Critical Thinking Paper

The Case for Universal Care

Ari Charles
May 5
th
, 2014
Green Group






In order to improve the overall health of the American population, reduce healthcare
costs and spending, and allow more funding to be allocated to important medical research, the
United States Congress and President Barack Obama must implement a fully single-payer
healthcare system in the United States by expanding Medicare coverage to all people.
The health of many Americans is in bad shape: in a 2013 report by Professor Steven H.
Woolf of Virginia Commonwealth University, in association with Institute of Medicine, the
United States was ranked the least healthy out of 17 highly developed nations, including Canada,
the United Kingdom, Australia, France, Germany, Sweden, Japan, and others (Woolf 2). Among
those nations, the United States had the highest rate of deaths caused by infant mortality, lung
cancer, coronary heart disease, diabetes, HIV/AIDS, and substance abuse (Woolf 5 6).
That so many Americans are in poor health is in part due to the rising costs of healthcare.
While other factors such as diet and exercise may contribute to the development of such
conditions, they are often left untreated for so long only because the poverty that mires many
Americans precludes them from purchasing health insurance (Milken Institute).
The Patient Protection and Affordable Care Act of 2010 (PPACA, often referred to as
Obamacare) was intended to at least partially solve the problem by ensuring that everyone in
the United States was covered by health insurance (Kaiser Foundation). The PPACA included
two primary sections the individual mandate, a requirement that the uninsured purchase
health insurance (though offering them subsidies to do so) and a crucial expansion of
Medicaid, the federally-regulated, state-operated insurance program for the poorest Americans,
so that all people making up to 138% of the federal poverty level (FPL) were made eligible for
the program. Combined, the two would have given access to health insurance to everyone in the
United States (Kaiser Foundation).
After President Obama signed the PPACA into law, the State of Florida filed suit against
Kathleen Sebelius, the Secretary of the Department of Health and Human Services. Twenty-six
other states and a conservative lobby group, the National Federation of Independent Business,
quickly followed. The Department counter-sued, and the cases quickly made their way through
District Court and the Appeals Circuit (Supreme Court of the United States). The PPACA was
struck down twice before the Supreme Court granted a writ of certiorari and merged the cases
into National Federation of Independent Business vs Sebelius. In 2012, the Court, while it upheld
the individual mandate portion of the PPACA, struck down the required Medicaid expansion
(Supreme Court of the United States).
As such, most of the states involved in the suit opted out of doing so, leaving almost five
million people stuck in a coverage gap whereby they were considered too poor to receive a
PPACA subsidy but too rich to qualify for Medicaid benefits. In an extreme example of this, a
married couple in Arkansas with two children making just $3,820 annually would be considered
to be above the threshold for receiving Medicaid benefits (Weaver). This gap is the primary
reason why the PPACA is simply not enough to solve the United States healthcare problem.
Not only are many people uninsured, but those who do have plans often pay
astronomically high prices for care. For example, at MD Anderson Cancer Centre in Houston,
every time a patient has their blood drawn, they are charged $36.00 for routine venipuncture,
followed by lab fees of up to $78.00 for the analysis performed on the blood sample. Though
MD Anderson is considered one of the nations top hospitals, their prices can reach up to a
staggering 400% of what a service costs to provide (Brill 3). These costs are often high for a
variety of reasons, among them being that the United States does not negotiate with drug and
medical device manufacturers on a national level for its supplies of such items. The lack of
lucrative government contracts to produce items ranging from pills to pacemakers means that
companies have no inducement to make their products cheap. Additionally, when uninsured
people receive care but are then unable to pay for it, providers must raise their prices on their
insured patients in order to make up the difference (Brill 7).
All of these high costs make the United States the worlds largest healthcare spender. The
United States annual healthcare expenditures are about $8,500 per capita, amounting to around
$2.7 trillion, or 17.7% of the GDP. Second-place Norway, in comparison, spends around $5,700
per person (World Health Organization).
Both the generally poor health of the American population when combined with these
high costs and rates of uninsurance create a serious problem with the United States healthcare
system. The task to fix it may seem like a monumental one, one that might require the most
significant piece of domestic policy in American history to be enacted. However, the solution is
much simpler. The government By simply expanding Medicare coverage to all people, and not
just those over 65 years of age, the United States Congress and President Obama can effectively
create a single-payer healthcare system for America.
Medicare is already the federally-run health insurance program for those over 65 years of
age. There are various different components to Medicare, including part A covering inpatient
and hospital services as well as part B for outpatient care, part C for other specialty items and
services, and part D for prescription drugs. The bulk of Medicare spending is in parts A and B,
and both of those components are taxpayer-funded, and that public funding is the key tenant of a
single-payer healthcare system (Kaiser Foundation).
Though Medicare is strapped for funding as it is, the United States is pulling out of its
wars in Iraq and Afghanistan. Defense spending should be on the downswing, freeing up more
money to go to healthcare. Additional reforms to the tax code (such as eliminating the flat 15%
tax rate on capital gains that allows Warren Buffet to pay lower taxes than his secretary) could
also raise additional funding at little cost to the end taxpayer.
The same sort of universal coverage that could be achieved through expanding Medicare
has been tried and has flourished in many other countries. Canadas single-payer program, also
named Medicare, has been in effect since 1968. The Canadian government covers approximately
99 percent of the healthcare services dispensed to the countrys residents with tax funding
(Katz). Some services such as dental and oral care or prescription drugs are still handled by
private plans (usually provided through employers), but they are still affordable (Katz).
However, despite all of the extra spending on healthcare, income and property taxes in Canada
are actually lower than those in the United States (Katz). The primary reason for this is that the
Canadian government chooses to be fiscally conservative by negotiating on a federal level for
drugs and medical devices, keeping costs down. For example, month of the prescription pill
Lipitor used to treat high cholesterol costs about $10 in Canada, but in the United States the
same bottle of medication might cost around $125 (Brill 6).
Furthermore, a study conducted by researcher Steven Katz and published in the Journal
of Health Affairs found that the widely-purported statement about many Canadians flocking to
the United States to receive treatment was simply untrue. The study, which used three different
rationales, discovered that only about only about one half of one percent of all annual visits made
by Canadians to the United States were for medical reasons, and almost all of those were for
elective procedures such as plastic surgery that were cheaper to receive in the United States
(Katz).
At MD Anderson, if the same patient were to be covered by expanded Medicare, the
hospital would have been paid around two dollars for each blood test, and that amount, one of
many Medicare approximates when calculating how much to reimburse providers for, is required
by law to take into account the overhead costs for delivering medical care to patients (Brill 4).
Medicare, if expanded to all, would lower care costs while providing that care to everyone. In
exchange for the high tax rates many Americans already pay, they would not have to pay
additionally for health insurance. The medical industry would remain securely in business,
becoming even more competitive as drug and medical device manufacturers actually competed
for the aforementioned contracts as they do in other countries such as Canada with universal
care systems (Katz).
While the private insurance industry would indeed suffer from monopolizing healthcare
in the hands of the government, the United States already has monopolies on central banking and
letter delivery, and many counties such as Montgomery County, Maryland impose their own
monopolies on alcoholic beverage sales. Latin American nations from Mexico to Colombia have
monopolized their oil and gas industries, and many public utilities in the United Kingdom,
Canada, Australia, and other commonwealth realms are government monopolies known as
Crown corporations. Government control of such a key industry would not harm the spirit of
entrepreneurship that the United States is known for. It would only ensure that everyone has
equal access to a most basic human necessity.
Finally, reducing healthcare spending would free up more money to be spent on medical
research and development. In the Fiscal Year 2014 budget, the National Institutes of Health
(NIH), the federally-funded medical research organization, requested $5 billion in appropriations
but only received about two-thirds of that amount (United States House of Representatives). By
saving money on care costs, NIH could receive more funding to support its critical work in
furthering the development of more advance medical treatment methods.
This wealth of evidence supporting the single-payer model makes the solution very clear:
in order to improve the overall health of the American population, reduce healthcare costs and
spending, and allow more funding to be allocated to important medical research, the United
States Congress and President Barack Obama must implement a fully single-payer healthcare
system in the United States by expanding Medicare coverage to all people.









Works Cited
Brill, Steven. "Bitter Pill: Why Medical Bills Are Killing Us." Time Apr. 2013: n. pag. Print.
Chronic Disease Impact. Milken Institute, n.d. Web. 19 Mar. 2014.
<http://www.chronicdiseaseimpact.com/>.
"Focus on Health Reform." Kaiser Family Foundation. Kaiser Family Foundation, n.d. Web. 20
Mar. 2014. <http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf>.
Katz, Steven J. "Phantoms in the Snow." Health Affairs (2002): n. pag. Print.
National Federation of Independent Business v. Sebelius. Supreme Court of the US. 28 June
2012. Print.
Shorter Lives, Poorer Health: U.S. Health in International Perspective. Washington: National
Academies P, 2013. Print.
United States. Cong. House. United States Budget for Fiscal Year 2014. 113th Cong., 1st sess.
H. Con. Res. 25. Washington: GPO, 2014. Print.
The Wall Street Journal. The Wall Street Journal, n.d. Web. 20 Mar. 2014.
<http://online.wsj.com/news/articles/SB100014240527023048511045793636210096707
40>.
World Health Organization. World Health Organization, n.d. Web. 23 Mar. 2014.
<http://www.who.int/en/>.





Annotated Bibliography
Brill, Steven. "Bitter Pill: Why Medical Bills Are Killing Us." Time Apr. 2013: n. pag. Print.
Chronic Disease Impact. Milken Institute, n.d. Web. 19 Mar. 2014.
<http://www.chronicdiseaseimpact.com/>.
This article gives great details about the rising costs of medical care in the United States with
specific example and other details. These examples are useful in proving a point about
those costs and the extreme markups placed on healthcare services.

"Focus on Health Reform." Kaiser Family Foundation. Kaiser Family Foundation, n.d. Web. 20
Mar. 2014. <http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf>.
The information sheet provides crucial background information on many currently health
programs in the United States, specifically Medicare and its different components.

Katz, Steven J. "Phantoms in the Snow." Health Affairs (2002): n. pag. Print.
The study helps dispel the myth that Canadians flock to the United States for care by using three
different rationales. The studys findings are indicative of the fact that a single-payer
system like the one proposed would not cause an exodus of doctors and patients.

National Federation of Independent Business v. Sebelius. Supreme Court of the US. 28 June
2012. Print.
This court case provides primary-source background to the history of the PPACA and the crucial
severance of the Medicaid portion of the PPACA from the PPACA.

Shorter Lives, Poorer Health: U.S. Health in International Perspective. Washington: National
Academies P, 2013. Print.
The study describes in detail using good statistics how the United States health is the worst
among 17 developed nations. This is important to arguing that the private care system
denies some people coverage and reduces the overall health of the population.

United States. Cong. House. United States Budget for Fiscal Year 2014. 113th Cong., 1st sess.
H. Con. Res. 25. Washington: GPO, 2014. Print.
This resolution shows how much funding was spent on the National Institutes of Health (NIH)
for Fiscal Year 2014 and how the number could increase if funding were freed up by
adopting a fully single-payer system.

The Wall Street Journal. The Wall Street Journal, n.d. Web. 20 Mar. 2014.
<http://online.wsj.com/news/articles/SB100014240527023048511045793636210096707
40>.
The article describes the plight of people who lie in the coverage gap created by the Supreme
Court decision and how they might be helped by adopting a fully single-payer system.

World Health Organization. World Health Organization, n.d. Web. 23 Mar. 2014.
<http://www.who.int/en/>.
These statistics provided by the WHO show how much funding the United States spends on
healthcare per capita annually and how large the amount is compared to other countries.

Critical Thinking Paper Problem-Solution Outline

I. Thesis and Introductory Paragraph
II. Overview of Current Problem
a. Poor health of many Americans as compared to the rest of the world
b. How the PPACA was supposed to solve much of the problems of the uninsured
c. The court case that lead to the removal of the Medicaid expansion from the
PPACA
d. The Coverage Gap
e. Rising prices for care
f. Rising government spending on care
III. Overview of Potential Solution
a. Overview of Medicare in its current form
b. The success of Canadas own Medicare program
c. Proof that the single-payer system does not cause people to flock abroad for care
d. How more funding could be freed up as a result for research purposes
IV. Conclusion