You Decide

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U.S. flag with medical symbol in place of stars and dollar bill as stripes, stethoscope resting atopShould the United States adopt a single-payer, universal health care plan?

  • Yes? But have you considered...
  • No? But have you considered...

…that some experts argue that a universal health care system would result in expensive and ineffective bureaucracy and would require tax increases?

Whereas supporters of a single-payer health care system assert that it would reduce medical costs, opponents of the universal health plans argue that medical costs and taxes would rise with the adoption of a single-payer system.

Some opponents of universal health care point to the U.S. Medicare program as an example of a costly system that functions poorly. According to Sue Blevins’ book Medicare’s Midlife Crisis, in 1965 the government projected that the annual cost of Medicare in 2000 would not exceed $2.5 billion, but in fact, Medicare costs closer to $325 billion per year — nearly 13 percent of the federal budget — and it’s not going to get any better as baby boomers age. Public Agenda, a nonpartisan opinion research organization, projects that by 2019, Medicare could go broke.

Others crunch the numbers on previous proposals and worry that a single-payer health care system would demand an increase in taxes that the average American can ill-afford. When a single-payer plan was proposed in 1999, a tax increase of $650 million was needed to implement the program. According to experts, that would have meant an 89 percent increase in federal income tax receipts or an overall 39 percent rise in all federal revenue.

And in 2003, Representative Richard Gephardt — then a presidential candidate — advocated a $200 billion universal health care plan. Columnist Robert Novak said that the increased tax burden on a family of four would be approximately $1600 a year. “This is heavy going for that $40,000-a-year family of four,” he wrote, adding that “the tax rate on the family’s income would be increased to 15 percent, costing the family $600 per year.” Novak asserted that over the first six years under the plan, the average American family would pay an additional $6,800 in taxes.

Other critics contend that centralizing health care paperwork and finances in a government organization would bury the system in a bureaucratic quagmire and will ultimately cost more. “Virtually everything that the government does costs more than when the same thing is done in private industry,” writes Thomas Sowell in “[W]hy in the world would we imagine that health care would be the exception?”

…that many argue that a universal health care system would result in better and more comprehensive care?

Many advocates of a single-payer health care system argue the greatest advantage would be that patient care would be based solely on medical needs — rather than cost-containment measures or an approval system dictated by health care corporations. In addition, patients would choose their own physicians and hospitals and develop a relationship with their health care providers that would help ensure a higher level of care. Eliminating the “middleman” from the managed care industry, they assert, would bolster the patient-physician relationship — a key factor in good health care.

Some opponents of universal health care worry that the government would dictate how doctors practice medicine. Evidence from other countries, however, shows that it’s rare for the government to interfere with physicians’ medical practices. Doctors in single-payer systems have much more autonomy than those practicing under the current U.S. system, in which approval must be routinely sought from an insurance company to perform procedures, prescribe some medications, and order certain tests for patients. Many doctors argue that they could do their jobs better if their clinical decisions were not dictated by an insurance company policy.

Only by getting profit out of health care can we restore the sacred trust between patients and doctors, proponents of universal health care say. Similarly, they argue, only by removing the profit motive can we make sure that the poorest and sickest aren't saddled with the highest costs and the least care and that “unprofitable” people aren’t left out of the system.

Many professional medical organizations in the United States have endorsed the adoption of a universal health care system, including, among others, the American Public Health Association, the American Medical Women’s Association, the American Medical Student's Association, the National Medical Association, the American College of Physicians and the American Nurses Association.


Considering this, should the United States adopt a single-payer, universal health care plan?

Nothing about the issues facing the candidates and American voters in 2008 is black and white. With these You Decide activities, you can explore both sides of an issue, put your own critical thinking to work, and discuss the pros and cons with others. In the end, perhaps you will ask different — and better — questions than those presented here.


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