Is This the End of Universal Healthcare?

Nurses, from left, Katie Murphy of Boston, Kimberly Wallace of Buffalo, N.Y., and Nora Watts of Westborough, Mass., participa
Nurses, from left, Katie Murphy of Boston, Kimberly Wallace of Buffalo, N.Y., and Nora Watts of Westborough, Mass., participate in a rally on Capitol Hill in Washington, Thursday, July 30, 2015, in support of Medicare on the 50th anniversary of Medicare and Medicaid. (AP Photo/Jacquelyn Martin)

For decades, universal healthcare has been an important policy issue for Democrats. Party faithful argue that providing access to healthcare is a basic right that should be afforded to all American citizens. Data suggests that providing healthcare access benefits society both socially and economically. Furthermore, a provision for this program brings us on par with what other industrialized nations fund for their citizens.

However, many on the Right refute the notion that universal healthcare is a right because it is not explicitly spelled out as such in the Constitution. Others, regardless of party affiliation, oppose the idea based on an array of philosophical and economic reasons.

It's no secret that Americans disagree on their views about universal healthcare. Yet the divisiveness isn't about a lack of empathy for our fellow man. It's about a lack of clarity. There is no consensus about what services a universal healthcare program would cover, or how such a program would be funded.

By definition, universal means "including or covering all or a whole collectively or distributively without limit or exception; especially: available equitably to all members of a society." A universal healthcare plan, then, should be something that applies to everyone in pretty much the same way. There is a built-in expectation of equality and even simplicity in the concept. Unfortunately, there's nothing universal about any major healthcare reform that has been implemented or proposed over the last ten years.

Back in 2006, almost 70% of Americans believed it was the government's responsibility to ensure that Americans have health coverage. In other words, most Americans supported the concept of universal healthcare. And in 2007, then-Senator Barack Obama echoed this notion by saying, "I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country."

President Obama tried to deliver on this pledge by presiding over the passage of the Patient Protection and Affordable Care Act (PPACA or "Obamacare") during the first term of his presidency. Obamacare was signed into legislation in 2010. But as the years passed, support for universal healthcare began to fall. By 2013, the first year of open enrollment in Obamacare, only 42% of Americans believed that it was the government's responsibility to mandate health coverage. It seems that Americans liked the idea of universal healthcare until they were presented with the myriad insurance plans, varying pricing options and high levels of complexity that went along with the Obamacare version of it.

By bringing many previously uninsured and under-insured Americans into a pool of covered members, the Affordable Care Act has forced insurance companies to take on considerable risk. Much of this risk has been passed on to consumers in the form of higher than expected co-pays, deductibles, and other rates of service that have made insurance, ironically, unaffordable for some. As a result, some individuals aren't buying health insurance at all. These folks are opting to pay the tax penalty for not having coverage because it's cheaper than buying insurance. Further, 19 states have chosen not to expand their Medicaid programs, leaving millions more without insurance. While Obamacare has expanded coverage for millions, about 10% of the American population is still uninsured. These are unfortunate and unintended consequences of a program that was supposed to provide universal healthcare coverage for Americans.

In an attempt to simplify the structure of America's health insurance system, Bernie Sanders has proposed his own "Medicare-for-all" plan. "Berniecare" would provide coverage for all Americans, for all services along the continuum of care. The program may sound simple, but the universality of Berniecare applies only to the fact that everyone in America would have healthcare coverage. Under Mr. Sanders' plan, the federal government would set guidelines that individual states would use to design their own programs. As a result, there could be at least 50 different approaches to implementing Berniecare across the country.

The Sanders campaign believes Berniecare will save the American people about $6 trillion over the next ten years. A separate estimate claims it will increase government spending by $28 trillion. It's hard to find agreement on the economic impact of the plan because it does not include many specifics, particularly with regard to how it will reduce America's unsustainably high cost of care delivery. It's an issue that worries Americans. A poll released this January indicated that 59% of likely U.S. voters consider reducing the cost of healthcare to be more important than making sure everyone has health insurance.

Our cost structure is too high to allow Americans to have access to all the care they want, when they want it. How can we afford to spend almost $100,000 on a course of medication for every hepatitis C patient? How can we financially justify providing 24-hour in-home care to every patient that wants to stay out of a nursing home and live independently? We cannot.

Until our cost structure is brought under control, we will not have a universal healthcare program in America. Therefore, the term "universal healthcare" should be eliminated from the political vernacular. Invoking the phrase will only cause confusion and frustration, as little consensus exists with regard to what it really means.

Instead, we need to advocate for ideas that improve the health of our citizenry, reduce bureaucracy and increase engagement in our healthcare experience. Patient-centric healthcare can be provided to every American. We just have to be prescriptive about what it means, how it's implemented and the terms of coverage for each of our unique constituencies.