Universal health care: Why not?

ACP is the leading professional organization in medicine that has always kept efficient and equitable patient care as its guiding light, supporting its members to reach that lofty goal. After a century of sustained and thoughtful efforts, enhancing the competency of its membership through evidence-based educational tools and vigorously advocating to improve the health care system for patients and enable physicians and other health care professionals to deliver world-class care, it assessed the U.S. health care landscape and found it lacking in key areas.

While acknowledging phenomenal progress in preventive and curative medicine, tremendous improvement in health care delivery models, and remarkable advancement in longevity of the population, the College saw too many Americans lacking coverage for medical care. Medical care was unaffordable for others, and there were additional barriers to equitable and efficient care, including administrative burdens and archaic payment models. After comprehensive research, review, and analysis, ACP published “Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians” in 2020, a series of landmark papers addressing critical questions and offering solutions for the ailing health care system in our country.

ACP envisions an efficient, equitable, affordable, patient-centered, and high-value health care system for all Americans. The system will be headed up by well-coordinated, physician-led teams of competent health care professionals, will address social drivers of health, will remove futile administrative and documentation burdens, and will utilize technology to deliver evidence-based care. The funding and payment models will be aligned to incentivize these objectives in providing better patient outcomes throughout the continuum of care. The research indicates that universal coverage is critical despite the fact that coverage does not necessarily mean access to care, let alone high-quality, affordable care when needed.

The pragmatic recommendations in the policy papers, based on extensive research and experiences around the world, emphasized addressing and eliminating social drivers of poor health and lack of health care, focusing on intersectionality of various barriers. The rather wide platform of obstacles to be navigated in providing optimal health and efficient health care include socioeconomic standing, geography, education and health literacy, intellectual and physical disability, race and ethnicity, sexual orientation and gender identity, and religious and cultural traditions. The College is particularly mindful of underserved and vulnerable populations, asking for improved access to high-quality nutrition, elimination of preventable causes of disability and death, and enhancement of critical public health infrastructure throughout the country.

The United States is the only economically advanced nation without universal health coverage, despite leading the world in health care spending. This dichotomy is due to the absence of a national, integrated, efficient health care system. U.S. health care spending increased to $4.3 trillion, $12,914 per person, or 18.3% of the nation's gross domestic product (the monetary value of goods and services bought by the end user) in 2021. Hospital services account for a third of the expenditure, followed by physician services at 20%. The obvious superfluous outlay of little benefit to patient care is the $300 to $400 billion in administrative costs and profits related to the health care insurance industry. Our health care administrative costs are estimated to be a third of the total spending on health care, double that of Canada. Our nation is in dire need and deserves a patient-centered, cost-effective, and proficient health care system.

The College recommends universal coverage, independent of a person's health status, income, employment, or place of residence, with essential benefits, adequate access, and lower administrative costs. It may be through a publicly financed coverage option, along with well-regulated, patient-focused private insurance, or a single-payer financing approach. There is no other prudent way to do it. To emphasize, neither of these approaches prohibits private health insurance. Universal health care in our country has to be designed to provide affordable, high-value, evidence-based care to all who require it, when, where, and how they need it, irrespective of any other factors. The system has to be integrated, progressive, evolving, vibrant, and cutting-edge. Any system worthy of our great people has to gradually reduce morbidity and mortality, increase longevity, and enrich quality of life. Of course, that will entail addressing all social and economic drivers of health as a part of a robust and responsive public health system, which focuses on identifying, screening for, and preventing physical and mental ailments.

The creation of a successful universal health care system, as described, will have to navigate political opposition, interest groups, cost concerns, fear of change, and resistance. It will have to address both valid and perceived concerns that have been well enunciated over the years as we have tried to right the rudderless health and health care ship. It will not be easy, but nothing worthwhile usually is. As physicians, as patient advocates, we will have to lead the country by increasing public awareness, forming alliances, and educating political leadership and policymakers on the unnecessary fragmentation of our system, its high cost, both financial and human, and the real benefits to society and our future generations of a responsive health care system. We will have to address concerns about the system in a clear, logical, respectful, and empathetic manner.

Equitable, universal access to appropriate health care is an ethical obligation of society, and universal health care will secure, to a great extent, the fundamental human right of health for our citizens. This right is what separates humane from inhumane existence, civilized from uncivilized societies, and true progress from the illusion of progress. The positive impact of universal health care in our country will be transformative. It will help eliminate the most common cause of personal bankruptcy in our country, it will unshackle our creative, working youth with sickness in the family to search for newer horizons, and it will do away with the indignities of undeserved medical debt for all. The unconditional respect and reverence for a fellow American's health and well-being, taken in its totality, should help to heal the centuries-old wounds of discrimination, bigotry, and injustice. Universal health care should lead us to the more perfect union envisioned for our nation. It is about time. Our collective dignity demands nothing less.