Universal Healthcare, a Third Rail
By Sarita Celaya
Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.
World Health Organization
Modern attitudes and issues surrounding US healthcare equity persist with great challenges that cannot be met without political will at a national level. The 1960s marked a major shift in American politics across many fronts, including a social transformation exemplified in President Lyndon B. Johnson’s Great Society, which featured the creation of Medicare and Medicaid, providing the elderly and poor with government-funded health care. This progress unfortunately has not been expanded enough to cover the healthcare needs of millions of Americans.
The Great Society aimed to defend and protect the healthcare rights of many marginalized groups, specifically those Americans experiencing poverty along with institutionalized racism and sexism. While Medicare and Medicaid were revolutionary programs for the elderly and those with limited income, respectively, healthcare equity could not be achieved solely by these programs.
To address persistent issues affecting healthcare equity, most prominently access to health care, universal healthcare needs to be established. Obstacles for patients to access providers include: insufficient numbers of providers within an area; inability of patients to travel to distant providers; discretion of providers in accepting some or any insurance plans, including Medicare and Medicaid; socioeconomic factors that impact a patient’s knowledge about obtaining insurance, selecting a provider, and understanding what they can have access to; and finally, patients’s ability to afford insurance and the accompanying deductibles and copays.
In an attempt to increase access to healthcare and achieve healthcare equity for the millions of uninsured or underinsured Americans, on March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). This law, in principle, provided for access to affordable health insurance nationwide. In reality, it fell short of that laudable goal. The law requires adults to have health insurance of their choosing and requires insurance companies to offer coverage under the ACA. Those who did not comply with the ACA’s requirement to obtain insurance would be imposed a tax penalty. However, the penalties negotiated during the drafting of the law were so low that young people would rather pay the penalty than pay for insurance. As a result, the pool of insured people that did not require frequent care—generally those between the ages of 18 and 35—did not participate in the “national group insurance plan.” When millions of Americans indeed chose to pay the penalty and not participate, the insurance companies ended up raising their premiums since they were left with a higher-than-expected number of high maintenance patients. Additionally, many states refused to implement the ACA, denying their residents access to the affordable care it provided. The ACA failed to deliver on its main promise because many Americans decided not to participate and pay the tax penalty, or they could simply not afford the ACA (or any other insurance). However, the ACA can be fixed with either changes in national policy or law, given the political will to do so.
A fully functional ACA jointly with Medicare and Medicaid is as close to universal healthcare as America is likely to get during my lifetime because the term itself is intrinsically offensive to many members of Congress. While Medicare and Medicaid are clearly underfunded, I want to explore a realistic fix to the broken ACA. With the premise that if all pay for health insurance the costs are lowered for everyone because of the dilution of risk to insurers, the ACA should be changed from what is basically a “suggested” participation to a mandatory participation, with a severe enough tax penalty for those who do not have private insurance or an ACA plan. This requires an amendment to the ACA, which a Republican Congress is not going to do. Since Executive Orders can be canceled or changed by any president, that mechanism to fix the ACA is out of the question for now. We are left with a solution based on an amendment to promote universal participation by individuals and States.
Political will is generated in politicians most effectively by grassroots movements, as it was with the Civil Rights Movement. Politicians will eventually respond to the wishes of their constituents if expressed strongly and continuously. Health equity cannot be achieved without the resources required to provide access to health care for all. A grassroots initiative has yet to arise to motivate Congress to act. Social Security may be “the” Third Rail of American politics, but Universal Healthcare is one as well. If we cannot bring ourselves to make healthcare services available to millions of our fellow Americans by fixing the ACA, the ideal of Universal Healthcare is nowhere near our horizon.
Sarita Celaya is a sophomore at the University of California Berkeley majoring in Molecular and Cell Biology with a concentration in Neurobiology.