Universal Health Care

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Universal health care is a situation in which all residents of a geographic or political region have access to most types of health care regardless of ability to pay.

Universal health care is provided in most developed countries, and many developing countries across the globe. In the 1880s, most Germans became covered under the mandatory health care system championed by Bismarck. The National Health Service in the United Kingdom was the world's first universal health care system provided by government. It was established in 1948. The most comprehensive today is in France, and the second most is in Italy. Other examples are Medicare (Australia) in Australia, established in the 1970s, and by the same name Medicare (Canada) in Canada, established between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa, though South Africa is one of the many countries attempting health care reform.Physicians for a National Health Program "International Health Systems".

Some government health care systems allow private practitioners to provide services, and some do not. In the U.K., doctors are allowed to provide services outside the government system; in Canada, some services are permitted and some are not.

Implementation

Universal health care is a broad concept and has been implemented in several ways. The common denominator for them all is that every resident of a geographic area — such as a country — is mandated to have guaranteed health care access at reasonable cost.

Most countries implement universal health care through legislation and taxation. Legislation directs what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient but are heavily subsidised by direct taxation and compensated to the patient to some extent either directly by the government or by some form of compulsory insurance.For an international comparison of ten different health care systems in ten developed countries - nine universal systems and one non-universal system (the US) - and their relative costs and key health outcomes, see http://www.nao.org.uk/publications/Int_Health_Comp.pdf. For a wider international comparison of 16 countries, each with universal health care, see the World Health Organisation publication at http://www.euro.who.int/document/e85400.pdf.

Europe Most of Europe has publicly sponsored and regulated health care. Countries include Austria, Belgium, Bosnia, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Estonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Malta, the Netherlands, Norway, Lichtenstein, Luxembourg, Poland, Portugal,Portugal: Bentes M, Dias CM, Sakellarides C, Bankauskaite V. Health Care Systems in Transition: Portugal. WHO are Regional Offices for Europe on behalf of the European Observatory on Health Systems and Policies, 2004. Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom. Physicians for a National Health Program "International Health Systems

United Kingdom The NHS is the world's largest centralized health service, and the world's third largest employer after the Chinese army and the Indian railways. It provides a very wide range of health services to virtually the entire population. Unlike most health systems, it does not bill its services to either its patients, an insurance fund or to the government. Even in-patient medicines, hospital supplies such as bandages and hip joints, as well hospital supplied meals and refreshments all are free to in-patients, and even outpatients receive free loans of medical aids such as crutches. This is a factor which reduces administration costs considerably over insurance based systems. It is entirely funded from general taxation. It was created in the aftermath of World War II, by Clement Attlee's The Labour Party (UK) government, based on the proposals of the William Beveridge Report, prepared in 1942.http://www.spartacus.schoolnet.co.uk/2WWbeveridgereport.htm The structure of the NHS in England and Wales was established by the National Health Service Act 1946 (1946 Act). Governments since 1997 have spent more money on the NHS and UK spending on health is now closer to (but still below) the European average. The new money has reduced waiting times and modernised the infrastructure, and has improved the salaries of medical staff. The outsourcing of medical services and support to the private sector is a recent innovation. Hospitals may have both medical services (such as independent Sector Treatment Centre), and non-medical services (such as catering) provided under long-term contracts by the private sector. Capital projects such as new hospitals have been privatized through the Private Finance Initiative, enabling the public sector borrowing requirement to be reduced.

See also Health care in the United Kingdom.

Americas Argentina, Brazil, Costa Rica, Canada, Chile, Cuba and Uruguay all have public health care provided. Mexico is planning to launch its own universal health care network.G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.

The United States is one of the few industrialized nations lacking universal health care. In the absence of a national program, more localized efforts are under way. Both MassachusettsSee Massachusetts health care reform and San Francisco, CaliforniaMeredith, Adams. " San Francisco launches universal health care". Chicago Tribune. 2007-09-18. Retrieved on 2007-10-09. have recently undertaken programs to achieve universal health care coverage within their jurisdictions.

Canada In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."Government of Canada, Social Union, News Release, " A Framework to Improve the Social Union for Canadians: An Agreement between the Government of Canada and the Governments of the Provinces and Territories, February 4, 1999," URL accessed 20 December 2006.

The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises or private corporations. Most doctors do not receive an annual salary, but receive a fee per visit or service. About 30% of Canadians' health care is paid for by the private sector or individuals. This mostly goes towards services not covered or only partially covered by Medicare (Canada) such as prescription drugs, dentistry and optometry. Many Canadians have private health insurance, often through their employers, that cover these expenses.

The Supreme Court of Quebec ruled, in Chaoulli v. Quebec, that private services must be allowed to compete with the public program.http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

Asia and Africa Australia, Brunei, India, Israel The Health Care System in Israel- An Historical Perspective Israel Ministry of Foreign Affairs. Retrieved June 7, 2006. Japan, Malaysia, New Zealand, Saudi Arabia, South Korea, Seychelles, Sri Lanka Ministry of Health and Nutrition, Sri Lanka, Taiwan Bureau of National Health Insurance, Taiwan and Thailand have universal health care.

Thailand Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to achieve this. Means-tested health care for the poor was replaced by a new more comprehensive insurance scheme - originally known as the 30 baht project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allows them to access services in their health district, and - if necessary - to be referred for specialist treatment elsewhere. The Thai system is relatively unusual in having a single, central purchasing agency - the National Health Security Office - which channels funds to a large number of contracting units for primary care (CUPs) that co-ordinate services in local districts. The bulk of finance comes from public revenues, with funding allocated to CUPs annually on a population basis. All public hospitals and some private hospitals participate in the scheme. Although the reforms have received a good deal of critical comment, they have proved popular with poorer Thais, especially in rural areas, and appear likely to survive even after the 2006 military coup. The current Public Health Minister, Mongkol Na Songkhla, recently announced his intention to abolish the 30 baht co-payment and make the UC scheme free. The Universal Coverage Policy of Thailand: An IntroductionG20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.Hughes, D. and Leethongdee, S. Universal coverage in the land of smiles: lessons from Thailand's 30 baht health reforms, Health Affairs 26(4):999-1008, 2007.

India India has partial universal health care system run by the local governments. The "government hospitals", some of which are among the best hospitals in India A list of the top rated hospitals in India. Several hospitals among these are government hospitals, Including AIIMS, provide treatment free of cost, or at a nominal cost. Selected drugs are offered free of charge in some hospitals.

Oceania Australia Medicare was introduced by the Gough Whitlam Labor Government on 1 July 1975 through the Health Insurance Act 1973. The Australian Senate rejected the changes multiple times and they were passed only after a joint sitting after the 1974 Australian electoral system#Double dissolutions election. Yet Medicare has been supported by subsequent governments and became a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. The original Medicare program proposed a 1.35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medicare was originally funded from general taxation. In October 1976, the Fraser Government introduced a 2.5% levy. The program is now nominally funded by an income tax surcharge known as the Medicare levy, which is currently set at 1.5% with exemptions for low income earners. In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%. There is an additional levy of 1.0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000) who do not have adequate levels of private hospital coverage. This is part of an effort by the current Liberal Party of Australia Federal Government to encourage people towards private health insurance.

New Zealand As with Australia, New Zealand's healthcare system is funded through general taxation.

Economics Funding models Universal health care in most countries has been achieved by a mixed model of funding, based on elements of compulsory safety net insurance for all (which may be levied on the individual and/or an employer), with special protections for the poor and disadvantaged (funded by taxation) with the option of private payments (either direct or via optional insurance) for services beyond that covered by the safety net.

Compulsory insurance This is usually enforced via legislation. Sometimes there may be a choice of several funds providing a basic service (e.g. as in Germany) or sometimes just a single fund (as in Canada).

Taxation Some countries (notably the UK) effectively have stripped away the pretence that there is insurance for the safety net and choose to fund health care directly from taxation.

Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation.

Single-payer This term is used in the U.S. debate to describe a funding mechanism meeting the costs of medical care from a single fund. Although the fund holder is sometimes assumed to be the government allocating funding from taxation, its proponents do not rule out the possibility of some other mechanism. It is therefore as yet undetermined whether a future U.S. single-payer universal health care system would be funded from taxation, from compulsory insurance or a mixture of both.

Private insurance Private insurance is most often used to meet what the core safety net services do not provide. E.g. cosmetic surgery for reasons of vanity, for special comforts like private rooms, or to obtain service more quickly than is otherwise possible.

Medical (health) insurance is subject to the well-known economic problem of adverse selection which may also be referred to as a market failure. Adverse selection in insurance markets occurs because those providing insurance have limited information with which to estimate the risks their clients wish to insure against. In simple terms, those with poor health will apply for insurance, raising the cost of providing insurance; those with good health will find the cost of insurance too expensive, raising costs further. In practical terms, adverse selection means that private insurers are economically incentivized to spend substantial sums on 'weeding out' bad risks in advance by providing medical insurance only to the most healthy. Among the potential solutions posited by economists are forms of universal health insurance, such as requiring all citizens to purchase insurance, limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals. Compulsory universal health insurance is a common thread, be it through single payer systems or by requiring individuals to have private health insurance.Michael Rothschild and Joseph Stiglitz, "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," Quarterly Journal of Economics, November 1976 (90:629-649) (known as the Rothschild-Stiglitz Model) Paulo Belli, How Adverse Selection Affects the Health Insurance Market

Financial inputs and outcomes compared The table below gives some indications of financial inputs and medical in a number of different countries, some of which have universal coverage and some of which do not. Interpreting data of this kind can be difficult because of other factors (e.g. genetic differences, diet) that are not controlled for.

{| class="wikitable sortable"!Country!Life expectancy!Infant mortality rate!Physicians per 1000 people!Nurses per 1000 people!Per capita expenditure on health (USD)!Healthcare costs as a percent of Gross domestic product!% of government revenue spent on health!% of health costs paid by government|-|Australia|80.5|5.0|2.14|9.95|2,669|9.9|16.7|69.9|-|[France|80.0|4.0|3.37|9.72|3,204|11.1|17.6|78.2|-|[Japan|80.5|3.0|3.28|10.24|3,149|9.4|13.6|85.2|-|[United Kingdom|79.5|5.0|2.30|12.12|2,428|8.0|15.8|85.7|-|USA (e.g. [Portugal). Some nations, such as Germany, FrancePhysicians for a National Health Program "International Health Systems". and JapanChua, Kao-Ping. "Single Payer 101". February 10, 2006. employ a multi-payer system in which health care is funded by private and public contributions. In 2001 Canadians paid $2,163 per capita versus $4,887 U.S., according to the Los Angeles Times (also, see table above). According to Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle, Canadians do better by every health care measure. According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.SIn Health, Canada Tops US; Our neighbors to the north live longer and pay less for care. The reasons why are being debated, but some cite the gap between rich and poor in the US, by Judy Foreman, Los Angeles Times, February 23, 2004..

A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, speciality healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency. One advantage of tying health care to local budgets is that that health care improvements and cost savings can be obtained by cross subsidy. For instance in Finland, type II diabetes patients can get discounted access to municipal owned sports facilities such as gyms and swimming pools, the discounts being rewarded to the community in the longer term because fitter patients will not need more expensive medical or personal care later in life. No entirely private health care system exists, although the Massachusetts 2006 Health Reform Statute in Massachusetts attempts to make private health care more affordable. Bill Frist argued in the New England Journal of Medicine that the free market will keep costs down, because individuals who have to pay for their own health care will make wiser decisions and not spend money on unneeded or inefficient care. A deregulated free market, Frist argues, will also encourage efficiency and innovation.

Politics Because most developed and many developing countries already have systems for universal health care that have been in place for many years, universal health care per se is not a matter of political debate. The exception is the United States, which does not have such a system currently and where health care is currently a hot political issue.

Within the U.S., those in favor of implementing universal health care, such as the advocacy group, Physicians for a National Health Program, argue that it would provide health care to the people who currently do not have it. Opponents of universal health care argue that universal health care will require higher taxes and a great likelihood of poorly performing healthcare facilities and physicians. http://www.jwpcivitasinstitute.org/newsroom/Magazine/Winter%2006%20Magazine.pdf; page 22. Opponents also claim that the absence of a market mechanism may slow innovation in treatment and research, and lead to rationing of care through waiting lists. Both sides of the political spectrum have also looked to more philosophical arguments, debating whether people have a fundamental right to have health care provided to them by their government.

A statistical comparison shows that it is not universal health care that leads to a doctor shortage, but the payment system to doctors that causes a doctors shortage. A 2001 study showed that doctors in Italy, Comparisons of Health Systems - Doctors per patients p.13 are paid a fee per patient per year, a per capita salary, without causing a doctor shortage; even maintaining the highest doctor per patient ratio seen at, 5.8 doctors per 1,000 patients. Canada has a doctor per patient ration of 2.1 doctors per 1,000 patients, compared to the UK with 1.8 and the US with 2.7.

In Canada, the self regulation of the health industry by the doctors union, the Canadian Medical Association, and its self-regulatory wing, College of Physicians and Surgeons of Ontario Michener Awards: Finalists for 2001 Award are not required to respond publicly to complaints against doctors unless disciplinary action was given, leading to cases where doctors have been taken to court multiple times for similar actions The unkindest cut. The Star.com

United States The United States does not have a universal health care system but does have certain publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, and the poorCenters for Medicare & Medicaid Services. CMS Programs & Information. Retrieved August 30, 2006. and federal law ensures Emergency Medical Treatment and Active Labor Act regardless of ability to pay.Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act. Retrieved August 30, 2006. The Massachusetts is attempting to implement a near-universal health care system by mandating that residents purchase Massachusetts 2006 Health Reform Statute by July 1, 2007. Fahrenthold DA. "Mass. Bill Requires Health Coverage." Washington Post; Wednesday, April 5, 2006; Page A01. California, Maine, Pennsylvania, and Vermont also are attempting universal systems.New York Times; January 9, 2007; California’s Governor Seeks Universal Care In addition, certain types of medical spending and particularly health insurance benefit from significant subsidy; in particular, employer-sponsored health insurance is a non-taxable benefit. In all, government spending (including tax benefits) accounts for more than 44.6% of total health spending in the U.S.http://www.nybooks.com/articles/18802 Krugman, Paul, and Wells, Robin, "The Health Care Crisis and What to Do About It", New York Review of Books, March 23, 2006.

Proponents of implementing a universal health care system in the United States argue that there are many flaws in the reasoning used against having such a system. Proponents cite the low life expectancy of American citizens compared to other industrialized nations, including those with national healthcare systems, such as Australia, the United Kingdom, Canada, and Sweden. CIA World Factbook table of life expectancies by country Infant mortality rates remain higher in the United States, despite declines in recent decades, and are higher than the average of the European Union. -see tableCIA World Factbook; Guide to Rank Order Pages and the complete article on the United States

In turn, critics note that there is very little correlation between life expectancy and infant mortality with the quality of health care, due to such factors as alternate causality and variations in the way countries collect their statistical data.National Center for Public Policy Analysis. Retrieved August 08, 2007. In fact, the United States led the world in life expectancy twenty years ago with virtually the same health system. Rather, many analysts attribute the lower life expectancy to the astronomical surge in obesity rates.New England Journal of Medicine. Retrieved August 08, 2007.Journal of the American Medical Association. Retrieved August 08, 2007.Center for Disease Control and Prevention. Retrieved August 08, 2007.

Current estimates put U.S. health care spending at approximately 15% of GDP, the highest in the world. "The World Health Report 2006 - Working together for health." Despite this, only an estimated 84.2% of citizens have some form of health insurance coverage, either through their employer, purchased individually, or through government sources. "Income, Poverty, and Health Insurance Coverage in the United States: 2006." U.S. Census Bureau. Issued August 2007. In 2003, approximately 61 million adults, or 35 percent of individuals ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs. Employers that do provide insurance, on average, spend between 4.6 and 8.7% of their payroll in health insurance premiums. The cost of health care premiums is rising much faster than the general rate of inflation or employee wages. Since 2001, premiums for family coverage have increased 78%, while inflation has risen 17% and wages have risen 19%, according to a 2007 study by the Kaiser Family Foundation.

Debate Common arguments forwarded by supporters of universal health care systems include:

Health care is a basic human rightUnited Nations, Universal Declaration of Human Rights, Adopted and proclaimed by General Assembly resolution 217 A (III) of 10 December 1948. Article 25 states: "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."Center for Economic and Social Rights. "The Right to Health in the United States of America: What Does it Mean?" October 29, 2004.National Health Care for the Homeless Council. "Human Rights, Homelessness and Health Care". or entitlement.Kereiakes DJ, Willerson JT. "US health care: entitlement or privilege?." Circulation. 2004 Mar 30;109(12):1460-2.
Ensuring the health of all citizens benefits a nation economically.William F. May. [http://www.religion-online.org/showarticle.asp?title=106 "The Ethical Foundations of Health Care Reform." The Christian Century, June 1-8, 1994, pp. 572-576.
Coverage should be provided to all citizens regardless of ability to pay.
The current US system is already funded 64% by tax money with the remaining 36% split between private and employer spending. A universal healthcare system would merely replace private/employer spending with tax revenues. Total spending would go down for individuals and employers. "Won’t this raise my taxes?" PHNP.org.
A single payer system could save $286 billion a year in overhead and paperwork.Public Citizen. "Study Shows National Health Insurance Could Save $286 Billion on Health Care Paperwork:" http://www.citizen.org. Administrative costs in the US health care system are estimated to be substantially higher than in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of US health care spending.http://content.healthaffairs.org/cgi/content/full/23/3/10 Reinhardt, Hussey and Anderson, "U.S. Health Care Spending In An International Context", Health Affairs, 23, no. 3 (2004): 10-25
For profit healthcare has been shown to have higher expenses and worse results.Physicans for a national health program "For-Profit Hospitals Cost More and Have Higher Death Rates" http://www.pnhp.org March 1, 2006.Physicans for a national health program "For-Profit HMOs Provide Worse Quality Care" http://www.pnhp.org
Several studies have shown a majority of taxpayers and citizens across the political divide prefer a universal healthcare system over our current systemTeixeira , Ruy. "Healthcare for All?" MotherJones September 27, 2005 .CBSNews. "Poll: The Politics Of Health Care" CBSNews March 1, 2007 .Blake, Aaron. "Poll shows many Republicans favor universal health care, gays in military" TheHill.com June 28, 2007.
Health care is increasingly unaffordable for businesses and individuals.Messerli, Joe. "Should the Government Provide Free Universal Health Care for All Americans?" BalancedPolitics.org. March 1, 2006.
Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.http://covertheuninsured.org/media/docs/release050205a.pdf
Providing access to medical treatment to those who cannot afford it reduces the severity of epidemics by reducing the number of disease carriers.
Wastefulness and inefficiency in the delivery of health care would be reduced.
America spends a far higher percentage of GDP on health care than any other country, and has worse ratings on a variety of subjects such as quality of care, efficiency of care, access to care, safe care, equity, right care and wait times according to the commonwealth fund. New Zealand, which spends one third per capita what the US spends on health care beats the US on every marker of efficiency and care. Although not definitive, this does lend credence to the idea that universal health care is more efficient than our for profit health care system as the US was inferior to Germany, the UK, Australia, New Zealand and to a lesser degree Canada in nearly all health care quality issues. This despite the fact that the US system costs 2-3x more per capita than the systems in these other countries. "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care" by Karen Davis, Ph.D., Cathy Schoen, M.S., Stephen C. Schoenbaum, M.D., M.P.H., Michelle M. Doty, Ph.D., M.P.H., Alyssa L. Holmgren, M.P.A., Jennifer L. Kriss, and Katherine K. Shea Commonwealth Fund, May 15, 2007 .
A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions. "The Best Care Anywhere" by Phillip Longman, Washington Monthly, January 2005.
By reducing paperwork a universal system would allow doctors to spend more time with patients, thereby increasing physician productivity. "Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act" www.pnhp.org
Patients would be encouraged to seek preventive care enabling problems to be detected and treated earlier.
A network effects national database would make diagnosis and treatment easier for doctors.
Universal health care could act as a subsidy to business, at no cost thereto. (Indeed, the Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.) "Detroit's big three seek White House help" Guardian Unlimited, November 15, 2006
Managed care networks, with their extensive provisions and guidelines, reduce doctor flexibility and limit patient choice.
The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.http://news.pajamasmedia.com/2006/05/18/8722240_Book_tells_how_p.shtml
The profit motive adversely affects the motives of healthcare. Because an applicant with a pre-existing condition (possibly from birth) would require more care, they are often blackballed from being able to obtain health insurance at a reasonable cost. Health insurance companies have greater profits if fewer medical procedures are actually performed, so agents are pressured to deny necessary and sometimes life-saving procedures to help the bottom line.
According to an estimate by Dr. Marcia Angell roughly 50% of healthcare dollars are spent on healthcare, the rest go to various middlemen and intermediates to providing healthcare. A streamlined, non-profit, universal system would increase the efficiency with which money spent on healthcare goes to healthcare. "Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act" www.pnhp.org

Common arguments forwarded by opponents of universal health care systems include:

Health care is not a right.Goodman, John. "Five Myths of Socialized Medicine." Cato Institute: Cato's Letter. Winter, 2005.Sade RM. "Medical care as a right: a refutation." N Engl J Med. 1971 Dec 2;285(23):1288-92. PMID 5113728. (Reprinted as "The Political Fallacy that Medical Care is a Right.") Kelley, David E. 2003. A Life of One's Own. Cato Institute
Providing health care is not the responsibility of government.http://www.cato.org/pubs/pas/pa565.pdf
Universal heath care would result in increased wait times, which could result in unnecessary deaths.http://www.cato-at-liberty.org/2006/05/02/depends-on-what-the-meaning-of-universal-is/
Poorer quality of care.
Unequal access and health disparities still exist in universal health care systems.
Universal health care plans will reduce efficiency because of more bureaucratic oversight and more paperwork, which could lead to fewer doctor-patient visits.http://www.cato.org/pubs/handbook/hb109/hb_109-7.pdf Advocates of this argument claim that the performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.Kelley, David E. 2003. A Life of One's Own. Cato Institute
Profit motives, competition, and individual ingenuity lead to greater cost control and effectiveness.
Uninsured citizens can sometimes still receive emergency care from alternative sources such as nonprofits and government-run hospitals.
Government-mandated procedures would reduce doctor flexibility.
Healthy people who take care of themselves should not have to pay for the burden of those who smoke, are obese, etc.
Loss of private practice options and possible reduced pay would dissuade many would-be doctors from pursuing the profession.
Likely loss of insurance industry jobs and business closure in the private sector.
Universal health care would eliminate the right to privacy between doctors and patients.http://www.cato.org/pub_display.php?pub_id=3057
Empirical evidence on single payer-insurance programs demonstrates that the cost exceeds the expectations of advocates.http://www.cato.org/pub_display.php?pub_id=3057
Universal health care systems, in an effort to control costs by gaining or enforcing monopsony power, sometimes outlaw medical care paid for by private, individual funds.http://www.cato-at-liberty.org/2006/08/23/revolt-against-canadian-health-care-system-continues/