should healthcare be free essay

Should the U.S. Government Provide Universal Health Care?

• History of Universal Health Care

27.5 million non-elderly Americans did not have health insurance in 2021, a decline from 28.9 million uninsured Americans in 2019. The largest group of Americans, almost 155 million non-elderly people, were covered by employer-sponsored health insurance. Less than 1% of Americans over 65 were uninsured, thanks to Medicaid, a government provided insurance for people over 65 years old.

The United States is the only nation among the 37 OECD (Organization for Economic Co-operation and Development) nations that does not have universal health care either in practice or by constitutional right. Read more background…

Pro & Con Arguments

Pro 1 The United States already has universal health care for some. The government should expand the system to protect everyone. A national health insurance is a universal health care that “uses public insurance to pay for private-practice care. Every citizen pays into the national insurance plan. Administrative costs are lower because there is one insurance company. The government also has a lot of leverage to force medical costs down,” according to economic expert Kimberly Amadeo. Canada, Taiwan, and South Korea all have national health insurance. In the United States, Medicare, Medicaid, and TRICARE function similarly. [ 178 ] Medicare is the “federal health insurance program for: people who are 65 or older, certain younger people with disabilities, [and] people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).” Patients pay a monthly premium for Medicare Part B (general health coverage). The 2023 standard Part B monthly premium is $164.90. Patients also contribute to drug costs via Medicare Part D. Most people do not pay a premium for Medicare Part A (“inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care”). More than 65.3 million people were enrolled in Medicare according to Feb. 2023 government data. [ 180 ] [ 181 ] Medicaid “provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.” More than 84.8 million people were enrolled in Medicaid as of Nov. 2022. [ 181 ] [ 182 ] [ 183 ] The Children’s Health Insurance Program (CHIP), often lumped in with Medicaid in these discussions, is a “low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program.” CHIP covers more than 6.9 million patients. [ 181 ] [ 182 ] [ 183 ] TRICARE is the “military health system that provides care to almost 10 million active-duty service members, retired personnel, and their families.” Active-duty military members pay $0 for health insurance, while retired members and their families paid a premium up to $1,165 per month (for a member and family) in 2021. [ 184 ] The United States already successfully maintains universal health care for almost 36% of the U.S. population, according to U.S. Census data released in Sep. 2022. As the Baby Boomer generation continues to age and more of the generation becomes eligible for Medicare, estimates suggest about 73.5 million people will use Medcare and about 47% of American health care costs will be paid for by public health services by 2027. [ 185 ] [ 186 ] If the government can successfully provide universal health care for 36% to almost 50% of the population, then the government can provide univeral health care for the rest of the population who are just as in need and deserving of leading healthy lives. Read More

Pro 2 Universal health care would lower costs and prevent medical bankruptcy. A June 2022 study found the United States could have saved $105.6 billion in COVID-19 (coronavirus) hospitalization costs with single-payer universal health care during the pandemic. That potential savings is on top of the estimated $438 billion the researchers estimated could be saved annually with universal health care in a non-pandemic year. [ 198 ] “Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households,” conclude researchers from the Yale School of Public Health and colleagues. [ 201 ] According to the National Bankruptcy Forum, medical debt is the number one reason people file for bankruptcy in the United States. In 2017, about 33% of all Americans with medical bills reported that they “were unable to pay for basic necessities like food, heat, or housing.” If all Americans were provided health care under a single-payer system medical bankruptcy would no longer exist, because the government, not private citizens, would pay all medical bills. [ 131 ] Further, prescription drug costs would drop between 4% and 31%, according to five cost estimates gathered by New York Times reporters. 24% of people taking prescription drugs reported difficulty affording the drugs, according to a Kaiser Family Foundation (KFF) poll. 58% of people whose drugs cost more than $100 a month, 49% of people in fair or poor health, 35% of those with annual incomes of less than $40,000, and 35% of those taking four or more drugs monthly all reported affordability issues. [ 197 ] [ 199 ] [ 200 ] Additionally, 30% of people aged 50 to 64 reported cost issues because they generally take more drugs than younger people but are not old enough to qualify for Medicare drug benefits. With 79% of Americans saying prescription drug costs are “unreasonable,” and 70% reporting lowering prescription drug costs as their highest healthcare priority, lowering the cost of prescription drugs would lead to more drug-compliance and lives not only bettered, but saved as a result. [ 197 ] [ 199 ] [ 200 ] Read More

Pro 3 Universal health care would improve individual and national health outcomes. Since 2020, the COVID-19 pandemic has underscored the public health, economic and moral repercussions of widespread dependence on employer-sponsored insurance, the most common source of coverage for working-age Americans…. Business closures and restrictions led to unemployment for more than 9 million individuals following the emergence of COVID-19. Consequently, many Americans lost their healthcare precisely at a time when COVID-19 sharply heightened the need for medical services,” argue researchers from the Yale School of Public Health and colleagues. The researchers estimated more than 131,000 COVID-19 (coronavirus) deaths and almost 78,000 non-COVID-19 deaths could have been prevented with universal health care in 2020 alone. [ 198 ] Another study finds a change to “single-payer health care would… save more than 68,000 lives and 1.73 million life-years every year compared with the status quo.” [ 201 ] Meanwhile, more people would be able to access much-needed health care. A Jan. 2021 study concludes that universal health care would increase outpatient visits by 7% to 10% and hospital visits by 0% to 3%, which are modest increases when compared to saved and lengthened lives. [ 202 ] Other studies find that universal health coverage is linked to longer life expectancy, lower child mortality rates, higher smoking cessation rates, lower depression rates, and a higher general sense of well-being, with more people reporting being in “excellent health.” Further, universal health care leads to appropriate use of health care facilities, including lower rates of emergency room visits for non-emergencies and a higher use of preventative doctors’ visits to manage chronic conditions. [ 203 ] [ 204 ] [ 205 ] An American Hospital Association report argues, the “high rate of uninsured [patients] puts stress on the broader health care system. People without insurance put off needed care and rely more heavily on hospital emergency departments, resulting in scarce resources being directed to treat conditions that often could have been prevented or managed in a lower-cost setting. Being uninsured also has serious financial implications for individuals, communities and the health care system.” [ 205 ] Read More

Con 1 Universal health care for everyone in the United States promises only government inefficiency and health care that ignores the realities of the country and the free market. In addition to providing universal health care for the elderly, low-income individuals, children in need, and military members (and their families), the United States has the Affordable Care Act (the ACA, formerly known as the Patient Protection and Affordable Care Act), or Obamacare, which ensures that Americans can access affordable health care. the ACA allows Americans to chose the coverage appropriate to their health conditions and incomes. [ 187 ] Veterans’ Affairs, which serves former military members, is an example of a single-payer health care provider, and one that has repeatedly failed its patients. For example, a computer error at the Spokane VA hospital “failed to deliver more than 11,000 orders for specialty care, lab work and other services – without alerting health care providers the orders had been lost.” [ 188 ] [ 189 ] Elizabeth Hovde, Policy Analyst and Director of the Centers for Health Care and Worker Rights, argues, “The VA system is not only costly with inconsistent medical care results, it’s an American example of a single-payer, government-run system. We should run from the attempts in our state to decrease competition in the health care system and increase government dependency, leaving our health care at the mercy of a monopolistic system that does not need to be timely or responsive to patients. Policymakers should give veterans meaningful choices among private providers, clinics and hospitals, so vets can choose their own doctors and directly access quality care that meets their needs. Best of all, when the routine break-downs of a government-run system threaten to harm them again, as happened in Spokane, veterans can take their well-earned health benefit and find help elsewhere.” [ 188 ] [ 189 ] Further, the challenges of universal health care implementation are vastly different in the U.S. than in other countries, making the current patchwork of health care options the best fit for the country. As researchers summarize, “Though the majority of post-industrial Westernized nations employ a universal healthcare model, few—if any—of these nations are as geographically large, populous, or ethnically/racially diverse as the U.S. Different regions in the U.S. are defined by distinct cultural identities, citizens have unique religious and political values, and the populace spans the socio–economic spectrum. Moreover, heterogenous climates and population densities confer different health needs and challenges across the U.S. Thus, critics of universal healthcare in the U.S. argue that implementation would not be as feasible—organizationally or financially—as other developed nations.” [ 190 ] And, such a system in the United States would hinder medical innovation and entrepreneurship. “Government control is a large driver of America’s health care problems. Bureaucrats can’t revolutionize health care – only entrepreneurs can. By empowering health care entrepreneurs, we can create an American health care system that is more affordable, accessible, and productive for all,” explains Wayne Winegarden, Senior Fellow in Business and Economics, and Director of the Center for Medical Economics and Innovation at Pacific Research Institute. [ 190 ] [ 191 ] Read More

Con 2 Universal health care would raise costs for the federal government and, in turn, taxpayers. Medicare-for-all, a recent universal health care proposal championed by Senator Bernie Sanders (I-VT), would cost an estimated $30 to $40 trillion over ten years. The cost would be the largest single increase to the federal budget ever. [ 192 ] The Congressional Budget Office (CBO) estimates that by 2030 federal health care subsidies will increase by $1.5 to $3.0 trillion. The CBO concludes, “Because the single-payer options that CBO examined would greatly increase federal subsidies for health care, the government would need to implement new financing mechanisms—such as raising existing taxes or introducing new ones, reducing certain spending, or issuing federal debt. As an example, if the government required employers to make contributions toward the cost of health insurance under a single-payer system that would be similar to their contributions under current law, it would have to impose new taxes.” [ 193 ] Despite claims by many, the cost of Medicare for All, or any other universal health care option, could not be financed solely by increased taxes on the wealthy. “[T]axes on the middle class would have to rise in order to pay for it. Those taxes could be imposed directly on workers, indirectly through taxes on employers or consumption, or through a combination of direct or indirect taxes. There is simply not enough available revenue from high earners and businesses to cover the full cost of eliminating premiums, ending all cost-sharing, and expanding coverage to all Americans and for (virtually) all health services,” says the Committee for a Responsible Federal Budget. [ 195 ] An analysis of the Sanders plan “estimates that the average annual cost of the plan would be approximately $2.5 trillion per year creating an average of over a $1 trillion per year financing shortfall. To fund the program, payroll and income taxes would have to increase from a combined 8.4 percent in the Sanders plan to 20 percent while also retaining all remaining tax increases on capital gains, increased marginal tax rates, the estate tax and eliminating tax expenditures…. Overall, over 70 percent of working privately insured households would pay more under a fully funded single payer plan than they do for health insurance today.” [ 196 ] Read More

Con 3 Universal health care would increase wait times for basic care and make Americans’ health worse. The Congressional Budget Office explains, “A single-payer system with little cost sharing for medical services would lead to increased demand for care in the United States because more people would have health insurance and because those already covered would use more services. The extent to which the supply of care would be adequate to meet that increased demand would depend on various factors, such as the payment rates for providers and any measures taken to increase supply. If coverage was nearly universal, cost sharing was very limited, and the payment rates were reduced compared with current law, the demand for medical care would probably exceed the supply of care–with increased wait times for appointments or elective surgeries, greater wait times at doctors’ offices and other facilities, or the need to travel greater distances to receive medical care. Some demand for care might be unmet.” [ 207 ] As an example of lengthy wait times associated with universal coverage, in 2017 Canadians were on waiting lists for an estimated 1,040,791 procedures, and the median wait time for arthroplastic surgery was 20–52 weeks. Similarly, average waiting time for elective hospital-based care in the United Kingdom is 46 days, while some patients wait over a year. Increased wait times in the U.S. would likely occur—at least in the short term—as a result of a steep rise in the number of primary and emergency care visits (due to eliminating the financial barrier to seek care), as well as general wastefulness, inefficiency, and disorganization that is often associated with bureaucratic, government-run agencies. [ 17 ] [ 190 ] Joshua W. Axene of Axene Health Partners, LLC “wonder[s] if Americans really could function under a system that is budget based and would likely have increased waiting times. In America we have created a healthcare culture that pays providers predominantly on a Fee for Service basis (FFS) and allows people to get what they want, when they want it and generally from whoever they want. American healthcare culture always wants the best thing available and has a ‘more is better’ mentality. Under a government sponsored socialized healthcare system, choice would become more limited, timing mandated, and supply and demand would be controlled through the constraints of a healthcare budget…. As much as Americans believe that they are crockpots and can be patient, we are more like microwaves and want things fast and on our own terms. Extended waiting lines will not work in the American system and would decrease the quality of our system as a whole.” [ 206 ] Read More

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Free Healthcare in the United States: A Possible Solution to Public Health Disparities

Nov 23, 2020 | Author Hala Atassi , Public Health Policy

Access to healthcare is one of the remarkable indicators that defines the quality of people’s lives. Despite the thousands of advanced technologies and countless healthcare clinics and hospitals, many people still cannot afford healthcare or health insurance. This has been a global concern for years, which many countries have resolved. However, the United States has yet to significantly progress towards making healthcare more accessible to low-income communities. There are many solutions to this problem that can be implemented today, upon which millions of suffering Americans depend.

Some studies have shown over the years that expensive health care is due to the high cost of defensive medicine, or in other words, physicians ordering expensive tests that may be unnecessary, as a way to deflect legal responsibility from themselves. Deviating from defensive medicine in the healthcare industry might impact physicians economically, but more importantly, it will help achieve affordable healthcare. 

Obamacare (the Affordable Care Act of 2010) is one program that focuses on extending healthcare to Americans and reducing public health disparities. This program lays down a foundation that people under the age of 26 will receive accessible care from their parent or guardian’s health care plans. Afterward, they must pay for their health care plan. Also, the program stipulates that the government provides free healthcare to retired adults from age 55 to 64, to avoid any insurance plan complications. Essentially, Obamacare seeks to expand access to healthcare care, regardless of the scale of one’s medical diagnosis, to ultimately save lives that would have been lost due to the inability to pay expensive medical bills.

Easier access to healthcare will result in a healthier nation. The healthcare system is one of the most important components in life, as the United States’ economy cannot be fully efficient and benefit all people until everyone can access quality, affordable healthcare. Free healthcare (or at least cheaper healthcare) would be the most effective system for America, which other countries like Switzerland and Singapore have demonstrated. The money spent by citizens on their healthcare could be redirected to other social support systems in America, like expanding access to nutritious foods as well. Although free healthcare has many perks, it also has disadvantages. Most notably, overloading health services with a large number of patients would overwhelm already busy healthcare systems. Patients may overuse the perk of free healthcare, leaving not taxpayers to suffer, but rather medical professionals and healthcare systems. Even so, the perceptible advantages of affordable healthcare outweigh the disadvantages. As it is, years of attempts to ameliorate the United States healthcare system have failed the American people, and the situation remains devastating and life-threatening for low-income communities. There should be no debate though as to whether America needs to redesign the public health system, as healthcare is a human right, and nobody should be dying because they cannot afford to live, especially when the government has the economic means to take care of them.

Bibliography:

Gerisch, Mary. “Health Care As a Human Right.” American Bar Association , www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/health-care-as-a-human-right/. 

“Free Health Care Policies.” World Health Organization , World Health Organization, 2020, www.who.int/news-room/fact-sheets/detail/free-health-care-policies. 

Gologorsky, Beverly. “Health Care in the US Should Be Affordable and Accessible.” The Nation , 9 May 2019, www.thenation.com/article/archive/tom-dispatch-health-care-should-be-affordable-and-accessible/. 

Luhby, Tami. “Here’s How Obamacare Has Changed America.” CNN , Cable News Network, 8 July 2019, www.cnn.com/2019/07/08/politics/obamacare-how-it-has-changed-america/index.html.

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Argumentative Essay: Healthcare Should Be Free

Imagine how helpless you would feel if you needed medical attention but could not get it because you were uninsured and could not afford the medical bill. Wouldn’t that make you feel dependent and unsupported because you can't receive the support you are entitled to? The US spends about $12,530 per person’s healthcare. Although the government provides its citizens with healthcare equally, not everyone needs the money for their healthcare, while others need more money than what is already provided to them. I think the American government should collectively spend for all of its citizens and make healthcare free for all Americans.. Healthcare is a human right that we should all be entitled to regardless of our class. It would save thousands of lives every year. Although many people argue that healthcare would increase the debt rate, free healthcare decreases the spending of the US.  Free healthcare should be enforced morally and logistically to all Americans. 

Healthcare should be provided to everyone at no cost because it is a basic human right that all Americans should be entitled to. In the article “Should All Americans Have the Right (Be Entitled) to Health Care?” It says, “The Declaration of Independence states that all men have “unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness,” [42] which necessarily entails having the health care needed to preserve life and pursue happiness.” This shows that healthcare is a right that all Americans should be entitled to. In this sentence, the author explains that the Declaration of Independence states that all men have the right to “Life, Liberty, and Pursuit to Happiness” this shows that healthcare is also considered a right, which falls into life and the pursuit of happiness. 

Healthcare saves thousands of lives which enforces the right to life and pursuit of happiness in the future. Free healthcare could save lives because many people die from illnesses they never got cured because of the cost of healthcare. In the article “Should All Americans Have the Right (Be Entitled) to Health Care?” Says, “According to a study from Harvard researchers, “lack of health insurance is associated with as many as 44,789 deaths per year,” which translates into a 40% increased risk of death among the uninsured.“ This proves that many people die because they were uninsured. This part of the passage shows a 40% increased risk of death among people who cannot get insured due to the lack of medical support given to the uninsured who can also not afford the medical bill. According to the “Centers for Medicare and Medicaid Services,” the number of people under the age of 65 who were uninsured at the time of the interview was 31.2 million people. This shows that many Americans under the age of 65 are uninsured and probably can not afford the medical bill. 

A common argument against this position is that free healthcare for all Americans would increase US debts. In the article “Should America Have Universal Health Care?” It says “From a study funded by the University of Massachusetts at Amherst, under a single-payer system where everyone has a right to healthcare, private and public healthcare spending could be lowered over 10 years by over 1.8 trillion dollars. This would be due to lower prescription and administrative drug costs.” Some people argue that free healthcare for all Americans would increase US debts. However, the text explains that providing free healthcare does not increase the spending of the US. Instead, It lowered the spending by $1.8 trillion because it lowered the price of drugs prescribed to patients. 

In conclusion, healthcare should be free for all Americans. All Americans should be provided free healthcare because it is a basic human right that all Americans should be entitled to. It would also save lives because many people die from illnesses they never got cured of due to the medical support they needed but did not receive and that was because they were uninsured. Logistically and Morally, Healthcare is a fundamental right that all Americans should be entitled to despite their income and what they can afford. This is an issue that requires us to come together and fight for our rights!

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Health Care is a Right, not a Privilege

“If you have your health, you have everything,” the classic saying goes. This is obviously not perfectly accurate, as many healthy people certainly do not have everything. However, it does reflect the connection that the right to health has to other human rights, and the interdependency that all human rights have with each other. Poor health can keep us from going to school or to work, caring for our families, or fully participating in our communities. States are responsible for respecting, protecting and fulfilling their human rights obligations, with international, regional, national and local actors supporting states and holding them accountable. The right to health exists, distinct from traditional political and civil rights, and there is an entire global apparatus built around making the right meaningful and real. I will spend this year exploring and evaluating these systems and human rights frameworks, seeking to understand how to best implement the human right to health.

So what does the right to health mean? States are obligated to fulfill the right through the provision of access to health care and hospitals, safe drinking water and sanitation, and food and housing. It entitles people to a system of disease prevention, treatment and control with access to essential medicines. It extends beyond these entitlements to people’s freedoms, such as the freedom to say no to medical treatment. It relates to a range of health determinants , including gender equality, healthy working conditions, and health-related education. The right to health is not the right to be healthy, which is outside of states’ direct control. This is why it is referred to as the right to the “highest attainable standard” of health. UN bodies, specialized agencies, the private sector, and even health professionals have responsibilities related to the right to health. The nature of businesses’ specific obligations are a bit unclear, and states are ultimately accountable for human rights violations, but there is a growing effort to define human rights standards that are applicable to businesses.

The right to health is idealistic in many ways, but it can be monitored and enforced. Accountability and monitoring take place at national, regional and international levels with involvement from states, NGOs, national human rights institutions, international treaty bodies and UN Special Rapporteurs. At the national level, administrative and political mechanisms contribute to accountability, such as national health policies and budgets. National judicial mechanisms can provide legal remedies to individuals when their rights are violated. Incorporating the right to health into national or subnational laws allows courts to judge violations with direct reference to the ICESCR. For example, Argentinian courts have ruled that the state must guarantee an available supply of antiretroviral drugs to people who are HIV-positive. Additionally, the Treatment Action Campaign in South Africa illustrates the ability of NGOs to use advocacy and social mobilization to fight for the right to health in its work for equal access to HIV treatment. In 2001, the Pretoria High Court ruled in favor of the Treatment Action Campaign and held that government restrictions on the drug nevirapine were unconstitutional, since the drug was proven to be effective but the government decided that it could only be distributed at two research sites. The Constitutional Court upheld the Pretoria ruling, stating that the government’s policy did not meet South Africa’s constitutional obligations to provide access to health care that “takes account of pressing social needs.” The government then removed nevirapine restrictions at public hospitals and clinics and created a comprehensive program to progressively realize the rights of pregnant women to prevent mother-to-child HIV transmission.

Through this series of blog posts, I will write about the usefulness of the human rights framework to global health endeavors. I strongly believe that, as the UN High Commissioner on Human Rights and WHO have stated , “The right to health is a fundamental part of our human rights and of our understanding of a life in dignity.” Physical and mental health allow adults to work and children to learn. The right to health cannot be realized without the realization of other rights that exist at the root of poverty, such as the rights to food, housing and water. Through exploring victories and pitfalls, I want to improve our understanding of how to best implement the right to health in practice. Achieving health equity worldwide requires innovative and interdisciplinary work, which necessitates a comprehensive understanding of international human rights law and governance.

Julia Kaufman is a T’18 Alumna and a 17′-18′ Human Rights Scholar at the Institute.

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Knowledge at Wharton Podcast

Does the u.s. need universal health care, december 8, 2020 • 11 min listen.

Wharton's Robert Hughes explains the moral and social benefits of universal health care and how such a system might look in the U.S.

• Public Policy

Wharton’s Robert Hughes speaks with Wharton Business Daily on SiriusXM about the need for universal health care in the U.S.

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.

Why Should Healthcare Be Free?

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.

Does the U.S. Hhave Universal Healthcare Now That Obamacare Exists?

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.

Why Doesn’t the U.S. Have Free Healthcare?

“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 at Wharton interviewed Hughes in 2019 about his paper. For an in-depth look into his research and advocacy, read the interview here .

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Is Health Care a Right?

Is health care a right? The United States remains the only developed country in the world unable to come to agreement on an answer. Earlier this year, I was visiting Athens, Ohio, the town in the Appalachian foothills where I grew up. The battle over whether to repeal, replace, or repair the Affordable Care Act raged then, as it continues to rage now. So I began asking people whether they thought that health care was a right. The responses were always interesting.

A friend had put me in touch with a forty-seven-year-old woman I’ll call Maria Dutton. She lived with her husband, Joe, down a long gravel driveway that snaked into the woods off a rural road. “You may feel like you are in the movie ‘Deliverance,’ ” she said, but it wasn’t like that at all. They had a tidy, double-wide modular home with flowered wallpaper, family pictures on every surface, a vase of cut roses on a sideboard, and an absurdly friendly hound in the yard. Maria told me her story sitting at the kitchen table with Joe.

She had joined the Army out of high school and married her recruiter—Joe is eleven years older—but after a year she had to take a medical discharge. She had developed severe fatigue, double vision, joint and neck pains, and muscle weakness. At first, doctors thought that she had multiple sclerosis. When that was ruled out, they were at a loss. After Joe left the military, he found steady, secure work as an electrical technician at an industrial plant nearby. Maria did secretarial and office-manager jobs and had a daughter. But her condition worsened, and soon she became too ill to work.

“I didn’t even have enough energy to fry a pound of hamburger,” she said. “I’d have to fry half of it and then sit down, rest, and get up and fry the rest. I didn’t have enough energy to vacuum one room of the house.” Eventually, she was diagnosed with chronic-fatigue syndrome and depression. She became addicted to the opioids prescribed for her joint pains and was started on methadone. Her liver began to fail. In 2014, she was sent two hundred miles away to the Cleveland Clinic for a liver-transplant evaluation. There, after more than two decades of Maria’s deteriorating health, doctors figured out what the problem was: sarcoidosis, an inflammatory condition that produces hardened nodules in organs throughout the body. The doctors gave her immunosuppressive medication, and the nodules shrank away. Within a year, she had weaned herself off the methadone.

“It was miraculous,” she said. In middle age, with her daughter grown up and in the Army Reserves herself, Maria got her life back and returned to school. All along, she’d had coverage through her husband’s work. “They have amazing insurance,” she said. “I think one year the insurance paid out two hundred thousand dollars. But we paid out, too.”

This was an understatement. Between a six-thousand-dollar deductible and hefty co-pays and premiums, the Duttons’ annual costs reached fifteen thousand dollars. They were barely getting by. Then one day in 2001 Joe blacked out, for no apparent reason, at a Girl Scout meeting for their daughter and fell down two flights of stairs, resulting in a severe concussion. It put him out of work for six months. Given the health-care costs and his loss of income, the couple ran out of money.

“We had to file for bankruptcy,” Joe said. He told me this reluctantly. It took them more than five years to dig out of the hole. He considered the bankruptcy “pretty shameful,” he said, and had told almost no one about it, not even his family. (This was why they didn’t want me to use their names.) He saw it as a personal failure—not the government’s. In fact, the whole idea that government would get involved in the financing of health care bothered him. One person’s right to health care becomes another person’s burden to pay for it, he said. Taking other people’s money had to be justified, and he didn’t see how it could be in cases like this.

“Everybody has a right to access health care,” he allowed, “but they should be contributing to the cost.” He pointed out that anyone could walk into a hospital with an emergency condition, get treated, and be billed afterward. “Yes, they may have collectors coming after them,” he said. “But I believe everybody should contribute for the treatment they receive.”

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Like her husband, Maria leans conservative. In the 2016 election, Joe voted for Donald Trump. Maria voted for Gary Johnson, the Libertarian candidate. But on health care she was torn. Joe wanted Obamacare repealed. She didn’t.

“I am becoming more liberal,” she said. “I believe that people should be judged by how they treat the least of our society.” At her sickest, she had been one of them. But she was reluctant to say that health care is a right. “There’s where the conservative side comes in and says, ‘You know what? I work really hard. I deserve a little more than the guy who sits around.’ ”

A right makes no distinction between the deserving and the undeserving, and that felt perverse to Maria and Joe. They both told me about people they know who don’t work and yet get Medicaid coverage with no premiums, no deductibles, no co-pays, no costs at all—coverage that the Duttons couldn’t dream of.

“I see people on the same road I live on who have never worked a lick in their life,” Joe said, his voice rising. “They’re living on disability incomes, and they’re healthier than I am.” Maria described a relative who got disability payments and a Medicaid card for a supposedly bad back, while taking off-the-books roofing jobs.

“Frankly, it annoys the crap out of me—they’re nothing but grasshoppers in the system,” Joe said, recalling the fable about the thriftless grasshopper and the provident ant.

The Duttons were doing all they could to earn a living and pay their taxes—taxes that helped provide free health care for people who did nothing to earn it. Meanwhile, they faced thousands of dollars in medical bills themselves. That seemed wrong. And in their view government involvement had only made matters worse.

“My personal opinion is that anytime the government steps in and says, ‘You must do this,’ it’s overstepping its boundaries,” Joe said. “A father, mother, two kids working their asses off—they’re making minimum wage and are barely getting by—I have no problem helping them. If I have someone who’s spent his whole life a drunk and a wastrel, no, I have no desire to help. That’s just the basics.”

Such feelings are widely shared. They’re what brought the country within a single vote of repealing major parts of President Obama’s expansion of health-care coverage. Some people see rights as protections provided by government. But others, like the Duttons, see rights as protections from government.

Tim Williams, one of my closest childhood friends, disagreed with the Duttons. Tim is a quiet fifty-two-year-old with the physique of a bodybuilder—he once bench-pressed me when we were in high school—and tightly cropped gray hair that used to be flame red. He survived metastatic melanoma, in the nineties, and losing his job selling motorcycles, during the great recession. He went through a year of chemotherapy and, later, three years without a job. He can figure out how to fix and build almost anything, but, without a college degree, he had few employment options. Hundreds of job applications later, though, he was hired as an operator at our town’s water-treatment plant, where I visited him.

The plant was built in the nineteen-fifties. We walked among giant pipes and valves and consoles that controlled the flow of water from local ground wells through a series of huge pools for filtration, softening, and chlorination, and out to the water towers on the tallest ridges surrounding the town. The low hum of the pump motors churned in the background.

People don’t think about their water, Tim said, but we can’t live without it. It is not a luxury; it’s a necessity of human existence. An essential function of government, therefore, is to insure that people have clean water. And that’s the way he sees health care. Joe wanted government to step back; Tim wanted government to step up. The divide seemed unbridgeable. Yet the concerns that came with each viewpoint were understandable, and I wondered if there were places where those concerns might come together.

Before I entered the field of public health, where it’s a given that health care is a right and not a privilege, I had grown up steeped in a set of core Midwestern beliefs: that you can’t get something for nothing, and that you should be reluctant to impose on others and, likewise, to be imposed upon. Here self-reliance is a totemic value. Athens, Ohio, is a place where people brew their own beer, shoot their own deer, fix their own cars (also grow their own weed, fight their own fights, get their own revenge). People here are survivors.

Monna French was one. She was fifty-three years old and the librarian at Athens Middle School. She’d been through a lot in life. She had started a local taxi company with her first husband, but they couldn’t afford health insurance. When she gave birth to her daughter Maggie and then to her son, Mac, the couple had to pay cash, pray that there’d be no unaffordable complications, and try to leave the hospital the next morning to avoid extra charges. When Monna and her husband divorced, litigation over the business left her with no income or assets.

“I had twenty-six dollars, two kids, and a cat,” she said.

She held down five part-time jobs, working as a teaching assistant for three different schools during the day, bartending at night, and selling furniture at Odd Lots department store on weekends, while her parents helped with the kids. Finally, she got the librarian job. It was classified as clerical work and didn’t pay well. But it meant that her family had health insurance, and a roof over their heads. She also met Larry, an iron worker and Vietnam veteran, who became her second husband. He had two children, but he was older and they were grown. Together, Monna and Larry had a child of their own, named Macie. Then, thirteen years ago, Maggie, at age sixteen, was killed in a car accident. Seven years ago, Larry’s son, Eric, who had spina bifida and multiple medical needs, died suddenly in his sleep, at the age of forty.

After twenty-two years as a librarian, Monna still makes only sixteen dollars and fifty cents an hour. Her take-home pay is less than a thousand dollars a month, after taxes and health-insurance contributions. Her annual deductible is three thousand dollars. Larry, now seventy-four, has retired, and his pension, military benefits, and Medicare helped keep them afloat.

For all her struggles, though, Monna is the kind of person who is always ready to offer a helping hand. When I visited her, there were stacks of posters on her porch, printed for a fund-raiser she was organizing for her daughter’s high-school marching band. She raised money for her township’s volunteer fire brigade. She was the vice-president of her local union, one of the largest in the county, which represents school-bus drivers, clerical staff, custodians, and other non-certified workers. She’d been deeply involved in contract negotiations to try to hold on to their wages and health benefits in the face of cutbacks.

“I don’t know anything about health care,” she protested when I asked her for her thoughts on the subject. In fact, she knew a lot. And, as she spoke, I thought I glimpsed a place where the health-care divide might just allow a bridge.

Monna considered herself a conservative. The notion of health care as a right struck her as another way of undermining work and responsibility: “Would I love to have health insurance provided to me and be able to stay home?” Of course, she said. “But I guess I’m going to be honest and tell you that I’m old school, and I’m not really good at accepting anything I don’t work for.”

She could quit her job and get Medicaid free, she pointed out, just as some of her neighbors had. “They have a card that comes in the mail, and they get everything they need!” she said. “Where does it end? I mean, how much responsibility do tax-paying people like me have? How much is too much?” She went on, “I understand that there’s going to be a percentage of the population that we are going to have to provide for.” When she was a young mother with two children and no home, she’d had to fall back on welfare and Medicaid for three months. Her stepson, Eric, had been on Medicaid and Social Security Disability Insurance before he died. Her eighty-three-year-old mother, who has dementia and requires twenty-four-hour care, was also on Medicaid. “If you’re disabled, if you’re mentally ill, fine, I get it,” Monna said. “But I know so many folks on Medicaid that just don’t work. They’re lazy.” Like the Duttons, she felt that those people didn’t deserve what they were getting.

But then we talked about Medicare, which provided much of her husband’s health care and would one day provide hers. That was different, Monna told me. Liberals often say that conservative voters who oppose government-guaranteed health care and yet support Medicare are either hypocrites or dunces. But Monna, like almost everyone I spoke to, understood perfectly well what Medicare was and was glad to have it.

I asked her what made it different.

“We all pay in for that,” she pointed out, “and we all benefit.” That made all the difference in the world. From the moment we earn an income, we all contribute to Medicare, and, in return, when we reach sixty-five we can all count on it, regardless of our circumstances. There is genuine reciprocity. You don’t know whether you’ll need more health care than you pay for or less. Her husband thus far has needed much less than he’s paid for. Others need more. But we all get the same deal, and, she felt, that’s what makes it O.K.

“I believe one hundred per cent that Medicare needs to exist the way it does,” she said. This was how almost everyone I spoke to saw it. To them, Medicare was less about a universal right than about a universal agreement on how much we give and how much we get.

Understanding this seems key to breaking the current political impasse. The deal we each get on health care has a profound impact on our lives—on our savings, on our well-being, on our life expectancy. In the American health-care system, however, different people get astonishingly different deals. That disparity is having a corrosive effect on how we view our country, our government, and one another.

The Oxford political philosopher Henry Shue observed that our typical way of looking at rights is incomplete. People are used to thinking of rights as moral trump cards, near-absolute requirements that all of us can demand. But, Shue argued, rights are as much about our duties as about our freedoms. Even the basic right to physical security—to be free of threats or harm—has no meaning without a vast system of police departments, courts, and prisons, a system that requires extracting large amounts of money and effort from others. Once costs and mechanisms of implementation enter the picture, things get complicated. Trade-offs now have to be considered. And saying that something is a basic right starts to seem the equivalent of saying only, “It is very, very important.”

Shue held that what we really mean by “basic rights” are those which are necessary in order for us to enjoy any rights or privileges at all. In his analysis, basic rights include physical security, water, shelter, and health care. Meeting these basics is, he maintained, among government’s highest purposes and priorities. But how much aid and protection a society should provide, given the costs, is ultimately a complex choice for democracies. Debate often becomes focussed on the scale of the benefits conferred and the costs extracted. Yet the critical question may be how widely shared these benefits and costs are.

Arnold Jonas is another childhood friend of mine. Blond, ruddy-faced, and sporting a paunch at fifty-two, he has rarely had a nine-to-five job and isn’t looking for one. The work he loves is in art and design—he once designed a project for the Smithsonian—but what usually pays the bills is physical labor or mechanical work. He lives from paycheck to paycheck. (“Retirement savings? Ha! You’re funny, Atul.”) Still, he has always known how to take care of himself. “I own my house,” he told me. “I have no debts.”

This is a guy who’s so handy that the cars he drives are rehabbed wrecks rebuilt from spare parts—including the old Volvo that he drove to the strip-mall Mexican restaurant near my family’s house, where we were catching up. But when I asked him about health care he could only shake his head.

“I just try not to think about it,” he said. He hadn’t seen a doctor in at least a decade. He got a health-care plan through an insurance-agent friend, but could only afford one with minimal benefits. He wasn’t sure whether he’d got an Obamacare subsidy. “I don’t read the fine print, because it’s going to be completely confusing anyway.” All he knew was that the plan cost him a hundred and ten dollars a month, and the high deductible (however many thousands of dollars it was, it was well beyond his savings account) made doctors’ visits almost out of the question.

“I am lucky I can get my teeth looked at because I’m dating a dental hygienist. But”—here he showed me his white-toothed grin—“I can’t date a dental hygienist and a cardiologist.”

Arnold, with his code of self-reliance, had eliminated nearly all sources of insecurity from his life. But here was one that was beyond his control. “The biggest worry I have would be some sort of health-care need,” he said. A serious medical issue would cost him his income. As an independent contractor, he isn’t eligible for unemployment benefits. And, having passed the age of fifty, he was just waiting for some health problem to happen.

So did he feel that he had a right to health care? No. “I never thought about it as a matter of rights,” he said. “A lot of these things we think are rights, we actually end up paying for.” He thinks that the left typically plays down the reality of the costs, which drives him crazy. But the right typically plays down the reality of the needs, which drives him crazy, too.

In his view, everyone has certain needs that neither self-reliance nor the free market can meet. He can fix his house, but he needs the help of others if it catches fire. He can keep his car running, but he needs the help of others to pave and maintain the roads. And, whatever he does to look after himself, he will eventually need the help of others for his medical care.

“I think the goal should be security,” he said of health care. “Not just financial security but mental security—knowing that, no matter how bad things get, this shouldn’t be what you worry about. We don’t worry about the Fire Department, or the police. We don’t worry about the roads we travel on. And it’s not, like, ‘Here’s the traffic lane for the ones who did well and saved money, and you poor people, you have to drive over here.’ ” He went on, “Somebody I know said to me, ‘If we give everybody health care, it’ll be abused.’ I told her that’s a risk we take. The roads are abused. A lot of things are abused. It’s part of the deal.”

He told me about a friend who’d undergone an emergency appendectomy. “She panicked when she woke up in the hospital realizing it would cost her a fortune,” he said. “Think about that. A lot of people will take a crappy job just to get the health benefits rather than start an entrepreneurial idea. If we’re talking about tax breaks for rich people to create jobs and entrepreneurialism, why not health care to allow regular people to do the same thing?”

As he saw it, government existed to provide basic services like trash pickup, a sewer system, roadways, police and fire protection, schools, and health care. Do people have a right to trash pickup? It seemed odd to say so, and largely irrelevant. The key point was that these necessities can be provided only through collective effort and shared costs. When people get very different deals on these things, the pact breaks down. And that’s what has happened with American health care.

The reason goes back to a seemingly innocuous decision made during the Second World War, when a huge part of the workforce was sent off to fight. To keep labor costs from skyrocketing, the Roosevelt Administration imposed a wage freeze. Employers and unions wanted some flexibility, in order to attract desired employees, so the Administration permitted increases in health-insurance benefits, and made them tax-exempt. It didn’t seem a big thing. But, ever since, we’ve been trying to figure out how to cover the vast portion of the country that doesn’t have employer-provided health insurance: low-wage workers, children, retirees, the unemployed, small-business owners, the self-employed, the disabled. We’ve had to stitch together different rules and systems for each of these categories, and the result is an unholy, expensive mess that leaves millions unprotected.

No other country in the world has built its health-care system this way , and, in the era of the gig economy, it’s becoming only more problematic. Between 2005 and 2015, according to analysis by the economists Alan Krueger and Lawrence Katz, ninety-four per cent of net job growth has been in “alternative work arrangements”—freelancing, independent contracting, temping, and the like—which typically offer no health benefits. And we’ve all found ourselves battling over who deserves less and who deserves more.

The Berkeley sociologist Arlie Russell Hochschild spent five years listening to Tea Party supporters in Louisiana, and in her masterly book “ Strangers in Their Own Land ” she identifies what she calls the deep story that they lived and felt. Visualize a long line of people snaking up a hill, she says. Just over the hill is the American Dream. You are somewhere in the middle of that line. But instead of moving forward you find that you are falling back. Ahead of you, people are cutting in line. You see immigrants and shirkers among them. It’s not hard to imagine how infuriating this could be to some, how it could fuel an America First ideal, aiming to give pride of place to “real” Americans and demoting those who would undermine that identity—foreigners, Muslims, Black Lives Matter supporters, feminists, “snowflakes.”

Our political debates seem to focus on what the rules should be for our place in line. Should the most highly educated get to move up to the front? The most talented? Does seniority matter? What about people whose ancestors were cheated and mistreated?

The mistake is accepting the line, and its dismal conception of life as a zero-sum proposition. It gives up on the more encompassing possibilities of shared belonging, mutual loyalty, and collective gains. America’s founders believed these possibilities to be fundamental. They held life, liberty, and the pursuit of happiness to be “unalienable rights” possessed equally by all members of their new nation. The terms of membership have had to be rewritten a few times since, sometimes in blood. But the aspiration has endured, even as what we need to fulfill it has changed.

When the new country embarked on its experiment in democracy, health care was too primitive to matter to life or liberty. The average citizen was a hardscrabble rural farmer who lived just forty years. People mainly needed government to insure physical security and the rule of law. Knowledge and technology, however, expanded the prospects of life and liberty, and, accordingly, the requirements of government. During the next two centuries, we relied on government to establish a system of compulsory public education, infrastructure for everything from running water to the electric grid, and old-age pensions, along with tax systems to pay for it all. As in other countries, these programs were designed to be universal. For the most part, we didn’t divide families between those who qualified and those who didn’t, between participants and patrons. This inclusiveness is likely a major reason that these policies have garnered such enduring support.

Health care has been the cavernous exception. Medical discoveries have enabled the average American to live eighty years or longer, and with a higher quality of life than ever before. Achieving this requires access not only to emergency care but also, crucially, to routine care and medicines, which is how we stave off and manage the series of chronic health issues that accumulate with long life. We get high blood pressure and hepatitis, diabetes and depression, cholesterol problems and colon cancer. Those who can’t afford the requisite care get sicker and die sooner. Yet, in a country where pretty much everyone has trash pickup and K-12 schooling for the kids, we’ve been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that’s open to all. Some even argue that such a system is un-American, stepping beyond the powers the Founders envisioned for our government.

In fact, in a largely forgotten episode in American history, Thomas Jefferson found himself confronting this very matter, shortly after his Inauguration as our third President, in 1801. Edward Jenner, in England, had recently developed a smallpox vaccine—a momentous medical breakthrough. Investigating the lore that milkmaids never got smallpox, he discovered that material from scabs produced by cowpox, a similar condition that afflicts cattle, induced a mild illness in people that left them immune to smallpox. Smallpox epidemics came with a mortality rate of thirty per cent or higher, and wiped out upward of five per cent of the population of cities like Boston and New York. Jefferson read Jenner’s report and arranged for the vaccination of two hundred relatives, neighbors, and slaves at Monticello. The President soon became vaccination’s preëminent American champion.

But supplies were difficult to produce, and the market price was beyond the means of most families. Jefferson, along with his successor, James Madison, believed in a limited role for the federal government. They did not take expanding its power and its commitments lightly. By the time Jefferson finished his two terms as President, however, city and state governments had almost entirely failed to establish programs to provide vaccines for their citizens. Thousands of lives continued to be lost to smallpox outbreaks. Meanwhile, vaccination programs in England, France, and Denmark had dramatically curbed the disease and measurably raised the national life expectancy. So, at Jefferson’s prompting, and with Madison’s unhesitating support, Congress passed the Vaccine Act of 1813 with virtually no opposition. A National Vaccine Agent was appointed to maintain stocks of vaccine and supply it to any American who requested it. The government was soon providing free vaccine for tens of thousands of people each year. It was the country’s first health-care entitlement for the general population. And its passage wasn’t in the least controversial.

Two centuries later, the Affordable Care Act was passed to serve a similar purpose: to provide all Americans with access to the life-preserving breakthroughs of our own generation. The law narrowed the yawning disparities in access to care, levied the taxes needed to pay for it, and measurably improved the health of tens of millions. But, to win passage, the A.C.A. postponed reckoning with our generations-old error of yoking health care to our jobs—an error that has made it disastrously difficult to discipline costs and insure quality, while severing care from our foundational agreement that, when it comes to the most basic needs and burdens of life and liberty, all lives have equal worth. The prospects and costs for health care in America still vary wildly, and incomprehensibly, according to your job, your state, your age, your income, your marital status, your gender, and your medical history, not to mention your ability to read fine print.

Few want the system we have, but many fear losing what we’ve got. And we disagree profoundly about where we want to go. Do we want a single, nationwide payer of care (Medicare for all), each state to have its own payer of care (Medicaid for all), a nationwide marketplace where we all choose among a selection of health plans (Healthcare.gov for all), or personal accounts that we can use to pay directly for health care (Health Savings Accounts for all)? Any of these can work. Each has been made to work universally somewhere in the world. They all have their supporters and their opponents. We disagree about which benefits should be covered, how generous the financial protection should be, and how we should pay for it. We disagree, as well, about the trade-offs we will accept: for instance, between increasing simplicity and increasing choice; or between advancing innovation and reducing costs.

What we agree on, broadly, is that the rules should apply to everyone. But we’ve yet to put this moral principle into practice. The challenge for any plan is to avoid the political perils of a big, overnight switch that could leave many people with higher costs and lower benefits. There are, however, many options for a gradual transition. Just this June, the Nevada legislature passed a bill that would have allowed residents to buy into the state’s Medicaid plan—if the governor hadn’t vetoed it. A similar bill to allow people to buy into Medicare was recently introduced in Congress. We need to push such options forward. Maintaining the link between health coverage and jobs is growing increasingly difficult, expensive, and self-defeating. But deciding to build on what’s currently working requires overcoming a well of mistrust about whether such investments will really serve a shared benefit.

My friend Betsy Anderson, who taught eighth-grade English at Athens Middle School for fifteen years, told me something that made me see how deep that well is. When she first started out as a teacher, she said, her most satisfying experiences came from working with eager, talented kids who were hungry for her help in preparing them for a path to college and success. But she soon realized that her class, like America as a whole, would see fewer than half of its students earn a bachelor’s degree. Her job was therefore to try to help all of her students reach their potential—to contribute in their own way and to pursue happiness on their own terms.

But, she said, by eighth grade profound divisions had already been cemented. The honors kids—the Hillary Clintons and Mitt Romneys of the school—sat at the top of the meritocratic heap, getting attention and encouragement. The kids with the greatest needs had special-education support. But, across America, the large mass of kids in the middle—the ones without money, book smarts, or athletic prowess—were outsiders in their own schools. Few others cared about what they felt or believed or experienced. They were the unspecial and unpromising, looked down upon by and almost completely separated from the college-bound crowd. Life was already understood to be a game of winners and losers; they were the designated losers, and they resented it. The most consistent message these students had received was that their lives were of less value than others’. Is it so surprising that some of them find satisfaction in a politics that says, essentially, Screw ’em all?

I met with Mark, a friend of Arnold’s, at the Union Street Diner, uptown near the campus of Ohio University, which makes Athens its home. The diner was a low-key place that stayed open twenty-four hours, with Formica tables and plastic cups, and a late-night clientele that was a mixture of townies and drunken students. I ordered a cheeseburger and onion rings. Mark ordered something healthier. (He asked me not to use his last name.) The son of a state highway patrolman, he had graduated from Athens High School five years ahead of me. Afterward, he worked as a cable installer, and got married at twenty-three. His wife worked at the Super Duper grocery store. Their pay was meagre and they were at the mercy of their bosses. So, the next year, they decided to buy a convenience store on the edge of town.

Mark’s father-in-law was a builder, and he helped them secure a bank loan. They manned the register day and night, and figured out how to make a decent living. It was never a lot of money, but over time they built up the business, opening gas pumps, and hiring college students to work the counter part time. They were able to make a life of it.

They adopted a child, a boy who was now a twenty-five-year-old graduate of the local university. Mark turned fifty-seven and remained a lifelong conservative. In general, he didn’t trust politicians. But he felt that Democrats in particular didn’t seem to recognize when they were pushing taxes and regulations too far. Health-care reform was a prime example. “It’s just the whole time they were coming up with this idea from copying some European model,” he said. “And I’m going, ‘Oh shit. This is not going to end up good for Mark.’ ” (Yes, he sometimes talks about himself in the third person.)

For his health coverage, Mark trusted his insurance agent, whom he’d known for decades, more than he trusted the government. He’d always chosen the minimum necessary, a bare-bones, high-deductible plan. He and his wife weren’t able to conceive, so they didn’t have to buy maternity or contraceptive coverage. With Obamacare, though, he felt forced to pay extra to help others get benefits that he’d never had or needed. “I thought, Well, here we go, I guess I’m now kicking in for Bill Gates’s daughter’s pregnancy, too.” He wanted to keep government small and taxes low. He was opposed to Obamacare.

Then, one morning a year ago, Mark’s back started to hurt. “It was a workday. I grabbed a Tylenol and I go, ‘No, this isn’t going to work, the pain’s too weird.’ ” It got worse, and when the pain began to affect his breathing he asked his wife to drive him to the emergency room.

“They put me in a bed, and eight minutes later I’m out,” he recalled. “I’m dying.” Someone started chest compressions. A defibrillator was wheeled in, and his heart was given a series of shocks. When he woke up, he learned that he’d suffered cardiac arrest. “They said, ‘Well, you’re going to Riverside’ ”—a larger hospital, in Columbus, eighty miles away. “And I went back out again.”

He’d had a second cardiac arrest, but doctors were able to shock him back to life once more. An electrocardiogram showed that he’d had a massive heart attack. If he was going to survive, he needed to get to Columbus immediately for emergency cardiac catheterization. The hospital got him a life-flight helicopter, but high winds made it unsafe to fly. So they took him by ground as fast as an ambulance could go. On the procedure table, a cardiologist found a blockage in the left main artery to his heart—a “widow-maker,” doctors call it—and stented it open.

“The medicine is just crazy good,” Mark said. “By twelve-thirty, I was fixed.”

After that, he needed five days in the hospital and several weeks at home to recover. Although he had to take a pile of drugs to reduce the chance of a recurrence, he got his strength back. He was able to resume work, hang out with his buddies, live his life.

It was only after this experience that Mark realized what the A.C.A. had given him. Like twenty-seven per cent of adults under sixty-five, he now had a preëxisting condition that would have made him uninsurable on the individual market before health-care reform went into effect. But the A.C.A. requires insurers to accept everyone, regardless of health history, and to charge the healthy and the less healthy the same community rate.

“This would have been a bad story for Mark,” he said. “Because the same time you’re being life-flighted is the same time you lose value to an employer. Your income is done.”

He no longer opposed the requirement that people get insurance coverage. Fire insurance wouldn’t work if people paid for it only when their house was on fire, and health insurance wouldn’t work if people bought it only when they needed it. He was no longer interested in repealing protections for people like him.

In this, he was like a lot of others. In 2013, before the implementation of the A.C.A., Americans were asked whether it was the government’s responsibility to make sure that everyone had health-care coverage, and fifty-six per cent said no. Four years after implementation, sixty per cent say yes.

“But that doesn’t mean I have to sign on for full-blown socialism—cradle-to-grave everything,” Mark said. “It’s a balance.” Our willingness to trust in efforts like health reform can be built on experience, as happened with Mark, though we must recognize how tenuous that trust remains. Two sets of values are in tension. We want to reward work, ingenuity, self-reliance. And we want to protect the weak and the vulnerable—not least because, over time, we all become the weak and vulnerable, unable to get by without the help of others. Finding the balance is not a matter of achieving policy perfection; whatever program we devise, some people will put in more and some will take out more. Progress ultimately depends on whether we can build and sustain the belief that collective action genuinely results in collective benefit. No policy will be possible otherwise.

Eight years after the passage of the Vaccine Act of 1813, a terrible mistake occurred. The Agent accidentally sent to North Carolina samples containing smallpox, instead of cowpox, causing an outbreak around the town of Tarboro that, in the next few months, claimed ten lives. The outrage over the “Tarboro Tragedy” spurred Congress to repeal the program, rather than to repair it, despite its considerable success. As a consequence, the United States probably lost hundreds of thousands of lives to a disease that several European programs had made vanishingly rare. It was eighty years before Congress again acted to insure safe, effective supplies of smallpox vaccine.

When I told this story to people in Athens, everyone took the repeal to be a clear mistake. But some could understand how such things happen. One conservative thought that the people in North Carolina might wonder whether the reports of lives saved by the vaccine were fake news. They saw the lives lost from the supposed accident. They knew the victims’ names. As for the lives supposedly saved because of outbreaks that didn’t occur—if you don’t trust the government’s vaccines, you don’t necessarily trust the government’s statistics, either.

These days, trust in our major professions—in politicians, journalists, business leaders—is at a low ebb. Members of the medical profession are an exception; they still command relatively high levels of trust. It does not seem a coincidence that medical centers are commonly the most culturally, politically, economically, and racially diverse institutions you will find in a community. These are places devoted to making sure that all lives have equal worth. But they also pride themselves on having some of the hardest-working, best-trained, and most innovative people in society. This isn’t to say that doctors, nurses, and others in health care fully live up to the values they profess. We can be condescending and heedless of the costs we impose on patients’ lives and bank accounts. We still often fail in our commitment to treating equally everyone who comes through our doors. But we’re embarrassed by this. We are expected to do better every day.

The repeal of the Vaccine Act of 1813 represented a basic failure of government to deliver on its duty to protect the life and liberty of all. But the fact that public vaccination programs eventually became ubiquitous (even if it took generations) might tell us something about the ultimate direction of our history—the direction in which we are still slowly, fitfully creeping.

On Mark’s last day in the hospital, the whole team came in to see him. He thanked them. “But I didn’t thank them for taking care of me,” he said. “I thanked them for when I was smoking, drinking, and eating chicken wings. They were all here working and studying, and I appreciated it.”

“That’s what you thanked them for?”

“Yeah,” he said. “Because if Mark wasn’t going to stop this, they were going to have to keep working hard. Something had to happen because Mark was clogging up.” And those people did keep working hard. They were there getting ready for Mark, regardless of who he would turn out to be—rich or poor, spendthrift or provident, wise or foolish. “I said, I am glad they do this every day, but I’m hoping to do it only once.” ♦

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Healthcare is a human right – but not in the United States

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The Supreme Court’s ruling on Dobbs v. Jackson in June is just the latest blow to health rights in the United States. National medical associations in the U.S. agree that abortion is essential to reproductive healthcare. So why would abortion not be protected as such? Because the U.S. does not, and never has, protected a right to health.  

Good health is the foundation of a person’s life and liberty. Injury and disease are always disruptive, and sometimes crippling. We might have to stop working, cancel plans, quarantine, hire help, and in cases of long-term disability, build whole new support systems to accommodate a new normal.

The U.S. remains the only high-income nation in the world without universal access to healthcare. However, the U.S. has signed and ratified one of the most widely adopted international treaties that includes the duty to protect the right to life. Under international law, the right to life simply means that humans have a right to live, and that nobody can try to kill another. Healthcare, the United Nations says, is an essential part of that duty. In 2018, the U.N. Committee on Civil and Political Rights said the right to life cannot exist without equal access to affordable healthcare services (including in prisons), mental health services, and notably, access to abortion. The U.N. committee mentioned health more than a dozen times in its statement on the right to life.

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The bottom line is: the U.S. can’t claim to protect life if it fails to protect health. And it has consistently failed on all three of the U.N.’s measures— the latest being access to abortion.

In the U.S., our debates around healthcare, and especially abortion, are hampered by a lack of right to health. Instead, the Supreme Court in 1973 protected access to abortion through the rights to privacy and due process, not health. Privacy is mentioned only twice by the U.N. committee commentary on the right to life.

Since Dobbs, several state legislatures have declared it fair game to criminalize abortion procedures even in cases where pregnancy threatens maternal health or life. Despite ample evidence that restrictive abortion laws lead to spikes in maternal mortality and morbidity—core public health indicators—the Court prior to the Dobb’s decision has defended abortion as merely a matter of privacy, not health or life. We know this is a myth. Abortion is deeply tied to the ability to stay healthy and in some cases, alive.

Regardless, our political parties remain deeply polarized on access to healthcare, including abortion. But lawmakers should know there is historical backing in the U.S. for elevating a right to health. None other than U.S. president Franklin D. Roosevelt, first proposed healthcare as a human right in his State of the Union address in 1944, as part of his ‘Second Bill of Rights.’ His list featured aspirational economic and social guarantees to the American people, like the right to a decent home and, of course, the right to adequate medical care.

Eleanor Roosevelt later took the Second Bill of Rights to the U.N., where it contributed to the right to health being included in the Universal Declaration of Human Rights in 1948. The right to health is now accepted international law, and is part of numerous treaties, none of which the U.S. Senate has seen fit to ratify. The U.S. conservative movement has historically declared itself averse to adopting rights that might expand government function and responsibility. In contrast, state legislatures in red states are keen to expand government responsibility when it comes to abortion. The conservative movement condemns government interference in the delivery of healthcare—except when it comes to reproductive health. The American Medical Association has called abortion bans a “direct attack” on medicine, and a “brazen violation of patients’ rights to evidence-based reproductive health services.”

Excepting access to abortion, U.S. lawmakers have largely left healthcare to the markets, rather than government. True, the government funds programs like Medicaid and Medicare but these programs vary significantly in quality and access by state, falling far short of providing fair, equitable, universal access to good healthcare.

The only two places where the U.S. government accepts some responsibility for the provision of healthcare are 1) in prisons and mental health facilities; and 2) in the military. While healthcare services in the U.S. prison system are notoriously deficient, they nevertheless exist and are recognized as an entitlement, underpinning the right to life. As an example, in 2005 a federal court seized control of the failing healthcare system in California’s Department of Corrections citing preventable deaths. In the military, free healthcare is an entitlement, and the quality of that care is deemed good enough even for the U.S. president.

So why doesn’t everyone in the U.S. have the same rights?

It is an uphill battle in a country that sees health and healthcare as a private matter for markets and individuals to navigate. But if we want to improve public health in the U.S. we need to start legislating healthcare as a right—and recognize that achieving the highest possible standards of public health is a legitimate government function.

photo: Tony Gutierrez / AP Photo

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Home — Essay Samples — Government & Politics — Health Care Reform — Should the Government Provide Free Health Care in America

Should The Government Provide Free Health Care in America

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Published: Apr 17, 2023

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Should healthcare | be free?

Access to good healthcare is vital so shouldn't it be available to everyone regardless of their financial situation? But can anything ever truly be 'free'? There's a range of different ways to fund healthcare but which is fairest? Let's dig deeper...

Build your own healthcare system - how would you organise and pay for it?

Should people who have medical conditions that are affected by their choices, e.g. lung cancer in people who smoke, have to pay more for their treatment?

• B : Yes, people who get an illness related to their lifestyle should pay more.
• A : No, it isn’t always clear whether a condition was caused by a person’s choices. We shouldn’t punish people by making it harder for them to access treatment. 

How do you think people should pay for healthcare?

• A : Collectively (e.g. through taxes) - people pay based on how much they earn, meaning richer people pay more and poorer people pay very little, regardless of how much treatment they need.
• B : Individually - people pay for each treatment only when they need it. Healthy people don’t pay as much, but sicker people pay more, and some poorer people may not be able to afford treatment.

People who are from poorer backgrounds often have worse health. Do you think:

• B : Money should be spent in a way that means people overall get the best possible health outcomes - we shouldn’t prioritise one group over another. 
• A : More money should be spent on people from poorer backgrounds to improve their health, even at the expense of some healthcare for wealthier people, to try to reduce health inequality.

Paying for healthcare collectively through taxes means that some new, very expensive treatments may not be affordable. Would you rather:

• A : Some treatments aren’t available for anyone because they are too expensive, but what is available is accessible and affordable to everyone who needs it. 
• B : Everyone is able to access all treatments, but they have to pay for it, meaning some people might not be able to afford them. 

Paying for healthcare collectively means that individuals don’t get to choose how much they spend on healthcare instead of other things, as paying for it is mandatory. Would you rather:

• B : People make their own decisions about how much to spend on healthcare. This means they risk not having enough money to pay for healthcare if they get very sick in future, but if they stay healthy they will have more money for other things.
• A : People are guaranteed healthcare over their lifetime, but they might not have as much money for things like education, food and hobbies - even if they are healthy and don’t use it.

Your spending decisions: what’s the bigger picture?

Did you answer A to more questions, or B? Let's see what this could mean in terms of real-life health spending. 

If you mostly chose A:

You prefer a healthcare system that favours giving everyone access to healthcare (also known as universal health care). Your healthcare system would probably look a lot like the National Health Service in the UK, where healthcare is paid for through taxes, and is mostly free to patients. It could also be paid for through mandatory insurance whereby citizens don’t get to choose how much they spend on healthcare, instead, it depends on how much they earn. But when they do get sick, they don’t have to pay extra, no matter how much healthcare they need. This collective payment system is usually cheaper overall, but it does sometimes mean that expensive treatments aren’t affordable.

If you chose mostly B:

You prefer a private healthcare system, like those in the USA or Switzerland. In these countries, patients pay for healthcare only when they need it, although most take out some kind of private insurance, in case they do get sick. The advantage of this system is that people get to choose how much they spend on health compared to other things, so healthy people can spend more on hobbies, travel or education, for example. There are also no national limits on what is affordable, so people with the money to pay for it can access the very latest treatments. The disadvantage is that the costs can be very high if you don’t have insurance. Even with insurance, costs are higher in non-mandatory private systems because fewer healthy people take out insurance. Healthy people paying into the health system can help make healthcare cheaper for people who need it. The result of this is that it is hard for poor people to get treatment they need, and health inequality is worse in these countries. 

A world tour of health funding

Most countries have a mixed model of funding healthcare for their citizens. However, generally, they can fall into one of the four systems explained below…

• This is a model that is famously adopted by the UK’s National Health Service (NHS) which ensures that ‘all people and communities can receive the health services they need without financial hardship’ (World Health Organisation, 2018). Although the majority of funding for the NHS comes from income taxes, you don’t have to be in work to be able to access NHS healthcare and, in this way, it is free at point of use. For some items such as prescriptions or dental procedures, there are additional charges, but these can be waived for certain groups. For example, you’re entitled to free prescriptions if you’re over 60 or under 16, among other reasons. This is in place to remove any potential barriers to care. The main limitation of this health care funding model is that it cannot provide every medical treatment for everyone. This particularly affects the newest treatments, which are often very expensive. In the UK, there is a body in place called the National Institute for Health and Care Excellence (NICE) which determines whether new treatments are cost-effective and therefore worth spending money on. 
• This is a common model of health funding adopted by most European countries and it can also provide universal health coverage by providing health care for all, regardless of personal income. In this system, every citizen buys a mandatory health insurance scheme, usually tied to their employment. The premium they pay depends on their income. By making insurance mandatory, healthy people have to buy insurance, pooling risk and making premiums more affordable for people with existing health problems. Those who can’t afford to pay (for example, those who are unemployed) are still enrolled and therefore able to access healthcare. Similar to UHC (see section above), there are limitations in the medical treatments that can be provided within this model of health funding, and organisations like NICE also exist in these countries. The key difference between the social insurance model and UHC is that the more you pay in can affect the quality of care you receive. So you might have shorter waiting times, for example, if you pay for a more expensive insurance scheme. In Germany, for example, those earning over an upper-income threshold (~EUR 60,000) can opt to purchase private insurance and gain access to a wider range of services and treatments.
• The private insurance model of healthcare funding is primarily used in the United States and Switzerland, although you can pay into similar schemes in other countries - including the UK - should you choose to. Unlike social insurance, private insurance is not linked to your earnings in the form of a tax or premium cap. You have to take out a policy as an individual, and your premium will depend on your health needs rather than your ability to pay. Unlike UHC and social insurance models, there are no limits to the kind of advanced and new medical treatments available within the private insurance system. But in reality, even with a comprehensive private policy, many of these treatments would be far too expensive for most patients to afford. Overall, within this model, healthcare access is based on what a person can afford rather than what they need. For some low-income people, families, pregnant women, elderly and disabled people, there is support with medical costs within government programs (such as US programmes Medicaid and ‘Obamacare’). However, there are still some people who struggle to qualify for this support and consequently struggle to afford any kind of medical cover.
• This is the model which tends to be in place when a country does not have a national funding structure, and as a result, it’s usually found in very low-income countries such as parts of sub-Saharan Africa. In other words, when you need to see a doctor, you have to pay for it yourself, without any kind of insurance or government support. This means there can be a lot of uncertainty for those who are unwell and many people are left in a vulnerable situation not knowing how they will cover the costs of care. In these countries, people frequently go without healthcare because they can’t afford it, although global initiatives are now seeking to bring UHC to these countries. 

The NHS in numbers

The UK National Health Service (NHS) celebrates its 70th anniversary in 2018. Take a look at this animation to see how it has changed over time. 

https://www.youtube.com/watch?time_continue=87&v=tn5Pt2TEgq4

Pre-1800: Healthcare was largely provided by untrained local people using homemade medicines.

1800: Doctors thought infection was caused by “bad air” they called “miasma”. Diseases spread fast and surgery was risky. 

1900: Developments in anaesthesia and sterile techniques meant patients could receive basic surgery without pain.  

Early 1900s: The World Wars posed a huge challenge for healthcare on the battlefield and at home. Many volunteers were needed like in this Oxfordshire hospital ward during the First World War. 

1948: Happy Birthday to the NHS! The service turns 70 in 2018. 

1950: Vaccination programs and antibiotics became mainstream, keeping people safe from serious diseases like smallpox, polio and tuberculosis.

2000: Thanks to better medical practices and healthier lifestyles, we're now living longer. If this trend continues, healthcare will need to keep up with the needs of an ageing population.

2018: Many predict that apps will take over diagnosis in the future. Would you trust an app with your healthcare? 

Should healthcare be free?

What does it mean when we say healthcare is ‘free’? Should there be a variety of healthcare providers on offer or just one national one? Prof. Joshua Hordern, Associate Professor of Christian Ethics at the University of Oxford answers these questions.  

If you’re ill or get badly injured in Britain, the chances are that you’ll seek help from the National Health Service (NHS for short). You’ll get treated by medical staff for free at your doctor’s surgery or at the hospital, and you won’t be issued with a hefty bill afterwards.

The NHS has existed for 70 years and Prof. Hordern says that it has a unique place in British society, even if people aren’t quite sure about how it works.

Taxing times

Prof. Hordern points out first of all that healthcare is not free in every sense in the UK but paid for by taxes. 

'We all pay for it,' he explains. 'Even those of us who don’t pay income tax still contribute towards healthcare through VAT and other taxes.' VAT stands for value added tax - it is a small amount of the price of many purchases and goes to the government.

He suggests that some people might even be willing to pay more taxes to fund healthcare, which is unsurprisingly an expensive undertaking. This is because in the UK, people feel very strongly about the importance of the NHS. 

'I think it’s peculiarly British,' he says. 'I think there’s a sense of national mission and vision around the NHS. It came out of the Second World War - but the founders never imagined the level of care now being provided.'

Part of the problem with the stretched NHS budget is that the UK's population is growing and people are living longer partly because of the quality of care they receive from the NHS throughout their lives. That means the NHS and society at large have more people to look after and many more people in their old age who need care.

Prof. Hordern says that lots of universities and other organisations now work with the NHS to do research into expensive treatments for illnesses and conditions, and this all costs money. He adds that these treatments might actually save us all money eventually but there isn’t any way to know that before the research starts. 

Responsibilities and costs

Although NHS healthcare might be free financially at the point of use, it isn’t free in other ways. For example, Prof. Hordern says that patients ought to use the shared resource of the NHS responsibly - we aren’t just free to do what we like. A good example is that people who have received an organ transplant should live in a way which honours the gift they have received, or if you make a doctor’s appointment you should make sure that you really need it and turn up to it on time.

He also says that the NHS is not free from personal cost for health service staff because of the long hours they work and the difficult things they do. That means that they - and their families - may suffer personal stress and strain. This is similar in some ways to the strains placed on armed service personnel and their families.

Private healthcare

Of course, people can also access health care outside the NHS but they would have to pay for it directly, whether through insurance or by finding the money afterwards. 'A good number of consultants work in the private sector as well as the public,' says Prof. Hordern. 'Some elements of private care are clearly very effective and good.'

He adds that there is considerable waste in the NHS, because it is hard for the people who work there both to be aware of how much things cost and to take tough decisions. If a hospital or a surgery is run as a business, it is possible - though by no means certain - that they will use money better.

The future of healthcare

What Prof. Hordern thinks is important is the way people view health and healthcare in the 21st century, and how they think about other national values.

'How do we think about our healthcare, as part of what identifies us and marks us as a nation?' he asks. 'How do we care for the most vulnerable in our society, especially the elderly?' With a large elderly population, it’s possible that older people will be suffering both psychologically and physically from loneliness and Prof. Hordern thinks that this is a huge health problem.

'The NHS isn’t set up to sort out loneliness,' he points out. He thinks that friends, family, neighbours and religious communities have a bigger role to play in supporting people who are ill or frail. If people aren’t seriously sick they don’t need to be in a hospital bed, and they could stay in their own homes if they had someone to look after them - but this can be difficult in the modern world, especially with the serious strain on public and private providers of social care at the moment.

'More and more of us are working, often long hours and in unstable employment,' he says. 'Life is demanding and expensive. So how do we build links in society? That’s an element of our lives which we have to work hard at renewing if we are to avoid social death for many people. In other words, a death before death, of isolation, of loneliness, of falling through the cracks.'

What health and care needs do you think we as a society should spend our money on? Would you be happy to pay for medical treatment? Do you think local communities could do more to take care of their most vulnerable members?

What changes could we make?

Dr. Marco Springmann discusses a new report from the Oxford Martin Programme on the Future of Food. It shows that a global switch to diets that rely more on fruit and vegetables than meat could save lives, reduce greenhouse gas emissions, lead to healthcare-related savings and avoid climate damages of $1.5 trillion (US). Would you be willing to make these changes? 

https://www.youtube.com/watch?v=MMnyFURBKAo

• The benefits of a digital healthcare system
• NHS funding’s north-south divide: why the ‘sicker’ north gets less money
• Should healthcare be free? Take this further...
• The biggest challenges for global healthcare
• The economics of tropical diseases
• The history of the NHS
• Vaccinations and the fight against poverty
• Medicines from the past - would you have tried them?

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July 15, 2024

Should the government provide free healthcare for all citizens?

Sample answer:.

In today’s world, the issue of healthcare is a hot topic of debate. Some people believe that the government should provide free healthcare for all citizens, while others argue that it should not be the responsibility of the government. In my opinion, I believe that the government should provide free healthcare for all citizens for several reasons.

First and foremost, access to healthcare is a basic human right. Every individual, regardless of their financial situation, should have the right to receive medical treatment when they are sick or injured. By providing free healthcare, the government can ensure that no one is denied access to essential medical services due to their inability to pay.

Moreover, free healthcare can lead to a healthier and more productive society. When people have access to regular check-ups and preventive care, they are less likely to develop serious illnesses that can be costly to treat. This can ultimately reduce the burden on the healthcare system and improve overall public health.

Additionally, providing free healthcare can help to reduce socioeconomic disparities in access to medical services. In many countries, individuals from lower-income backgrounds are at a disadvantage when it comes to receiving quality healthcare. By implementing a system of free healthcare, the government can work towards creating a more equitable society where everyone has an equal opportunity to lead a healthy life.

In conclusion, I believe that the government should provide free healthcare for all citizens. Not only is it a basic human right, but it can also lead to a healthier and more equitable society. By ensuring that everyone has access to medical treatment, the government can contribute to the overall well-being of its citizens.

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Essay on Free Healthcare

Students are often asked to write an essay on Free Healthcare in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Free Healthcare

Introduction.

Free healthcare means medical services are provided without cost. It’s a system where the government pays for citizens’ health needs.

Benefits of Free Healthcare

Free healthcare ensures everyone gets medical attention, regardless of their financial status. It reduces health inequalities and promotes a healthier society.

Challenges of Free Healthcare

However, free healthcare can lead to long waiting times and may lower the quality of care. It can also put financial pressure on the government.

Despite challenges, free healthcare is essential for a fair society. It ensures everyone has access to medical care.

250 Words Essay on Free Healthcare

Economic implications.

One of the primary arguments against free healthcare is the potential economic strain. Critics argue that it could lead to increased taxes and government spending, potentially destabilizing the economy. However, proponents counter this by stating that the economic benefits, such as reduced sick days and increased productivity, may outweigh the costs.

Healthcare Quality and Accessibility

Another concern is the potential decline in the quality of healthcare due to overburdened facilities and staff. However, proponents argue that free healthcare would increase accessibility, particularly for low-income individuals, leading to overall improved public health.

Universal Human Right

Advocates for free healthcare often cite the Universal Declaration of Human Rights, which states that everyone has a right to a standard of living adequate for health and well-being. They argue that free healthcare is a moral obligation of societies to ensure the well-being of all their members.

In conclusion, free healthcare is a complex issue with valid arguments on both sides. It requires careful consideration of economic implications, healthcare quality, and moral obligations. As future leaders, it is important for us to continue this discussion with empathy and critical thinking.

500 Words Essay on Free Healthcare

The idea of free healthcare has been a contentious topic for decades, stirring debates among policymakers, healthcare professionals, and citizens alike. In essence, free healthcare implies that the government provides medical services without charging the end-users. The concept is rooted in the belief that healthcare is a fundamental human right, irrespective of one’s financial standing. However, while the idea may seem ideal on the surface, it is critical to delve into its implications, advantages, and challenges.

Advantages of Free Healthcare

Furthermore, free healthcare can alleviate financial stress associated with medical costs. In many countries, medical debt is a leading cause of bankruptcy. Free healthcare can eliminate this burden, allowing individuals to allocate their resources to other essential areas such as education or housing.

Despite its potential benefits, free healthcare also presents significant challenges. The most prominent is the financial strain on the government. Funding free healthcare requires substantial public expenditure, which can lead to increased taxes or cuts in other public services.

Free Healthcare: A Balancing Act

Given the advantages and challenges, implementing free healthcare requires a delicate balancing act. Policymakers must ensure that the provision of free healthcare does not compromise the quality of care or place an undue financial burden on the state.

One potential solution could be a hybrid healthcare system, where basic healthcare is provided for free, while additional services are charged. This could strike a balance between ensuring universal access to healthcare and maintaining the sustainability of the system.

If you’re looking for more, here are essays on other interesting topics:

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Health Care: Should It Be For Free or Should We Pay For Our Treatment?

For several years, there has been debate over whether or not it is wise to have people responsible for any or more of their medical services. The challenge of saving individuals from the risk of medical bills while simultaneously trying to provide doctors, hospitals, and other medical services with resources for product development is at the heart of the issue. Free medical care offers the best cost security, but it also provides the smallest motivation for efficient production. Various innovations, such as indemnity insurance, can increase hospital incentives to produce efficiently. However, such instruments may be inefficient since they are not commonly used.

The Right to Free Health care

The free health care demand is based on the assumption that health care is a humanitarian right that we should not deny to anyone. Since it is a right, just like life, liberty, and happiness, the government should support it.

This right to free health cover, however, is a self-defeating argument. This is because everyone has the right to keep the fruits of their labor. As a result, no one has the right to free food, clothes, or health care. This is because someone must produce these goods. As a result, giving them away for free is an infringement on the rights of those who produce them. Physicians and surgeons have human rights in the same way as patients do. Suppose the government asked them to offer services for free. Then it would is an infringement on their right to earn a living.

Similarly, when governments begin taxing one person to support the health care of the other, they are simply transferring the fruits of one man’s labor to another. People may voluntarily contribute to their countrymen’s illness. Forcing people to sacrifice a percentage of their income is morally wrong.

As a result, no one has a valid right to free health care. Politicians made these are simply statements to expand the scope of government to gather more tax dollars. Once they have these tax dollars, they invest some of them in hospitals while embezzling some of them to create private wealth. Nationalized health care is a scam that we must avoid at all costs.

Advantages of Free Health care

According to Galambos (2018), universal health care plans are critical for countries to reduce health care costs. They give the government power over the medication process as well as negotiations. There are no administrative costs associated with dealing with private health insurers. So a single centralized government department may easily deal with physicians for quick solutions. 

The public can receive standardized care to ensure equal treatment from the available institutions. The government’s plan will provide all people who need it with access to available resources. Most importantly, unless the government approves, medication prices would stay low and unchanged. Other competitive conditions, such as the United States plan, focus on the most recent technologies to attract coincidence in patients.

Children who receive adequate health care are more likely to avoid future social costs. As a result, the government will save money in the long run. Thus, they can raise a healthy generation of children. Because proper health care benefited the young generation, the risk of some diseases may be minimized or reduced (Glassman, 2017).

Governments with control over health care administration can enact policies that guide patients to the best options.  For example, it may control access to appropriate drugs while eliminating alternative options. This may include illegal options. They can also increase a sin tax to reduce the chances of a smoking population. Raising the prices of cigarettes and alcohol would prevent people from participating in activities. This will directly improve their health.

Disadvantages of Free Health care

Free health care is not only morally incorrect. It also causes significant economic damage. The free health care system distorts the economy.

1. Monopoly

Health care systems are monopolized in countries such as Canada. This means that the government is now involved in all patient-doctor interactions.

As a result, a monopolistic bureaucracy delivers health care services rather than a free and open market. Customers’ demands are inherently sensitive in free markets. Companies that pay attention to consumer needs survive, whereas those that do not fail. Bureaucracies, on the other hand, have no reason to be customer-friendly. Monopolies exclude all competitive service providers and can survive by offering mediocre service. As a result, the government’s monopoly is lowering health-related quality in these countries.

2. Excess Demand

When something is free, consumers do not value it. The same is true for health care. When patients have to pay for their own treatment, they are more careful when seeking medical advice. This is why countries with free health care systems find themselves with an excess of demand. Patients flock to physicians for even the most minor of illnesses. As a result, those countries require more doctors and hospitals. To meet this unreasonable demand, they must extend the entire medical system.

Also, according to a study , users in public hospitals, as opposed to commercial healthcare, had unsatisfactory service results.

3. Shortages

Health care is expected to be treated the same as any other service. People who really need it should be able to purchase it. Citizens have to wait in line to receive their services due to the government’s monopolistic system. This is different from food, clothes, or any other good or service. Shortages and long wait times are unavoidable consequences of free health care systems. These situations are common in countries such as Canada. In countries where patients have to pay for these services, on the other hand, they can receive immediate medical attention. Government-provided free health service worsens the situation for everyone.

4. Tax Dollars

By nature, a free-for-all health system would be inefficient. However, governments in these countries claim that they would reduce inefficiency. They create elaborate plans which necessitate the spending of ever-increasing amounts of tax money. In the end, the system becomes so wasteful that society pays several times the amount it would have otherwise paid for its health care needs. Health care costs significantly increase the fiscal deficit in countries where a free health system has been implemented.

The fear of universal health care governments derives from their tendency to avoid the high costs associated with it. Moreover, administration logistics and management complexity are considered expensive and have a high failure rate.

Since the general income is derived from taxes, which increases the prices of goods across the board, healthier people may bear the cost of a few sickly citizens. As many European countries have shown, the problems posed by universal health care are manageable. Well-managed states can successfully manage universal health care in their respective countries. The benefits of having access to free health care outweigh the disadvantages. The word “universal health care” does not mean that everyone will be covered for all expenses. Instead, it focuses on easy accessibility for all citizens, making it an effective choice. The plan’s long-term benefits show that the argument for free health care is a better option to consider.

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Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons

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Every citizen of every country in the world should be provided with free and high-quality medical services. Health care is a fundamental need for every human, regardless of age, gender, ethnicity, religion, and socioeconomic status.

Universal health care is the provision of healthcare services by a government to all its citizens (insurancespecialists.com). This means each citizen can access medical services of standard quality. In the United States, about 25% of its citizens are provided with healthcare funded by the government. These citizens mainly comprise the elderly, the armed forces personnel, and the poor (insurancespecialists.com).

Introduction

Thesis statement.

• Universal Healthcare Pros
• Universal Healthcare Cons

Works Cited

In Russia, Canada, and some South American and European countries, the governments provide universal healthcare programs to all citizens. In the United States, the segments of society which do not receive health care services provided by the government usually pay for their health care coverage. This has emerged as a challenge, especially for middle-class citizens. Therefore, the universal health care provision in the United States is debatable: some support it, and some oppose it. This assignment is a discussion of the topic. It starts with a thesis statement, then discusses the advantages of universal health care provision, its disadvantages, and a conclusion, which restates the thesis and the argument behind it.

The government of the United States of America should provide universal health care services to its citizens because health care is a basic necessity to every citizen, regardless of age, gender, ethnicity, religion, and socioeconomic status.

Universal Healthcare Provision Pros

The provision of universal health care services would ensure that doctors and all medical practitioners focus their attention only on treating the patients, unlike in the current system, where doctors and medical practitioners sped a lot of time pursuing issues of health care insurance for their patients, which is sometimes associated with malpractice and violation of medical ethics especially in cases where the patient is unable to adequately pay for his or her health care bills (balancedpolitics.org).

The provision of universal health care services would also make health care service provision in the United States more efficient and effective. In the current system in which each citizen pays for his or her health care, there is a lot of inefficiency, brought about by the bureaucratic nature of the public health care sector (balancedpolitics.org).

Universal health care would also promote preventive health care, which is crucial in reducing deaths as well as illness deterioration. The current health care system in the United States is prohibitive of preventive health care, which makes many citizens to wait until their illness reach critical conditions due to the high costs of going for general medical check-ups. The cost of treating patients with advanced illnesses is not only expensive to the patients and the government but also leads to deaths which are preventable (balancedpolitics.org).

The provision of universal health care services would be a worthy undertaking, especially due to the increased number of uninsured citizens, which currently stands at about 45 million (balancedpolitics.org).

The provision of universal health care services would therefore promote access to health care services to as many citizens as possible, which would reduce suffering and deaths of citizens who cannot cater for their health insurance. As I mentioned in the thesis, health care is a basic necessity to all citizens and therefore providing health care services to all would reduce inequality in the service access.

Universal health care would also come at a time when health care has become seemingly unaffordable for many middle income level citizens and business men in the United States. This has created a nation of inequality, which is unfair because every citizen pays tax, which should be used by the government to provide affordable basic services like health care. It should be mentioned here that the primary role of any government is to protect its citizens, among other things, from illness and disease (Shi and Singh 188).

Lastly not the least, the provision of universal health care in the United States would work for the benefit of the country and especially the doctors because it would create a centralized information centre, with database of all cases of illnesses, diseases and their occurrence and frequency. This would make it easier to diagnose patients, especially to identify any new strain of a disease, which would further help in coming up with adequate medication for such new illness or disease (balancedpolitics.org).

Universal Healthcare Provision Cons

One argument against the provision of universal health care in the United States is that such a policy would require enormous spending in terms of taxes to cater for the services in a universal manner. Since health care does not generate extra revenue, it would mean that the government would either be forced to cut budgetary allocations for other crucial sectors of general public concern like defense and education, or increase the taxes levied on the citizens, thus becoming an extra burden to the same citizens (balancedpolitics.org).

Another argument against the provision of universal health care services is that health care provision is a complex undertaking, involving varying interests, likes and preferences.

The argument that providing universal health care would do away with the bureaucratic inefficiency does not seem to be realistic because centralizing the health care sector would actually increase the bureaucracy, leading to further inefficiencies, especially due to the enormous number of clientele to be served. Furthermore, it would lead to lose of business for the insurance providers as well as the private health care practitioners, majority of whom serve the middle income citizens (balancedpolitics.org).

Arguably, the debate for the provision of universal health care can be seen as addressing a problem which is either not present, or negligible. This is because there are adequate options for each citizen to access health care services. Apart from the government hospitals, the private hospitals funded by non-governmental organizations provide health care to those citizens who are not under any medical cover (balancedpolitics.org).

Universal health care provision would lead to corruption and rent seeking behavior among policy makers. Since the services would be for all, and may sometimes be limited, corruption may set in making the medical practitioners even more corrupt than they are because of increased demand of the services. This may further lead to deterioration of the very health care sector the policy would be aiming at boosting through such a policy.

The provision of universal health care would limit the freedom of the US citizens to choose which health care program is best for them. It is important to underscore that the United States, being a capitalist economy is composed of people of varying financial abilities.

The provision of universal health care would therefore lower the patients’ flexibility in terms of how, when and where to access health care services and why. This is because such a policy would throw many private practitioners out of business, thus forcing virtually all citizens to fit in the governments’ health care program, which may not be good for everyone (Niles 293).

Lastly not the least, the provision of universal health care would be unfair to those citizens who live healthy lifestyles so as to avoid lifestyle diseases like obesity and lung cancer, which are very common in America. Many of the people suffering from obesity suffer due to their negligence or ignorance of health care advice provided by the government and other health care providers. Such a policy would therefore seem to unfairly punish those citizens who practice good health lifestyles, at the expense of the ignorant (Niles 293).

After discussing the pros and cons of universal health care provision in the United States, I restate my thesis that “The government of United States of America should provide universal health care to its citizens because health care is a basic necessity to every citizen, regardless of age, sex, race, religion, and socio economic status”, and argue that even though there are arguments against the provision of universal health care, such arguments, though valid, are not based on the guiding principle of that health care is a basic necessity to all citizens of the United States.

The arguments are also based on capitalistic way of thinking, which is not sensitive to the plight of many citizens who are not able to pay for their insurance health care cover.

The idea of providing universal health care to Americans would therefore save many deaths and unnecessary suffering by many citizens. Equally important to mention is the fact that such a policy may be described as a win win policy both for the rich and the poor or middle class citizens because it would not in any way negatively affect the rich, because as long as they have money, they would still be able to customize their health care through the employment family or personal doctors as the poor and the middle class go for the universal health care services.

Balanced politics. “Should the Government Provide Free Universal Health Care for All Americans?” Balanced politics: universal health . Web. Balanced politics.org. 8 august https://www.balancedpolitics.org/universal_health_care.htm

Insurance specialists. “Growing Support for Universal Health Care”. Insurance information portal. Web. Insurance specialists.com 8 august 2011. https://insurancespecialists.com/

Niles, Nancy. Basics of the U.S. Health Care System . Sudbury, MA: Jones & Bartlett Learning, 2010:293. Print.

Shi, Leiyu and Singh, Douglas. Delivering Health Care in America: A Systems Approach . Sudbury, MA: Jones & Bartlett Learning, 2004:188. Print.

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IvyPanda. (2018, October 11). Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/

"Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." IvyPanda , 11 Oct. 2018, ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

IvyPanda . (2018) 'Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons'. 11 October.

IvyPanda . 2018. "Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." October 11, 2018. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

1. IvyPanda . "Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." October 11, 2018. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

Bibliography

IvyPanda . "Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons." October 11, 2018. https://ivypanda.com/essays/pros-and-cons-of-universal-health-care-provision-in-the-united-states/.

Why Healthcare Should Be Free

Why healthcare should be free. Every day we see people seek, we watch the news and we see people can’t pay their medicines because they are really expensive. I saw someone staying all month in bed because he could not pay the hospital. There is a lot of people dead just because of not having free healthcare they want to be healthy but there is no opportunity for them. Healthcare should be free because we have a lot of people who are not insured, we have high prices for medicines, and also our people deserve free healthcare because they pay taxes for everything. First of all, if we see some of the facts, 44 million of people have no insurance according to estimation of 2015. http://www.pbs.org/. The people who are most at risk today are those who have no insurance at all because they cannot get service when they needed and they are not catching real problems. It was a girl named Alicia. This girl had a car accident and was in a life or death conditions. What …show more content…

They figured out she did not had insurance and they were waiting till someone comes and pay for her bot no one came. So the girl died. “Sherry Glied, PHD, associated professor of public health Columbia University” shared this fact in public. https://www.mailman.columbia.edu. Second of all, healthcare should be free because the prices of medicines, hospitals, doctors, are very expensive. Hundreds of millions people are into poverty annually by the cost of accessing their local healthcare services. “David Nicholas says that the world need free healthcare for all”. https://www.linkedin.com. He says that Americans spend twice as much on healthcare per capita than any other country in the world. Also Dr. Mercola, support him in one article when she said that there is no freedom with this prices Joni Capo Professor: Dominique Brown 5/10/16 INRW 0420 Argumentative Essay that we pay for hospital.

Care For All : A Case For Universal Healthcare

The economics of healthcare is not at all simple. What you put in is certainly not necessarily indicative of what you get out, as shown by the striking discrepancy between what we pay and what we get out of our healthcare system. This is demonstrated further by comparing our system to those of France and Italy, who come in first and second, respectively, in WHO’s international ranking of healthcare systems (“World Health Organization’s Ranking of the World’s Health Systems”). Counter to what many Americans may believe, a number of European nations do not have completely socialized medicine.

Health Care Right or Privilege?

As I stated previously I think that all people should be allowed access to Health Care and I do think it is a right as an individual. I do believe also that it should not just be free. I feel that all persons should have to pay something for the services and medication they receive. With the cost of medical care estimated to reach the trillions in the next decade we must do something to help to keep those costs down as low as possible. However under the current condition of our economy, with nearly 10 million people in the country being out of work it would

Argumentative Essay: Free Healthcare In The United States

Even though free healthcare is negatively associated with U.S. debt, deficit, and higher tax pay, all Americans should have the absolute right to free healthcare because it can save lives.

Essay Free Healthcare in the US

• 7 Works Cited

I strongly believe that all American citizens should be entitled free healthcare. This is due to that fact that this can play a big role of ensuring that there is an improved access to health services. In addition, ensuring that all American citizens have an access to the right health care will also decrease health care costs. For instance, by allowing people to receive regular and preventive medical care and not wait until they are persistently ill to request treatment when medical costs are much higher (Niles, 2011). In relation to this free health care will promote equal chance by decreasing the number of people who are economically deprived in society (Niles, 2011). This can be because of bad health and other medically-related financial problems.

Obamacare : The Land Of The Free

America: The Land of the Free. Or, as someone who is familiar with the US health care system would call it, America: The Land of Overpriced Health Care That Covers a Fraction of it’s People. The US spends more money on their health care than any other country, yet there is a myriad of problems that exist within the system preventing it from being efficient. Billions of dollars are poured into the system for medication and treatment, when a lot of this spending is unnecessary.

Deductive Arguments For Universal Healthcare

Should Universal Healthcare be available to all regardless of their ability to pay in the same way that other services like education are available to all for free?

Free Healthcare And Health Care

As humans, the right to medical care is something that should be seen as a privilege. No one should have to worry about if they are able to receive the healthcare that they require. Everyone has the right to receive the care that they should need. The only way to provide equal care for everyone in America is if healthcare were to be free. Though many countries around the world are able to provide free healthcare, this is something that is unfortunately not possible for all countries. There would be many issues that would arise if free healthcare were provided here in America. Due to the fact that quality care would be difficult to find, taxes would be increased, and much more, health care should not be free.

A Universal Health Care System

Americans should have access to healthcare because no American should go in debt in order to be seen by a Doctor.

Free Health Care Research Paper

Another benefit associated with free health care system is that it preserves life as it ensures free treatment to the entire citizens despite their financial status. Apparently, the life of a human being is sacred and incomparable with any amount of money. It is unethical for an individual to die due to lack of finance. As stated by Obama, the United States is known to have the most skilled doctors and healthcare facilities in the world (526). Ironically, the two third of the Americans have no access to health insurance cover, meaning, they cannot afford to get the health services from the best doctors and the best facilities in the country. To protect life and to avoid unnecessary deaths of the innocent citizens, free access to medical services should be a distinct system to be employed in the United States of America.

Universal Health Care And Healthcare

Many developed countries such as Canada and United Kingdom have embraced universal health care with United States being the only exception that has not embraced universal health care to its citizens. One of the reasons is that universal health care will ensured that all Americans citizens to have the right to health care and will decrease health care costs by allowing people to receive regular and prevent medical care. And not have to wait until they are chronically ill to seek treatment when medical costs is way much higher. Another reason is health care should be a right because it will promote equal opportunity by decreasing the number of people who are economically disadvantaged in society due to bad health and medically-related financial trouble. And they won’t have to worry about when they get sick and have to pay. So I really think is a good idea that the government should provide health

The United States Should Provide Universal Health Care For All Of Its Citizens

I. More than 43 million Americans reported being uninsured throughout 2002 and millions more lack coverage for shorter periods. The lack of insurance negatively affects not only the uninsured, but their families, the communities in which they live, and the country as a whole (The Institute of Medicine).

Is health care a basic right? Essay

Health Care, like all other services comes at a financial cost. While we should strive to make health care available and affordable to all, the bottom line is that it is a service that can only be provided if the voting populous agrees on its need. Basic human rights do not cost money. We have the right to life and liberty which is great and we do not have to pay for it. We have the right to basic medical care as well. But we can only have that if other people

Persuasive Essay On Health Care

Healthcare is the maintenance or improvement of health and the prevention of sickness diagnosis, and treatment of disease, illness, and injury. Because of the need for healthcare is so important, the America government had to come up with a way to make sure people have healthcare and be able to pay for it. The government came up with a healthcare system that use insurance and premiums to make sure one has coverage when they go to the hospital for healthcare needs. If the government and hospitals really care about people’s health, then why do they make insurance and premiums so high that people cannot afford them? In 2005 there was an estimate 45 million Americans that lacked health insurance, and the numbers have been climbing since (Clemmitt, Universal Coverage 1). If the government says that they care about human life, then there should just be universal coverage so everyone can get their healthcare needs met no matter if that person is poor or rich.

U.S. Healthcare vs Canada and India

In principle, they should be able to get comprehensive, free, publicly financed and publicly provided healthcare. In practice, individuals have to pay a significant amount of funds out-of-pocket to obtain any healthcare and it is often the main source of healthcare, even for the poor.

Should The Government Provide Free Health Care For All Citizens?

The fact that health care isn’t free for everyone causes problems. Wealthy people being able to afford health care and poor people not are the first and biggest problem that we have today. This is very unfair. Whether a person is rich or poor, they still need the proper treatment and care in order for

Related Topics

• Health economics
• Health insurance
• Universal health care
• United States

Argumentative Essay: Should Health Care Be Free?

Show More Healthcare should be free because some people can not pay for a visit. Someone can be really ill and need a trip to the doctors but it is expensive to pay for it. There are times i’ve seen where adults and/or children have been in car accidents and those people result in being hurt. It is not those people’s fault that someone else caused an accident and so therefore there should be healthcare for those type of people who aren’t really the cause of an injury. If people have and can afford health care then those people have a better chance to be living their lives healthier knowing that they get checked up and there is really nothing to worry about. In addition to this, health care should be free because if people can’t afford to pay and someone is really ill then there might be a chance …show more content… Health care needs to be free because my friend needed braces but her mother was not able to afford it because it was too expensive. If healthcare was free then my friend wouldn’t have a problem getting braces and she wouldn’t be insecure about her smile. Opponents may argue that health care shouldn’t be free because the government has to pay more taxes. Yet, if all adults paid for health care it would save them a lot of money. It would save them trips from having to save up money for a check up but not only that, but also all the other check ups like for example a dentist appointment: “I mean, people have access to health care in America. After all, you just go to an emergency room” (www.amsa.org). The only way to get free health care is by paying more money to get yourselves a visitHealth care shouldn’t be free because adults

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He is dangerous in word, deed and action

He puts self over country, he loathes the laws we live by, donald trump is unfit to lead.

The editorial board is a group of opinion journalists whose views are informed by expertise, research, debate and certain longstanding values . It is separate from the newsroom.

Next week, for the third time in eight years, Donald Trump will be nominated as the Republican Party’s candidate for president of the United States. A once great political party now serves the interests of one man, a man as demonstrably unsuited for the office of president as any to run in the long history of the Republic, a man whose values, temperament, ideas and language are directly opposed to so much of what has made this country great.

It is a chilling choice against this national moment. For more than two decades, large majorities of Americans have said they are dissatisfied with the direction of the country, and the post-Covid era of stubborn inflation, high interest rates, social division and political stagnation has left many voters even more frustrated and despondent.

The Republican Party once pursued electoral power in service to solutions for such problems, to building “the shining city on a hill,” as Ronald Reagan liked to say. Its vision of the United States — embodied in principled public servants like George H.W. Bush, John McCain and Mitt Romney — was rooted in the values of freedom, sacrifice, individual responsibility and the common good. The party’s conception of those values was reflected in its longstanding conservative policy agenda, and today many Republicans set aside their concerns about Mr. Trump because of his positions on immigration, trade and taxes. But the stakes of this election are not fundamentally about policy disagreements. The stakes are more foundational: what qualities matter most in America’s president and commander in chief.

Mr. Trump has shown a character unworthy of the responsibilities of the presidency. He has demonstrated an utter lack of respect for the Constitution, the rule of law and the American people. Instead of a cogent vision for the country’s future, Mr. Trump is animated by a thirst for political power: to use the levers of government to advance his interests, satisfy his impulses and exact retribution against those who he thinks have wronged him.

He is, quite simply, unfit to lead.

The Democrats are rightly engaged in their own debate about whether President Biden is the right person to carry the party’s nomination into the election, given widespread concerns among voters about his age-related fitness. This debate is so intense because of legitimate concerns that Mr. Trump may present a danger to the country, its strength, security and national character — and that a compelling Democratic alternative is the only thing that would prevent his return to power. It is a national tragedy that the Republicans have failed to have a similar debate about the manifest moral and temperamental unfitness of their standard-bearer, instead setting aside their longstanding values, closing ranks and choosing to overlook what those who worked most closely with the former president have described as his systematic dishonesty, corruption, cruelty and incompetence.

That task now falls to the American people. We urge voters to see the dangers of a second Trump term clearly and to reject it. The stakes and significance of the presidency demand a person who has essential qualities and values to earn our trust, and on each one, Donald Trump fails.

Moral Fitness Matters

Presidents are confronted daily with challenges that require not just strength and conviction but also honesty, humility, selflessness, fortitude and the perspective that comes from sound moral judgment.

If Mr. Trump has these qualities, Americans have never seen them in action on behalf of the nation’s interests. His words and actions demonstrate a disregard for basic right and wrong and a clear lack of moral fitness for the responsibilities of the presidency.

He lies blatantly and maliciously, embraces racists , abuses women and has a schoolyard bully’s instinct to target society’s most vulnerable. He has delighted in coarsening and polarizing the town square with ever more divisive and incendiary language. Mr. Trump is a man who craves validation and vindication, so much that he would prefer a hostile leader’s lies to his own intelligence agencies’ truths and would shake down a vulnerable ally for short-term political advantage . His handling of everything from routine affairs to major crises was undermined by his blundering combination of impulsiveness, insecurity and unstudied certainty.

This record shows what can happen to a country led by such a person: America’s image, credibility and cohesion were relentlessly undermined by Mr. Trump during his term.

None of his wrongful actions are so obviously discrediting as his determined and systematic attempts to undermine the integrity of elections — the most basic element of any democracy — an effort that culminated in an insurrection at the Capitol to obstruct the peaceful transfer of power.

On Jan. 6, 2021, Mr. Trump incited a mob to violence with hateful lies, then stood by for hours as hundreds of his supporters took his word and stormed the Capitol with the aim of terrorizing members of Congress into keeping him in office. He praised these insurrectionists and called them patriots; today he gives them a starring role at campaign rallies, playing a rendition of the national anthem sung by inmates involved with Jan. 6., and he has promised to consider pardoning the rioters if re-elected. He continues to wrong the country and its voters by lying about the 2020 election, branding it stolen, despite the courts, the Justice Department and Republican state officials disputing him. No man fit for the presidency would flog such pernicious and destructive lies about democratic norms and values, but the Trumpian hunger for vindication and retribution has no moral center.

To vest such a person with the vast powers of the presidency is to endanger American interests and security at home as well as abroad. The nation’s commander in chief must uphold the oath to “preserve, protect and defend the Constitution.” It is the closest thing that this secular nation has to a sacred trust. The president has several duties and powers that are his alone: He has the sole authority to launch a nuclear weapon. He has the authority to send American troops into harm’s way and to authorize the use of lethal force against individuals and other nations. Americans who serve in the military also take an oath to defend the Constitution, and they rely on their commander in chief to take that oath as seriously as they do.

Mr. Trump has shown, repeatedly, that he does not. On numerous occasions, he asked his defense secretary and commanders in the American armed forces to violate that oath. On other occasions, he demanded that members of the military violate norms that preserve the dignity of the armed services and protect the military from being used for political purposes. They largely refused these illegal and immoral orders, as the oath requires.

The lack of moral grounding undermines Mr. Trump even in areas where voters view him as stronger and trust him more than Mr. Biden, like immigration and crime. Veering into a kind of brutal excess that is, at best, immoral and, at worst, unconstitutional, he has said that undocumented immigrants were “ poisoning the blood of our country ,” and his advisers say he would aim to round them up in mass detention camps and end birthright citizenship . He has indicated that, if faced with episodes of rioting or crime surges, he would unilaterally send troops into American cities. He has asked aides if the United States could shoot migrants below the waist to slow them down, and he has said that he would use the Insurrection Act to deploy the military against protesters.

During his time in office, none of those things happened because there were enough people in military leadership with the moral fitness to say “no” to such illegal orders. But there are good reasons to worry about whether that would happen again, as Mr. Trump works harder to surround himself with people who enable rather than check his most insidious impulses.

The Supreme Court, with its ruling on July 1 granting presidents “absolute immunity” for official acts, has removed an obstacle to Mr. Trump’s worst impulses: the threat of legal consequences. What remains is his own sense of right and wrong. Our country’s future is too precious to rely on such a broken moral compass.

Principled Leadership Matters

Republican presidents and presidential candidates have used their leadership at critical moments to set a tone for society to live up to. Mr. Reagan faced down totalitarianism in the 1980s, appointed the first woman to the Supreme Court and worked with Democrats on bipartisan tax and immigration reforms. George H.W. Bush signed the Americans With Disabilities Act and decisively defended an ally, Kuwait, against Iraqi aggression. George W. Bush, for all his failures after Sept. 11, did not stoke hate against or demonize Muslims or Islam.

As a candidate during the 2008 race, Mr. McCain spoke out when his fellow conservatives spread lies about his opponent, Barack Obama. Mr. Romney was willing to sacrifice his standing and influence in the party he once represented as a presidential nominee, by boldly calling out Mr. Trump’s failings and voting for his removal from office.

These acts of leadership are what it means to put country first, to think beyond oneself.

Mr. Trump has demonstrated contempt for these American ideals. He admires autocrats, from Viktor Orban to Vladimir Putin to Kim Jong-un. He believes in the strongman model of power — a leader who makes things happen by demanding it, compelling agreement through force of will or personality. In reality, a strongman rules through fear and the unprincipled use of political might for self-serving ends, imposing poorly conceived policies that smother innovation, entrepreneurship, ideas and hope.

During his four years in office, Mr. Trump tried to govern the United States as a strongman would, issuing orders or making decrees on Twitter. He announced sudden changes in policy — on who can serve in the military , on trade policy, on how the United States deals with North Korea or Russia — without consulting experts on his staff about how these changes would affect America. Indeed, nowhere did he put his political or personal interests above the national interest more tragically than during the pandemic , when he faked his way through a crisis by touting conspiracy theories and pseudoscience while ignoring the advice of his own experts and resisting basic safety measures that would have saved lives.

He took a similar approach to America’s strategic relationships abroad. Mr. Trump lost the trust of America’s longstanding allies, especially in NATO, leaving Europe less secure and emboldening the far right and authoritarian leaders in Europe, Latin America and Asia. He pulled out of the Iran nuclear deal, leaving that country, already a threat to the world, more dangerous, thanks to a revived program that has achieved near-weapons-grade uranium.

In a second term, his willingness to appease Mr. Putin would leave Ukraine’s future as a democratic and independent country in doubt. Mr. Trump implies that he could single-handedly end the catastrophic war in Gaza but has no real plan. He has suggested that in a second term he’d increase tariffs on Chinese goods to 60 percent or higher and that he would put a 10 percent tariff on all imported goods, moves that would raise prices for American consumers and reduce innovation by allowing U.S. industries to rely on protectionism instead.

The worst of the Trump administration’s policies were often blocked by Congress, by court challenges and by the objections of honorable public servants who stepped in to thwart his demands when they were irresponsible or did not follow the law. When Mr. Trump wanted an end to Obamacare, a single Republican senator, Mr. McCain, saved it, preserving health care for millions of Americans. Mr. Trump demanded that James Comey, his F.B.I. director, pledge loyalty to him and end an investigation into a political ally; Mr. Comey refused. Scientists and public health officials called out and corrected his misinformation about climate science and Covid. The Supreme Court sided against the Trump administration more times than any other president since at least Franklin D. Roosevelt.

A second Trump administration would be different. He intends to fill his administration with sycophants, those who have shown themselves willing to obey Mr. Trump’s demands or those who lack the strength to stand up to him. He wants to remove those who would be obstacles to his agenda, by enacting an order to make it easier to fire civil servants and replace them with those more loyal to him.

This means not only that Americans would lose the benefit of their expertise but also that America would be governed in a climate of fear, in which government employees must serve the interests of the president rather than the public. All cabinet secretaries follow a president’s lead, but Mr. Trump envisions a nation in which public service as Americans understand it would cease to exist — where individual civil servants and departments could no longer make independent decisions and where research by scientists and public health experts and investigations by the Justice Department and others in federal law enforcement would be more malleable to the demands of the White House.

Another term under Mr. Trump’s leadership would risk doing permanent damage to our government. As Mr. Comey, a longtime Republican, wrote in a 2019 guest essay for Times Opinion, “Accomplished people lacking inner strength can’t resist the compromises necessary to survive Mr. Trump and that adds up to something they will never recover from.” Very few who serve under him can avoid this fate “because Mr. Trump eats your soul in small bites,” Mr. Comey wrote. “Of course, to stay, you must be seen as on his team, so you make further compromises. You use his language, praise his leadership, tout his commitment to values. And then you are lost. He has eaten your soul.” America will get nowhere with a strongman. It needs a strong leader.

Character Matters

Character is the quality that gives a leader credibility, authority and influence. During the 2016 campaign, Mr. Trump’s petty attacks on his opponents and their families led many Republicans to conclude that he lacked such character. Other Republicans, including those who supported the former president’s policies in office, say they can no longer in good conscience back him for the presidency. “It’s a job that requires the kind of character he just doesn’t have,” Paul Ryan, a former Republican House speaker, said of Mr. Trump in May .

Those who know Mr. Trump’s character best — the people he appointed to serve in the most important positions of his White House — have expressed grave doubts about his fitness for office.

His former chief of staff John Kelly, a retired four-star Marine Corps general, described Mr. Trump as “a person who admires autocrats and murderous dictators. A person that has nothing but contempt for our democratic institutions, our Constitution and the rule of law.” Bill Barr, whom Mr. Trump appointed as attorney general, said of him , “He will always put his own interest and gratifying his own ego ahead of everything else, including the country’s interest.” James Mattis, a retired four-star Marine general who served as defense secretary, said , “Donald Trump is the first president in my lifetime who does not try to unite the American people — does not even pretend to try.”

Mike Pence, Mr. Trump’s vice president, has disavowed him. No other vice president in modern American history has done this. “I believe that anyone who puts themselves over the Constitution should never be president of the United States,” Mr. Pence has said . “And anyone who asked someone else to put them over the Constitution should never be president of the United States again.”

These are hardly exceptions. In any other American administration, a single cabinet-level defection is rare. But an unprecedented number of Mr. Trump’s appointees have publicly criticized his leadership, opposed his 2024 presidential candidacy or ducked questions about his fitness for a second term. More than a dozen of his most senior appointees — those he chose to work alongside him and who saw his performance most closely — have spoken out against him, serving as witnesses about the kind of leader he is.

There are many ways to judge leaders’ character; one is to see whether they accept responsibility for their actions. As a general rule, Mr. Trump abhors accountability. If he loses, the election is rigged. If he is convicted, it’s because the judges are out to get him. If he doesn’t get his way in a deal, as happened multiple times with Congress in his term, he shuts down the government or threatens to.

Americans do not expect their presidents to be perfect; many of them have exhibited hubris, self-regard, arrogance and other character flaws. But the American system of government is more than just the president: It is a system of checks and balances, and it relies on everyone in government to intervene when a president’s personal failings might threaten the common good.

Mr. Trump tested those limits as president, and little has changed about him in the four years since he lost re-election. He tries to intimidate anyone with the temerity to testify as a witness against him. He attacks the integrity of judges who are doing their duty to hold him accountable to the law. He mocks those he dislikes and lies about those who oppose him and targets Republicans for defeat if they fail to bend the knee.

It may be tempting for Americans to believe that a second Trump presidency would be much like the first, with the rest of government steeled to protect the country and resist his worst impulses. But the strongman needs others to be weak, and Mr. Trump is surrounding himself with yes men.

The American public has a right to demand more from their president and those who would serve under him.

A President’s Words Matter

When America saw white nationalists and neo-Nazis march through the streets of Charlottesville, Va., in 2017 and activists were rallying against racism, Mr. Trump spoke of “very fine people on both sides.” When he was pressed about the white supremacist Proud Boys during a 2020 debate, Mr. Trump told them to “stand back and stand by,” a request that, records show, they took literally in deciding to storm Congress. This winter, the former president urged Iowans to vote for him and score a victory over their fellow Americans — “all of the liars, cheaters, thugs, perverts, frauds, crooks, freaks, creeps.” And in a Veterans Day speech in New Hampshire, he used the word “vermin,” a term he has deployed to describe both immigrants and political opponents.

What a president says reflects on the United States and the kind of society we aspire to be.

In 2022 this board raised an urgent alarm about the rising threat of political violence in the United States and what Americans could do to stop it. At the time, Mr. Trump was preparing to declare his intention to run for president again, and the Republican Party was in the middle of a fight for control, between Trumpists and those who were ready to move on from his destructive leadership. This struggle within the party has consequences for all Americans. “A healthy democracy requires both political parties to be fully committed to the rule of law and not to entertain or even tacitly encourage violence or violent speech,” we wrote.

A large faction of one party in our country fails that test, and that faction, Mr. Trump’s MAGA extremists, now control the party and its levers of power. There are many reasons his conquest of the Republican Party is bad for American democracy, but one of the most significant is that those extremists have often embraced violent speech or the belief in using violence to achieve their political goals. This belief led to the Jan. 6 attack on the Capitol, and it has resulted in a rising number of threats against judges, elected officials and prosecutors.

This threat cannot be separated from Mr. Trump’s use of language to encourage violence, to dehumanize groups of people and to spread lies. A study by researchers at the University of California, Davis, released in October 2022, came to the conclusion that MAGA Republicans (as opposed to those who identified themselves as traditional Republicans) “are more likely to hold extreme and racist beliefs, to endorse political violence, to see such violence as likely to occur and to predict that they will be armed under circumstances in which they consider political violence to be justified.”

The Republican Party had an opportunity to renounce Trumpism; it has submitted to it. Republican leaders have had many opportunities to repudiate his violent discourse and make clear that it should have no place in political life; they failed to. Sizable numbers of voters in Republican primaries abandoned Mr. Trump for other candidates, and independent and undecided voters have said that Mr. Trump’s language has alienated them from his candidacy.

But with his nomination by his party all but assured, Mr. Trump has become even more reckless in employing extreme and violent speech, such as his references to executing generals who raise questions about his actions. He has argued, before the Supreme Court, that he should have the right to assassinate a political rival and face no consequences.

The Rule of Law Matters

The danger from these foundational failings — of morals and character, of principled leadership and rhetorical excess — is never clearer than in Mr. Trump’s disregard for rule of law, his willingness to do long-term damage to the integrity of America’s systems for short-term personal gain.

As we’ve noted, Mr. Trump’s disregard for democracy was most evident in his attempts to overturn the results of the 2020 election and to encourage violence to stop the peaceful transfer of power. What stood in his way were the many patriotic Americans, at every level of government, who rejected his efforts to bully them into complying with his demands to change election results. Instead, they followed the rules and followed the law. This respect for the rule of law, not the rule of men, is what has allowed American democracy to survive for more than 200 years.

In the four years since losing the election, Mr. Trump has become only more determined to subvert the rule of law, because his whole theory of Trumpism boils down to doing whatever he wants without consequence. Americans are seeing this unfold as Mr. Trump attempts to fight off numerous criminal charges. Not content to work within the law to defend himself, he is instead turning to sympathetic judges — including two Supreme Court justices with apparent conflicts over the 2020 election and Jan. 6-related litigation. The playbook: delay federal prosecution until he can win election and end those legal cases. His vision of government is one that does what he wants, rather than a government that operates according to the rule of law as prescribed by the Constitution, the courts and Congress.

As divided as America is, people across the political spectrum generally recoil from rigged rules, favoritism, self-dealing and abuse of power. Our country has been so stable for so long in part because most Americans and most American leaders follow the rules or face the consequences.

So much in the past two decades has tested these norms in our society — the invasion of Iraq under false pretenses, the failures that led to the 2008 financial crisis and the recession that followed, the pandemic and all the fractures and inequities that it revealed. We need a recommitment to the rule of law and the values of fair play. This election is a moment for Americans to decide whether we will keep striving for those ideals.

Mr. Trump rejects them. If he is re-elected, America will face a new and precarious future, one that it may not be prepared for. It is a future in which intelligence agencies would be judged not according to whether they preserved national security but by whether they served Mr. Trump’s political agenda. It means that prosecutors and law enforcement officials would be judged not according to whether they follow the law to keep Americans safe but by whether they obey his demands to “go after” political enemies. It means that public servants would be judged not according to their dedication or skill but by whether they show sufficient loyalty to him and his MAGA agenda.

Even if Mr. Trump’s vague policy agenda would not be fulfilled, he could rule by fear. The lesson of other countries shows that when a bureaucracy is politicized or pressured, the best public servants will run for the exits.

This is what has already happened in Mr. Trump’s Republican Party, with principled leaders and officials retiring, quitting or facing ouster. In a second term, he intends to do that to the whole of government.

Election Day is less than four months away. The case against Mr. Trump is extensive, and this board urges Americans to perform a simple act of civic duty in an election year: Listen to what Mr. Trump is saying, pay attention to what he did as president and allow yourself to truly inhabit what he has promised to do if returned to office.

Voters frustrated by inflation and immigration or attracted by the force of Mr. Trump’s personality should pause and take note of his words and promises. They have little to do with unity and healing and a lot to do with making the divisions and anger in our society wider and more intense than they already are.

The Republican Party is making its choice next week; soon all Americans will be able to make their own choice. What would Mr. Trump do in a second term? He has told Americans who he is and shown them what kind of leader he would be.

When someone fails so many foundational tests, you don’t give him the most important job in the world.

From top, photographs and video by Damon Winter/The New York Times (2) and Jay Turner Frey Seawell (5).

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