practitioners are among the stakeholders for whom universal healthcare presents implications. There is no doubt that despite its numerous drawbacks, universal healthcare holds the key to the delivery of quality and affordable care. Nurses have important roles to play in pushing for universal healthcare. Partnering with public agencies and organizations for the purpose of campaigning for universal healthcare is among these roles (Mitchell, 2015). Nurses can become involved by joining forces with other parties and imposing pressure on policy makers to take action and make universal healthcare a reality in the US. It is important to understand that even without universal healthcare in place, nurses can take steps to enhance access. In such places as China and Hong Kong, nurses are going beyond their basic duties and ensuring that as many patients as possible are able to access quality services (Chan, Fung & Chan, 2017). The sacrifice and dedication for these nurses prove that even as they pressure policymakers to take action, nurses can implement small and simple steps. Nurses can also strengthen systems and participate in research as part of their efforts to challenge policy makers to implement universal coverage (Marziale, 2016). Overall, nurses have an obligation to take individual initiative while working with other stakeholders.

Universal healthcare affects nurses in a number of ways. As already noted, the US has failed to deliver coverage to all of its citizens. The implication of this is that the duty of offering care has been left to practitioners. Since their capacity to deliver care is limited, the practitioners are often forced to turn away patients (“Doctors and Hospitals”, 2016). With universal health coverage, nurses and other practitioners will no longer be placed in the awkward position of refusing to offer treatment. Collaborating with two other scholars, Mariana Schveitzer (2016) explored the impacts of universal coverage on nursing. In their article, these scholar note that “nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care” (Schveitzer, Zoboli, & Vieira, 2016, p. 1). Here, these scholars essentially predict that as the US adopts universal healthcare, the nursing community will need to make changes so as to ensure that patients receive the best possible quality of care.

Ethical Concerns 

There are a number of ethical concerns that surround universal healthcare. The trade-offs that would need to be made for universal healthcare to be provided are among these ethical concerns (Norheim, 2015). It is feared that in order to deliver universal healthcare, the government may be forced to make compromises. For example, coverage for certain conditions and services that are considered unimportant may be limited. While necessary, these compromises are considered unfair and unethical (Norheim, 2015). The need to treat universal coverage as a basic human right is another ethical issue (Sade, 2012). The US is among few nations which are yet to join the world in recognizing healthcare as an inviolable human right. How the US will implement universal healthcare without overburdening the economy is perhaps the greatest ethical concern surrounding this issue. The country will need to balance competing interests and ensure fairness in the financing of universal healthcare.

Options for Resolution 

Different models for universal healthcare have been developed. Each of these models possesses distinct features and delivers unique advantages. The main models are the Beveridge model, the Bismarck model, the national health insurance model and the out-of-pocket model (“Health Care Systems”, 2009). Under the Beveridge model, the government maintains nearly total control and ownership of medical institutions. The few private institutions receive payments for services delivered from the government. The key advantage of this model is that it helps to minimize costs since the government is able to monitor and influence the operations of practitioners and medical institutions (“Health Care Systems”, 2009). Spain, New Zealand and Great Britain are among the nations whose healthcare systems are based on the Beveridge model. The primary feature of the Bismarck model is the establishment of an insurance industry (“Health Care Systems”, 2009). Employers and employees make contributions to a pool which is then used to pay for medical services. As opposed to the system that the US has in place, the Bismarck model discourages the pursuit of profit. Instead, focus is placed on attending to the needs of employees. This model is similar to the Beveridge model in that it allows the government to exercise tight control, thereby keeping costs down (“Health Care Systems”, 2009). Some of the countries that have adopted this model include Belgium, Germany, Japan and the Netherlands.

The national health insurance model is a promising framework that could help the US to deliver universal coverage. Essentially, this model allows the government to establish an insurance program that is funded through contributions made by citizens (“Health Care Systems”, 2009). Payment for services to the citizens comes from this program. Lower administrative costs are the main advantage of this model. Taiwan and South Korea are some of the countries that have embraced the national health insurance model (“Health Care Systems”, 2009). Lastly, as the name suggests, the out-of-pocket model sees individuals pay for treatment individually. This model is mostly observed in poor nations where proper universal coverage initiatives are lacking (“Health Care Systems”, 2009). Since this model is riddled with inefficiencies and promotes inequalities, the US should not even consider it.

Preferred Solution 

It is recommended that as part of it efforts to deliver universal coverage, the US should adopt the Bismarck model. This recommendation is based on the numerous benefits of this model and the drawbacks of the alternatives. Research has shown that the Bismarck model helps to minimize infant mortality while extending life expectancy (Zee & Kroneman, 2007). If the US wishes to keep the number of infants who die low and increase the life expectancy of its people, it should base its universal healthcare plan on the Bismarck framework. Another benefit of this model is that it is cost-effective. This point has been made in the discussion above. That it compels all citizens to obtain insurance is another benefit of the Bismarck model (Kulesher & Forrestal, 2014). By forcing all its citizens to have insurance, the US will be able to ensure universal healthcare when it adopts the Bismarck model.

The benefits that the Bismarck model presents are not the only basis of the recommendation that the US should use this model. The failure and drawbacks of other models are another rationale. The Beveridge model is one of the alternatives which are neither feasible nor viable for the US. Limited choice and the inability of patients to receive coverage for particular services that are costly are some of the drawbacks of this model (Lazarus, 2017). The best argument for the adoption of the Bismarck model is the fact that it has worked for countries which have adopted it. For example, in Germany, the adoption of the Bismarck model has allowed the country to deliver coverage to all segments of the population (Kulesher & Forrestal, 2014). Furthermore, this model was accompanied with laws which prohibited discrimination of individuals with certain health risks. Thanks to the Bismarck model, Germany has ensured that such vulnerable groups as the unemployed and children are able to access care (Khazan, 2014). The German healthcare system is also highly efficient and equitable. For the US to enjoy these benefits, it needs to follow the example of Germany by adopting the Bismarck model.

In conclusion, the US healthcare system is in desperate need of an overhaul. This system has failed to adequately address the needs of the American people. The genesis of the system’s failures can be traced to the lack of universal coverage. Political divisions and the actions of lobby groups are among the factors that should be blamed for the hurdles that the US continues to encounter in its attempt to provide universal healthcare. As it pursues universal coverage, the US needs to be wary of the ethical concerns which surround this issue. It should also scrutinize the various models available for universal coverage. While all the models are interesting, the US should adopt the Bismarck model. In addition to enhancing coverage, this model will also minimize costs while allowing Americans to receive care for a wide range of conditions.

References

Abutaleb, Y. (2018). U.S. healthcare spending to climb 5.3 percent in 2018: agency . Reuters.

Retrieved June 25, 2018 from https://www.reuters.com/article/us-usa-healthcare-spending/u-s-healthcare-spending-to-climb-5-3-percent-in-2018-agency-idUSKCN1FY2ZD

Chan, W. Y., Fung, I. M., & Chan, E. (2017). Universal health coverage through community

Nursing services: China vs. Hong Kong. Revista Latino-Americana de Enfermagem. 

DOI: 10.1590/1518-8345.1664.2838

Doctors and hospitals tell patients: show us the money before treatmen t. (2016). NPR. 

Retrieved June 25, 2018 from https://www.npr.org/sections/health-shots/2016/12/07/504589131/doctors-and-hospitals-tell-patients-show-us-the-money-before-treatment

Health care systems- the four basic models. (2009). PBS. Retrieved June 25, 2018 from

https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

Key facts about the uninsured population . (2017). Henry J. Kaiser Family Foundation. Retrieved

June 25, 2018 from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

Khazan, O. (2014). What American healthcare can learn from Germany. Retrieved June 25,

2018 from https://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/

Kiley, J. (2017). Public support for ‘single payer’ health coverage grows, driven by Democrats .

Pew Research Center. Retrieved June 25, 2018 from http://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-single-payer-health-coverage-grows-driven-by-democrats/

Kulesher, R., & Forrestal, E. (2014). International models of health systems financing. Journal of 

Hospital Administration, 3 (4), 127-139.

Lazarus, D. (2017). Fixing healthcare: which single-payer system would be best for California? 

LA Times. Retrieved June 25, 2018 from http://www.latimes.com/business/lazarus/la-fi-lazarus-single-payer-california-choices-20170307-story.html

Jones, G. H., & Kantarjian, H. (2015). Health care in the United States- basic human right or

Entitlement? Annals of Oncology, 26 (10), 2193-5.

Marziale, M. H. P. (2016). Universal access to health and universal health coverage: nursing

Contributions. Revista Latino-Americana de Enfermagem. DOI: 10.1590/1518-8345.1664.2838

Mitchell, P. H. (2015). Nursing and health policy perspectives. International Nursing Review. 

Retrieved June 25, 2018 from https://onlinelibrary.wiley.com/doi/pdf/10.1111/inr.12212

Murray, J. L. C. (2016). Measuring the health-related sustainable development goals in 188

Countries: a baseline analysis from the global burden of disease study 2015. The Lancet. 

DOI: http://dx.doi.org/10.1016/S0140-6736(16)31467-2

Norheim, O. F. (2015). Ethical perspective: five unacceptable trade-offs on the path to universal

Health coverage. International Journal of Health Policy and Management, 4 (11), 711-4.

Oberlander, J. (2017). The end of Obamacare. New England Journal of Medicine, 376, 1-3.

DOI: 10.1056/NEJMp1614438

Sade, R. M. (2012). Health care reform: ethical foundations, policy, and law. Journal of 

American College of Surgeons, 215 (2), 286-296.

Schveitzer, M. C., Zoboli, E. L. C., & Vieira, M. M. (2016). Nursing challenges for universal

Healthcare coverage: a systematic review. Revista Latino-Americana de Enfermagem. 

DOI: 10.1590/1518-8345.0933.2676

Weigel, D. (2017). Sanders introduces universal health care, backed by 15 Democrats. The

Washington Post. Retrieved June 25, 2018 from

https://www.washingtonpost.com/powerpost/sanders-will-introduce-universal-health-care-backed-by-15-democrats/2017/09/12/d590ef26-97b7-11e7-87fc-c3f7ee4035c9_story.html?utm_term=.3ece59013c68

Zee, J., & Kroneman, M. W. (2007). Bismarck of Beveridge: a beauty contest between

Dinosaurs. BMC Health Services Research. DOI: 10.1186/1472-6963-7-94