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An Evaluation of the Current Healthcare System in America_ the Value of a Public Option in Health Insurance Coverage – PDF VERSION

Jessica Guo1, Katherine Morse2, Layla Shaffer3

1Ward Melville High School, East Setauket, NY, 11733; 2Hebrew Academy of the Five Towns and Rockaway, Cedarhurst, NY, 11516;  3The Lawrenceville School, Lawrenceville, NJ, 08648

Abstract

 By analyzing the United States healthcare system through the context of bioethics, we sought to provide an alternative solution to the intrinsic fallacies in the current health insurance coverage system. We proposed a free public option for healthcare that coexists with alternative private health insurance options. This assures that all Americans will have vital health services, while maximizing the feasibility of implementation. This change would not only guarantee citizens of their fundamental rights by shifting insurance away from its commodified identity but would also lower drug prices, directly aid those with low socioeconomic statuses, and even help in the prevention of chronic illness. Given the roots of the broken healthcare system in political theory, ideological polarization, and the United States’ history of racial discrimination, it is imperative that changes be made now in order to correct the decades of injustice surrounding the field of healthcare. While the recent previous efforts made in the U.S (Medicare, Medicaid, Affordable Care Act (ACA)) have not been sufficient in guaranteeing coverage, their mere existence demonstrates that expanding healthcare is a realistic and ethical next step for the US to take. 

 

• Introduction

Over the past century, technology has turned the tide on previously fatal diseases. Pneumonia and polio are essentially nonexistent today due to modern drugs, and the severity of illnesses such as cancer and Parkinson’s disease has been reduced thanks to new medical discoveries. However, chronic diseases are on the rise worldwide. The middle class is growing, and urbanization is accelerating- causing people to adopt a more sedentary lifestyle. Obesity is surging, and the 2019 Adult Obesity Prevalence Maps show that 12 states have an adult obesity prevalence at or above 35%, which is up 9 states from 2018[1]. Pandemics, most notably COVID-19, but also Ebola, SARS, MERS, and H1N1 have also clearly demonstrated the speedy and deadly nature of infections. 

To mitigate these health concerns, coordinated and agile healthcare is required. However, there are four health care models, and some are better than others. Each country can also combine models to create an insurance system. The first model is the Beveridge model, which was developed by Sir William Beveridge in the United Kingdom in 1948; in this case, there is an establishment of a national health service, in which the government acts as the single-payer. This is entirely funded by taxes, and there are no out-of-pocket fees, guaranteeing that all tax-paying citizens will have equal access to care. Criticism has arisen due to its potential for overutilization. Without monetary concerns, patients could potentially demand services that are unnecessary or wasteful, resulting in taxes. Countries using this plan include Great Britain, Spain, Cuba, New Zealand, most of Scandinavia, and to some extent Hong Kong[2].

 The second model is the Bismarck model, which is a more decentralized system created by Otto von Bismarck near the end of the 19th century. This structure looks fairly similar to that of America, as the “sickness funds” are jointly financed by employers and employees through payroll deductions. Unlike the United States though, the Bismark plans are required to cover the entire employed population. This model only covers the employed, so it doesn’t provide coverage to others and only allocates treatments to those who are financially contributing, which does not include the retired. This model is found in Germany, France, Belgium, the Netherlands, Japan, and Switzerland[3].

The National Health Insurance (NHI) Model is a combination of Beveridge and Bismark. Like the Beveridge model, payment comes from a single government run insurance program that all citizens must pay into. However, like the Bismarck model, there are private-sector providers. Essentially, there are private providers that the government insurance programs pay for. The model provides universal health care, does not make a profit, and does not deny claims. Because there’s no marketing, no financial motive to deny claims, and no profit concerns, this system is cheaper and administratively easier. The only major issue is that there can potentially be long waits for treatments, which can turn into a serious health policy issue. Canada first adopted the model, but Taiwan and South Korea have also later become an NHI system[4].

 The last structure is the out-of-pocket model, which is most common in underdeveloped areas or countries that lack the organization and financial resources to implement any mass medical care. In this model, patients must pay for all procedures out of pocket, so the wealthy have access to professional medical care while the poor do not. Rural regions of Africa, India, China, and South America use this system. Healthcare in these instances, is intensely driven by income[5].

Each system has its benefits and drawbacks. Healthcare should be an unalienable right, yet many throughout the world suffer without it. This paper sought to explore the advantages of providing a public option for everyone, while also keeping the private insurance sector for those who can afford it. 

 

• Drawbacks of the Current System

Although the United States has taken measures to improve healthcare access, a recent study revealed that 30% of Americans are unsatisfied with the current system[6]. This transcends political views, as 6:10 people from multiple political affiliations agreed change needs to be made. In 2016, the U.S was ranked last on the Healthcare Access and Quality (HAQ) Index in amenable mortality among eight other comparable countries, as shown in figure 1. A higher rating suggests few deaths due to a higher standard of care and access, while a lower rating suggests the opposite. In this section, the current healthcare model used in the United States is examined, with a particular focus on drawbacks and ethical concerns.

 

Figure 1: Healthcare Quality and Access (HAQ) Index Rating, 2016. 

Source:  KFF analysis of data from: “Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016,” 2018, The Lancet

 

• Current Policies

The United States spends an exorbitant amount on healthcare. The country has a fee-for-service plan, which emphasizes quantity over quality because the doctors and other healthcare providers are paid per service provided.The US spends more than any other industrial nation, and although a complex issue, two reasons stand out as to why[7]. A majority of US health insurance is private, so billing and record-keeping tasks are monumental, and an immense number of people are needed to process the paperwork[7]. This costs about $360 billion annually, which is 14 percent of all US healthcare costs[8]. Second, the fee-for-service model is an underlying issue. Healthcare professionals can charge anything they deem fit for their services. In 2010, the average US appendectomy cost $13,123, compared to $3,810 in Canada. The average US hip replacement cost $34,354 while only $10,753 in Canada, the average US normal childbirth cost $8,435 while only $2,667 in Canada, and the average US bypass surgery cost $59,770 while only $22,212 in Canada. Diagnostic tests also exhibit a vast cost discrepancy, as the average cost of a head CT is $464 in the US, compared to $65 in Canada, and the average MRI costs $1,009 in the US compared to $304 in Canada[9].

The Patient Protection and Affordable Care Act (H.R.3590) and the Health Care Education and Reconciliation Act (H.R.4872) — together known as the Affordable Care Act (ACA) strive to achieve a three-pronged goal: improving care for individuals, improving the health of populations, and lowering costs. The United States has the most expensive healthcare system in the world, but it does not deliver the best care it can. The ACA moves away from the current fee-for-service payment that creates incentives to deliver more care, but not necessarily better care, and towards a model that is focused on delivering high quality and low-cost care. The delivery system is also fragmented and oftentimes healthcare providers fall on opposite sides of the spectrum. On one hand, small practice physicians work independently of each other and other healthcare providers, such as hospitals and imaging facilities, and not as one united system. As a result, there can be a lag in information sharing and difficulty in keeping track of a patient’s care and condition. On the other hand, there are larger coordinated healthcare systems that have hospitals, doctors, and other healthcare professionals that all work together. This current fragmentation significantly drives the increasing administrative costs and in turn healthcare costs, as well as the inconsistent quality of care in the entire population. Healthcare systems that provide greater coordination have saved money, enhanced quality, created value, and increased cohesion. The Centers for Medicare and Medicaid Services is currently testing new forms of care delivery, such as Accountable Care Organizations (ACO)[10].

Additionally, although 29% of Americans do have public insurance, this coverage does not begin to match coverage in the rest of the industrial world. Medicare does cover some costs for the elderly, but it is often inadequate, as many must still pay hundreds or even thousands of dollars in premiums, deductibles, coinsurance, and copayments. Medicaid funds some costs for the low-income, but many low-income families are not poor enough to receive Medicaid. Eligibility also differs between states. 

Overall, the ACA has provided affordable healthcare insurance to more Americans and helped to change the healthcare delivery system to improve quality of care and control costs. However, more change is needed. After the ACA was implemented in 2010, in 2016 the Hispanic uninsured rate fell from 32.6% to 19.1%. But despite these gains, people of color remained more likely to be uninsured than Caucasians. Additionally, the Trump administration began rolling back ACA policies, resulting in uninsured rates increasing for Hispanic, African American, and Caucasian people between 2016 and 2019[11]. Evidently, more policies need to be implemented to protect the vulnerable populations within the United States. 

 

• Healthcare disparities

Health problems in the U.S are more often found among people from low-income backgrounds and among people of color. In 2011, life expectancy in Caucasians was 78.4 years, while in African Americans it was 73.6 years[12] . In 2019, the uninsured rate for the nonelderly was 20.0% in the Hispanic population, 11.4% in the African American population, and 7.8% in the Caucasian population[12].

Additionally, the most unsettling evidence is centered around children. Poor children are almost five times more likely to be in worse health than their counterparts in wealthier families[13]. Children in low-income families are more likely than those in more affluent families to experience health issues, many of which can last throughout adolescence and adulthood[14]. This evidence clearly demonstrates the change needed in the child healthcare sector in the U.S. The State Children’s Health Insurance Program (SCHIP) was started in 1997 to help children from low-income families, but fails to cover many[15]. Helping children is a preventive measure, as any money spent to minimize harmful effects will pay for itself multiple times throughout the child’s life. The children will have fewer health problems growing up, which reduces cost and improves efficiency in school. 

Unfortunately, with the current system, many low-income populations lack medical insurance or have inadequate insurance. The U.S. healthcare model relies on a direct-fee system- those under 65 are expected to self pay medical expenses and those 65+ are covered by medicare – and private health insurance – usually through one’s employer. Both of these do not benefit the poor. This model has contributed to high healthcare costs, high rates of uninsured individuals, and higher rates of health problems. The current insurance model incurs huge administrative costs, and in 2012, almost 50 million people, including 8 million children, were without insurance. 

 

• Ethical concerns

The four principles of bioethics (autonomy, justice, beneficence, non-maleficence) can be applied for further validation that change is needed. Autonomy is the right of competent adults to make well-informed decisions about their own medical care. This requires that the adult be aware of the risks and benefits of each option before deciding a treatment method[16]. Whether this principle is violated is determined by each individual physician and cannot be generalized at a federal level. Justice requires laws that ensure new or experimental treatments are distributed equally among all populations. The rate of insured Caucasians is significantly greater than the rate of insured African Americans or Hispanics, and the life expectancy of African Americans is lower than Caucasians. Also, because of the American delivery system’s fragmentation, citizens receive inconsistent medical care quality, regardless of income or ethnicity. Thus, as it pertains to equal access to healthcare, justice is violated. Beneficence is the principle that care is provided with the intent of helping the patient involved, and nonmaleficence is the principle that physicians “do no harm” or minimize harm while treating patients[16]. Again, this must be evaluated on an individual basis. Overall, major ethical concerns lie within the equal distribution of healthcare, as the current system is unreliable due to inconsistency as well as favoring the more affluent Caucasian population. 

 

• Solution: A Public Option for Healthcare Coverage 

The aforementioned flaws in the United States’ healthcare system make it evident that reform is desperately needed. Healthcare is a universal human right, and it is unacceptable that in the second half of 2019, 35.7 million persons of all ages (11.0%) were uninsured[17]. Everyone in America must have access to healthcare and health coverage. To that end, we propose a system that creates a free public option for healthcare coverage that would run alongside private health insurance options. The public option for healthcare coverage would be open to everyone who chooses. All other government-funded health coverage systems would be consolidated under the public option, along with their funding. Additional funding can come from increasing taxes or from cutting the military budget. In 2015, the military spending took up 54% of the US discretionary spending, while medicare and healthcare only took up 6%[18].

The public option for healthcare coverage will allow Americans to keep their private health insurance or have a free alternative. The transition will be easier and less burdensome for taxpayers than a Medicare-for-all system while still ensuring everyone has health coverage. Even though such a system does not level the playing field for everyone, it ensures everyone will have access to some form of healthcare, and helps create a more equal society.

 

• Promoting competition with private healthcare systems

The U.S. commercial health insurance companies currently have a strong hold on the healthcare coverage markets since they are highly concentrated and are in high demand[19]. People need insurance and must go through these companies if they do not qualify for current government programs. Thus, commercial health insurance companies can charge high prices and offer inadequate services to consumers without the threat of losing customers, since most other companies offer similar plans. A public option would open up the healthcare market by giving consumers another option. Private health insurance companies would be forced to provide better rates and services to ensure they do not lose their customers, effectively giving back market power to the consumer and helping even those who keep their private health insurance. 

 

• Lowering drug prices

Figure 2: Drugs in the US cost much more than their equivalent in the UK and Canada: Eight best selling brand drugs for conditions ranging from diabetes to asthma and ADHD.

Source:  Financial Times analysis of data from: “Why prescription drugs cost so much more in America,” 2019, The Financial Times.

 

Currently, pharmaceutical agencies have a monopoly on drugs, and their consumers have no choice but to pay for their necessary medications. According to the American Journal of Managed Care, 29.3 million patients pay anywhere from $300 to $800+ a month for their essential insulin. Yet, insulin costs $2.28-$3.42 to produce, and one vial of analog insulin costs $3.69-$6.16 to make[20]. Figure 2 shows that many drugs cost hundreds of dollars more in the U.S. than in Canada or the United Kingdom. Brand name drugs in the US have profit margins as much as four times higher than those in more regulated European and Japanese markets.

 

Every other developed country prevents the stronghold of pharmaceutical companies and regulates drug prices “often through price negotiations pegged to cost-effectiveness analysis or some other measure of clinical benefit”[21]. A public option incentives the government to regulate the prices of drugs since the government would have to provide coverage for the drugs. A public option also gives the US government more spending power over these companies, which can allow them to pressure the companies to lower their prices. 

The pharmaceutical companies claim to require such steep prices in order to fund research, but in actuality, the money they get from their products mainly goes to profit, not research. Drug companies are making far more than all their research costs from just the top 20 drugs they sell alone. The excess money gained from these 20 drugs went to profit, not excess research. On top of that, even more profit was gained from the next 100 or 200 brand-name drugs.[21] Amazon spends the most on research and development worldwide and has an operating margin of under 5% and, while drug companies have an average operating margin of 22%[22].Amazon makes much lower profits than any drug companies, yet still spends more on research and development than all the drug companies, showing more profit does not correlate to more research. Considering this, lower drug prices would not need to cut drug research and development spending. If lowering prices prompts a company to defund their research, it is because of their own greed to have exorbitant profits, not the lower drug price. 

 

• Implementing an ACO system

An Accountable Care Organization (ACO) is a network of healthcare professionals working in union to provide higher quality care and limit spending. As previously mentioned, the American healthcare system is fragmented, causing sloppy and incoherent standards of care. In ACOs, however, doctors, hospitals, and other healthcare providers voluntarily work together, and all are held accountable for their patient’s health. Information is shared within the organization, saving money and time. This takes the first steps in mitigating the long standing issue of healthcare fragmentation[23].

Financial incentives are also provided if care is delivered efficiently. In 2015, there were 6 million Medicare beneficiaries in an ACO, and when combined with the private healthcare sector, an estimated 23.5 million Americans were being served by an ACO. Although these numbers are increasing, hopefully the public model proposed in this paper further expands ACOs. Medicare is traditionally a fee-for-service system, and while ACOs do not scrap this model entirely, doctors and hospitals are focused on prevention and chronic disease management. Bonuses are offered when patient costs are lower, meaning providers are paid greater amounts for keeping their patients healthy and out of the hospital.  

These organizations provide greater care and organization, and by doing so, citizens are given access to not only basic healthcare, but they are also given premium care[24].

 

• Regulating healthcare costs

 

Figure 3: Medical Prices in 2017 as a percent of US prices 

Sorce: From “Price Transparency Alone Won’t Keep Health Care Costs Down,” by J. Schultz, 2020, January 15, Minnesota Reformer. 2021 by Minnesota Reformer.

As shown in figure 3, the United States has the higher prices for healthcare services than any other industrialized country. Government regulations hold down prices in most other countries, but in America, prices are only set through Medicare and Medicaid[7]. The price settings used in medicare and medicaid will be continued in the public option, but on a much larger scale that will likely decrease the health care expenses in America significantly. The public option cannot do much to regulate in the private sector since they set prices with providers independently; however, the private insurance companies may be incentivized to work towards lower costs for their customers to prevent losing them to the public health coverage option. 

Additionally, some of the excessive costs of healthcare in America are caused by an alarmingly high hospitalization rate. Limited access to good primary care is at the root of the hospitalization rates[7]. Many people would not have to have costly hospital visits if they had adequate primary care to address their illness early on. A public health coverage option would give widespread access to primary care options, reducing the costs associated with a high hospitalization rate. 

 

• Helping people with lower socioeconomic status and minorities

Lower socioeconomic status (SES) families are more likely to be uninsured and usually have decreased quality health insurance[25]. Nonelderly Native Americans, Hispanic, Native Hawaiian or Other Pacific Islanders, and Black people remained more likely to be uninsured than their White counterparts. This disparity affects health outcomes and life expectancies[26].

Having a lower SES increases the risk for many diseases[27]. Obesity rates are much greater among low SES populations[28]. Hypertension is the leading risk factor for death worldwide and is far more prevalent among people of lower SES[29]. Similarly, When a diabetic has a lower SES, they have a greater mortality risk than diabetics with high SES[30]. Compared to insured diabetics, uninsured diabetics are responsible for 55% more emergency room visits annually[31].

A public health option will provide services to all those who need it and specifically serve minority and lower SES populations who are the most vulnerable to being uninsured. People with lower SES are in dire need of a public option considering that they have a high risk of getting sick and a lower rate of health coverage. 

 

• Preventing chronic illnesses 

America is struggling with a growing chronic disease epidemic[32]. In 2017 50% of the American population is affected by chronic disease. Caring for chronic disease consumes more than 85% of healthcare costs.  

The economic strain associated with this crisis can be mitigated with preventative health initiatives. A public option of health coverage would incentivize the government to “(i) offer primary prevention of chronic disease risk prior to the onset of irreversible complications, and (ii) promote wide-spread preventive efforts across multiple societal domains” since they would be paying for the treatments needed for non-communicable, preventable chronic diseases[33].

It is not guaranteed that the government will implement these preventative measures. Still, the health coverage system may lead to the promotion of healthy lifestyle behaviors, environmental spaces in low and middle-income communities, and policies promoting healthier food and drink choices[34].

Investing just 10 USD per person annually in community-based programs to combat physical inactivity, poor nutrition, and smoking would save the U.S. nearly $18 billion annually in 10 to 20 years (in 2004 dollars). The monetary savings of the program equates to a return of 5.60 USD for every dollar spent[35]. The government will likely want to make this investment when the healthcare costs of a sick population end up on its shoulders. 

• Lifting unfair cost burdens on the sick

Rawls’ veil of ignorance suggests that a truly just society is one in which those who are either born with or are subject to chronic illnesses aren’t expected to unfairly bear a cost merely by the happenstance of having developed such an illness. 

Annually, it costs a patient with a chronic disease an average of $6,032 in direct health care costs. People with chronic disease have health care costs 5 times that of a person without a chronic disease[36]. 

The cost of healthcare should be equitably distributed across the population with a public health coverage system rather than borne disproportionately by high-risk groups. 

 

• Affordable healthcare is a public investment  

Funding public health coverage can be compared to funding public schools. When public education was first proposed, many people deemed it a waste of money and a right only for those who could afford it. Thankfully, a public education system was invested in anyways, and it boomed the productivity of the American workforce. Education and health are both essential for a functioning economy. Sickness shirks the workforce and decreases productivity. The cost of lost productivity lost to obesity in the U.S. is projected to equate to USD 66 billion annually[37]. A public option for healthcare coverage will ensure people can get the medical attention they need, creating a healthier population. A healthier population will offset the costs of a public option of health coverage by increasing productivity. 

1. Roots of the Broken Healthcare System in the United States 

After closely examining the possible solution to the issues associated with the American healthcare structure, it is important to understand the underlying factors that contributed to its defective nature.

The fragmented U.S healthcare system that one sees today is by no means, a stand-alone product of twenty first century American Society. Rather, the pervading issues within the country’s ability to provide healthcare to its citizens stems from a deep-rooted, systematic gap in fundamental human rights and economic accessibility. Such flaws are a byproduct of the supply and demand system of healthcare, which presents insurance as a commodity only for those who can afford it. Thus, by treating healthcare coverage as a piece within a Capitalist system instead of a fundamental human right, the United States created a foundation of injustice and harm for the quality of life of its citizens. 

When looking at the political theories underlying the United States healthcare system, one can see the presence of the Social Contract Theory, a strain of thought created by John Locke and Thomas Hobbes. Essentially, the theory describes the natural rights of humans as those that they are born with: “specific innate capacities or essential properties – their rationality, autonomy, and dignity”[38]. The problem with such ideas -that paint individual rights as more important than society- is that they disclude other forms of disadvantages that impact various communities within America. Being born into a family that can’t afford healthcare has no correlation with that individual’s worth and thus should not determine if that person receives health care insurance. Take the insurance of public education. In a rare deviation from the Social Contract theory that permeates U.S society, the legal backbone of this country has come to recognize that education is a fundamental right and should not be awarded to those with the most money. Thus, if one were to see that humans are not born self-sufficient, but become self-supporting only as a result of society, the Social Contract Theory no longer applies to the United States system of healthcare. Evidently, by treating insurance as a “good” within America’s hallmark Free Market, and applying these political ideologies to an inapplicable context, the basic idea of human rights is misconstrued, thereby exposing the current hypocrisies and disjunction within an outdated system of thought. 

Moreover, when taking a further look into the disparities within healthcare access, one can clearly see the connection between the long standing systematic racism coursing through American history and the current issues of the American healthcare system. Prior to the creation of the Affordable Care Act (ACA), nearly one in three Hispanic Americans and one in five Black Americans were uninsured compared to around one in eight white Americans[11]. Such a deficit is reflective of the current pernicious impact of racial discrimination on healthcare accessibility. However, even after the enactment of the ACA, 30 million Americans remain uninsured, with half of them identifying as people of color. Moreover, despite the passage of Medicaid which aimed to  assist the uninsured, fourteen states–who also have the highest proportion of Black Americans– have refused to expand the program[11]. This small glimpse into the racial inequality of the healthcare system dates back to segregation. Often affordability and even access to adequate health services can be traced to the income gap, racial inequities in the workplace, public works accessibility, and a plethora of other realities that people of color face as a result of the century long discrimination of non-white people in America. For instance, unequal job opportunities and disproportionate average household income levels play a large role in such a disparity as the average annual cost for health care premiums is almost 20 percent of the average household income—a significant burden, when taking into account other economic challenges for this demographic[39]. It would be a vast oversimplification to ascribe the issues of the U.S healthcare system to economic imparity alone; hence, looking at the racial undertones of the current healthcare system provides an imperative perspective to consider. 

Looking forward to the future of change within the U.S healthcare system, it is important to keep in mind the political roots that might cause resistance to reform. Over the last few decades, the U.S has headed down a path of exponentially increasing political polarity within its two party system, with the topic of health care at the core of contestation. Nowhere can such potent debate be seen more than in 2013, when congressional Republicans orchestrated a government shutdown seeking to deprive the Obama administration of the resources it needed to implement the ACA[40]. In fact, the politicization of healthcare issues is nothing new: dating back to the 1920s–when the first proposals designed to create a national healthcare system emerged–each time a new initiative is proposed, strong social opposition ensues, setting the stage for ineffective compromise that defines the fragmented system today. Looking forward, it is clear that the age-old issue of federal involvement, fears of socialism, and tax increases will play a part in the arduous opposition for any type of single payer system. Yet, the recent rise in recognition for a new method in insurance gives a glimpse of hope that perhaps the roots of the difficulties in healthcare can be overcome and that although healthcare and politics are tightly intertwined, we work to separate the two; ensuring that a fundamental right as important as life or death is treated with more importance than mere debates over policy.

 

• Conclusion

The current status of the healthcare system in America is unacceptable. Health care coverage is unfairly worse for minority groups and people of lower socioeconomic status; this is no surprise when it is taken into account the racial disparities that have existed in healthcare for decades. Also, most private insurance companies operate through employer provided health coverage, often leaving out the unemployed. Even with government health coverage such as Medicare and the Affordable care act, tens of millions remain uninsured. Only a government operated insurance plan that is open to everyone can truly insure every American. A public option system will provide health coverage for everyone, without forcing anyone to stop using their private insurance companies, and without being extremely burdensome on taxpayers.

The public option would have positive impacts on both those lacking health coverage, and healthcare in America as a whole. A shift toward preventive health initiatives, lower drug prices, and consumer based private healthcare is likely to occur as a result of the public option. Also, sicker individuals would no longer be burdened unfairly with the costs of chronic illness merely for having a disease. Health coverage for everyone will create a healthier workforce that essentially leads to more productivity. Thus, health coverage is a worthy public investment. Overall, it is unethical to deny people health coverage, and outdating political thought must not prevent people from their right to equitable healthcare. 

 

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