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The Peculiarities Of Universal Healthcare In The World

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One study in the American Journal of Public Health estimated in 2009 that as many as 45,000 people died every year because of the lack of health insurance. “Uninsured, working-age Americans have 40 percent higher death risk than privately insured counterparts”(The Harvard Gazette). With universal healthcare, this number would decrease significantly because everyone would be insured without financial stress on individuals. Take this story from The Huffington Post to validate these claims; “Georgeanne Koehler has devoted dozens of hours to telling anyone who would listen about how her brother died. Billy Koehler’s died from cardiac arrest after his implanted defibrillator ran out of batteries, is a testament to how someone can perish from lack of access to health care”. Some countries have been proactive and have created universal healthcare policies such as Norway who was the first country to enact universal healthcare as a single-payer system in 1912. 16 years later, Japan and New Zealand created a universal healthcare policy leading a new wave of people establishing new healthcare policies. Belgium, Sweden, and North Korea all established some form of a universal healthcare policy from 1945-1955. Universal healthcare has improved the wellbeing of populations and has created more organized society. Right now, 31 out of the 32 developed countries have universal healthcare, the United States being the only one without universal healthcare. From there, once there are enough models of what this healthcare policy could look like, getting the rest of the world on board might be a challenge, but it could help less developed countries develop more, and have more sustainable populations. Some countries have already enacted a universal healthcare movement, but with the rest of the world on board, public health would improve, healthcare spending would decrease, and good health habits could be instilled in children at a young age.

Although universal healthcare has mostly positive outcomes, there are some potential issues to address and how they can be avoided. One is the issue of government spending and where the money would come from to fund a universal healthcare system without increasing tax payers spending too much. The way this issue could be avoided is by establishing an efficient and effective system to use taxpayer’s money, but not overly tax people. Unfortunately, in most cases taxes must be raised to provide universal coverage. In this case, yes, taxes would be more, but if everything is put in perspective, people wouldn’t be spending money directly on healthcare, instead they would put money towards taxes and save money overall in the long run. It would be a big change, but it’s important to look beyond the present and see how enforcing these policies now can really benefit the population in the long run. A specific example is in the United States, the government is currently paying an annual $7.65 trillion, but with a certain universal healthcare plan put in place, $2.1 trillion could be deducted from that and saved over time.

To set a basis of knowledge for this paper, the definition of universal healthcare according to The Balance, is, “a system that provides quality medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay”. A major goal of universal healthcare is that is it truly universal, and is equal for every person so no one experiences financial burden because of the need for healthcare. Some common misconceptions of universal healthcare are that it is absolutely free, it is easy to create a universal system, and that it is the same everywhere in the world. It is important to understand that universal healthcare is only the necessities. It is also important to note that, 'Countries are using a bottom-up approach by working to prioritize poor and vulnerable populations, as they usually have the highest need for healthcare but the least access' (The Balance). The name universal healthcare can be misleading because it sounds like it is uniform and identical everywhere, but that is not the case. Depending on the location the policy is enforced, it can vary in terms of systems. Healthcare systems are organized differently around the world to best suit the population and have the most efficient organization. According to Stratfor and Forbes, the organization of a healthcare system can be influenced by demographics, economics, history and, of course, politics all help determine the shape of a country's health care system, from who pays for medical services to what services are available and what training is required to perform them. Though maintaining a robust health care system is a universal problem, it lacks a universal solution. Creating a universal healthcare system isn’t something you can just flip a switch and it will be enforced. It is a system that needs to be well engineered and organized in order for it to function and benefit the population. Afterall, the point of universal healthcare is to create an accessible and equal system to sustain a population medically.

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Another basis of knowledge to set is the difference between universal and non-universal healthcare systems. In the research I have done, the main systems that appear to be in place are single-payer, two-tier, and universal. First off, single-payer healthcare is a system also called; 'Medicare for all'. The system entails that everyone in the given country or place is provided with the necessary healthcare including doctors, hospital care, dental care, eye care, and medications by one single paying source-hence the name 'single-payer'. According to VerywellHealth, there are currently 17 countries who use and single-payer healthcare system. Two-tier healthcare is a system in which the government provides a basis of healthcare, but also offers a secondary coverage tier of care for those able and willing to pay for a higher standard of care. In this case, single-payer healthcare and universal coverage work hand in hand. Some countries have found this to work including Denmark, France, Australia, Ireland, Hong Kong, Singapore, and Israel (VerywellHealth). Finally, universal coverage is a system in which everyone has access to healthcare. Universal health coverage comes in many different forms, but nonetheless, there are currently 32 countries with some universal coverage policy. Within these 32 countries, there are some exceptions where 98% of their population is covered, so it isn’t considered truly universal coverage. On the other hand, 18 out of those 32 countries have entirely universal coverage with 100% of the population covered. Those countries are Australia, Canada, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, the Netherlands, New Zealand, Norway, Portugal, the Slovak Republic, Slovenia, Sweden, Switzerland, and the United Kingdom. Something to note is that, 'They [single-payer system and universal coverage] are not the same thing, despite the fact that people sometimes use them interchangeably. And while single-payer systems generally include universal coverage, many countries have achieved universal coverage without using a single-payer system' (VerywellHealth).

Now that there’s a basis to this topic, it’s time to discuss the main reasons why universal coverage is a better option than what some countries have today. The main one is that with universal coverage, every registered citizen has access to the healthcare they need. This means that people who couldn’t afford to be insured before would be given the care they need at no cost. This would create a stronger and more sustainable population. Also, universal coverage lowers the overall healthcare costs of an economy because the government controls the price of medication and medical services (The Balance). Government costs also go down because there is only one system and insurer for the population, so there are no administrative costs as there are with private insurers. Overall, universal coverage creates a more efficient, uniform and sustainable system for the population. A final pro to universal coverage is that if children have health coverage and are educated about their health at a young age, healthy habits can be instilled in them as they grow up, and can be set up for a better, healthier life.

In talking about the pros to universal health coverage, it’s important to look at countries with universal coverage policies in place and see how their healthcare runs. Aaron Carroll and Austin Frakt from The New York Times did an interesting interactive article on several healthcare systems around the world-some of which are universal, some that are not-and had healthcare professors, physicians, and economists vote for which country they thought had the best healthcare system to ultimately come out with the “best” healthcare system in the world. Additionally, within the article, there was a poll that readers could take after each comparison to input their opinion as well. The countries compared in this article were Canada (single-payer universal), Britain (single-payer universal), Singapore (partly universal), United States (a mixture of everything), France (universal), Australia (universal), Switzerland (universal with required insurance), and Germany (universal multi-payer). To start off, Britain won vs. Canada. The “judges” reasoning was that the British system was more efficient and had the same quality as Canada with less spending. Britain also won the public vote with 76% of the 106,4899 that voted. The next pairing was the United States vs. Singapore. The US has a mix of everything for healthcare. There is Medicare for select groups of people, private insurance through employment, private hospitals, and several million people without healthcare. Singapore has inexpensive basic care, and Singapore’s workers contribute around 37 percent of their wages to mandated savings accounts that may be spent on health care, housing, insurance, investment or education, with part of that being an employer contribution. The government, which helps control costs, is involved in decisions about investing in new technology. It also uses bulk purchasing power to spend less on drugs, controls the number of medical students and physicians in the country, and helps decide how much they can earn (NY Times). The United States won this faceoff with the judges (4-1) and the public with 53% out of the 89,943 people that voted. One of the judges said, “The lack of data in Singapore is a problem, and it had higher rates of unnecessary hospitalizations and far higher heart attack and stroke mortality rates than the United States. Plus, the U.S. has a highly dynamic and innovative health care system. It is the engine for new diagnostics and treatments from which Singapore and other nations benefit”. The next faceoff was with France and Australia. Australia provides free inpatient care in public hospitals, access to most medical services and prescription drugs. There is also voluntary private health insurance, giving access to private hospitals and to some services the public system does not cover (NY Times). In France, everyone must buy health insurance, or insurance is provided through an employer or by voluntary health insurance (95% of the population). 75% of doctors provide free healthcare to patients. France won this battle 4-1 with the judges, and with the public (80% of the 85,306 voted France). Some of the judges said, “It provides almost everything you’d want, and it’s expensive only compared with countries other than the United States. (Compared with the U.S., it’s a bargain,” and “It has seemingly done a better job of using markets to create competition across public and private hospitals — which provides incentives for quality provision and innovation”.

The final faceoff was between Switzerland and Germany. Switzerland has a universal system, but requires everyone to buy insurance. Their system is sometimes compared to the Affordable Care Act (ACA) but is said to be a better version of it. In Germany, the amount individuals pay for healthcare is based on their income. Patients have a lot of choice among doctors and hospitals, and cost sharing is quite low. It's capped for low-income people, reduced for care of those with chronic illnesses, and nonexistent for services to children (NY Times).

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