Rice University's premier undergraduate journal of scholarship in domestic and international policy.
Rahul Shah
Dec 16, 2023
Considering Approaches for Federal Healthcare Policy
Photo by Shelly Shoots/Shutterstock
At only two months old, Isla Weston faced a dire diagnosis of toxoplasmosis, a condition requiring immediate treatment to avert a fatal outcome. Given the severity of the illness, her family not only had to worry about her treatment and recovery but also the astronomical price hike of the essential medication, surging from a mere $14 per tablet to an astonishing $750 overnight (Vermont Legislature, 2016). This tragic incident mirrors the predicament of millions of Americans grappling with ever-increasing healthcare costs. Over the past decade, health insurance premiums and deductibles have skyrocketed far past the rate of workers' earnings, leaving over 25 million U.S. adults without access to healthcare (Peterson, 2023). For many Americans, the unaffordability of necessary medical treatment is dire. For example, a staggering 37 million Americans struggle with diabetes, and one-fifth of them don’t receive any treatment whatsoever (CDC, 2023). Consequently, a grim statistic emerges: at least 26,000 Americans die annually due to the lack of health insurance (Tanne, 2008).
Even for those able to secure healthcare, the burden of exorbitant medical bills remains a daunting obstacle for Americans. Medical debt forces 11.2 million individuals into poverty annually (Weissman, 2016). Such harrowing circumstances demand immediate attention and comprehensive healthcare policy reform.
Current Proposals
Medicare-for-All is one of the most popular proposals for healthcare reform in the United States. In Medicare-for-All, a more accessible government-funded program would replace the current system of for-profit insurance. This proposal, championed by various proponents like Senator Bernie Sanders (Vermont) or Rep. Pramila Jayapal (Washington) in legislative chambers and public discourse, aims to provide free healthcare access to every American while eliminating premiums, deductibles, and copayments (Katz, 2020). This particular policy transformation is a radical departure from the current healthcare system, where consumers and healthcare providers navigate a convoluted landscape of billing intricacies and protracted negotiations with countless insurance companies. Medicare-for-All simplifies this complex ecosystem by shifting the administrative burden to the government, thus allowing hospitals and healthcare providers to focus on delivering accessible, quality care and conserving valuable resources.
Medicare-for-All does have a host of its own challenges, however. By shifting costs and administrative burdens away from customers and hospitals or health clinics, the responsibility falls on the federal government. Conservative estimates claim that Medicare-for-All could cost upwards of 30 trillion dollars over the next ten years (Luthra, 2020). Further, the current Medicaid system does a poor job allocating and distributing capital, which has caused an increase in inefficiency (Waddill, 2023). It is plausible that an even larger and more comprehensive healthcare system would further exacerbate such inefficiencies. The costs of implementing Medicare-for-All would be passed down to Americans whether it be through taxes, inflationary policy, the ever-expanding federal deficit or some combination of the three.
Political Cost/Feasibility
A more important issue at hand is the political feasibility of implementing Medicare-for-All. Political complexities and challenges burden the pathway to implementing single-payer healthcare like Medicare-for-All. Healthcare policy is inherently tied to emotions surrounding fear, survival, illness, and mortality, making it an especially sensitive and polarizing issue. Historical examples illustrate the seismic shifts in political landscapes that can result from healthcare policy changes. And, once massive political shifts happen, the result is oftentimes the abandonment of the costly and ever expansive healthcare reform, dooming the new policy to failure and dysfunction.
For instance, in April 1972, the left-leaning French general elections marked a continent-wide apex for the European Social Democrats and the expansion of robust welfare states, including the growth of a universal healthcare system across the continent. However, the subsequent election cycle saw a reversal of this trend. The French elections gave rise to the emergence of a national firebrand, Jean-Marie LePen, and the French Radical Right Populist party, which aimed to appeal to centrist voters who felt overlooked. Many consider this event as the birth of modern far-right politics in post-World War II Europe. The example of the 1972 French General elections demonstrates the volatile nature of universal healthcare policy in politics and the potential political turbulence that such proposals can generate.
In the United States, the Affordable Care Act, commonly known as Obamacare, played a pivotal role in shifting the balance of power in Congress and propelling Donald Trump to the presidency (University of Chicago Press, 2020). Healthcare policy can polarize voters, with opposition often rooted in concerns about government expansion. Many in the American middle and right wings view such expansion as morally questionable because of deeply rooted American values about limiting government power. This phenomena serves to escalate the political costs of single-payer healthcare proposals. This perception necessitates careful consideration by policymakers to navigate these political hurdles successfully.
Solutions
To advance healthcare reform while avoiding significant political backlash, policymakers must adopt strategies that emphasize individual choice and freedom in the context of universal healthcare systems. Offering an opt-out healthcare system policy, similar to Germany’s healthcare system, would enable individuals to choose private insurance over government-provided care (WHO, 2023). In the American legislature, Pete Buttigieg's "Medicare for All Who Want It" plan is gaining traction. The plan is aimed at providing a public health insurance option while preserving the option for individuals to keep their private insurance if they preferred. Under this proposal, Americans could choose to enroll in a government-administered Medicare-like plan, while those satisfied with their existing private insurance could maintain their coverage. Buttigieg argued that this approach would gradually transition the country toward universal healthcare without eliminating the choice of private insurance for those who wished to retain it (Simon and Glenn, 2019). The plan is polling incredibly well. Almost 70% of voters support a public health insurance option, in contrast to the roughly 50% of voters who support Medicare-for-all (Galvin 2023). While such a system preserves individual choice and minimizes concerns regarding government overreach, it does have its potential drawbacks. Primarily, it would mandate that citizens who chose to opt out do end up having to pay for both private and public health insurance. If this was not the case, many higher-income individuals and families would choose to use private health insurance and deprive the government of necessary funding needed to run the Medicare-for-All plan. This would be an additional financial strain and block access to private insurance to all but a select group of wealthy individuals, further perpetuating health inequalities.
Additionally, policymakers could explore alternative approaches, such as expanding the scope of Medicare and Medicaid, instead of creating an entirely new government-sponsored health insurance program. These approaches allow for incremental change, potentially garnering broader support and minimizing the political turbulence associated with comprehensive healthcare reform. However, as with Medicare and Medicaid in the past, the ever-changing political landscape makes it difficult to set healthcare policy in place for long periods of time. It is plausible that such a policy would be subject to intense scrutiny and be overturned or overridden.
In conclusion, the healthcare policy landscape in the United States and globally is rife with challenges: exorbitant costs, access disparities, and political polarization. Medicare-for-All and similar single-payer proposals offer promising solutions to address these issues. However, the subsequent political costs necessitate creative and pragmatic strategies to navigate the complexities of healthcare policy successfully. Implementing an opt-out healthcare system or expanding existing programs like Medicare and Medicaid offer pathways towards meaningful reform while accommodating the diversity of opinions and concerns within the healthcare policy debate. Ultimately, the goal remains the same: ensuring that every individual, like young Isla Weston, can access the care they need without facing financial ruin.
The views expressed in this publication are the author’s own and do not necessarily reflect the position of The Rice Journal of Public Policy, its staff, or its Editorial Board.
Peterson. “The Share of Americans without Health Insurance in 2022 Matched a Record Low.” Peter G. Peterson Foundation, www.pgpf.org/blog/2023/11/the-share-of-americans-without-health-insurance-in-2022-matched-a-record-low#. Accessed 6 Dec. 2023.
Tanne, Janice Hopkins. “More than 26,000 Americans Die Each Year Because of Lack of Health Insurance.” BMJ (Clinical Research Ed.), U.S. National Library of Medicine, 19 Apr. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2323087/.
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