The Price tag Put on Lives
Among the systems in place in the United States, the healthcare system remains arguably the most relevant in the everyday lives of Americans. The strength of a nation’s healthcare system can dictate the well-being of its people. However, in the United States, the quality of medical care does not come without a cost, one that many Americans are unable to afford. While healthcare is not completely free in any country, many nations have universal healthcare systems that are free or low-cost; these include the United Kingdom, Brazil, and Denmark. This fact raises a question: why does the United States, a highly developed country, lack an affordable health-care system? Although US legislation does not explicitly guarantee a right to healthcare, existing laws and programs show that free and reduced-cost care is both legally supported and necessary for protecting public health and promoting equal access.
Healthcare in the United States is expensive for a number of reasons. The combination of structural, economic, and legal factors drives up the cost of nearly every part of the system. Unlike many other healthcare systems, the US healthcare system is largely profit-driven. America relies heavily on private insurance, pharmaceutical, and insurer companies that set prices in ways that maximize revenue rather than minimize cost. These prices are set with little government regulation due to the market-based healthcare system. The predominant “fee-for-service” system incentivizes providers to order more drugs, tests, and procedures to increase overall profit. Malpractice insurance and the fear of lawsuits also encourage some physicians to order extra tests to avoid liability. Medical services, prescription drugs, and life-saving treatments also lack a standardized national price, allowing providers to charge widely different prices for the same procedure. Particularly, a major driver for the cost of healthcare is the high cost of prescription drugs. Unlike other countries, the federal government does not negotiate drug prices for most medications. This grants corporations the power to set high prices for their medicinal drugs. Due to patents, drug manufacturers can set their prices high even if their cost of production is low, simply due to the fact that there exists minimal competition. Legal factors also contribute to the high cost. Regulatory systems, such as FDA approval for new drugs and devices, are crucial for safety, but can increase the time and cost required for innovations to reach the market. Finally, price transparency is limited; less than 20 percent of Americans say they know how much they will have to pay before receiving healthcare treatments. This means that consumers likely don’t weigh the cost of their treatment before receiving it, making consumer comparison nearly impossible; this removes a market shifter that will normally keep prices down. As a culmination of these ideas, the price of healthcare is extremely high for everyday Americans.
The Affordable Care Act (ACA), often called Obamacare, is one of the most significant healthcare laws in U.S. history because it fundamentally changed the way millions of Americans can access affordable healthcare. In 2010, the ACA attempted to fill several of the largest gaps in the healthcare system through the creation of insurance marketplaces, where individuals could purchase subsidized plans. It also expanded Medicaid eligibility for citizens in participating states and prohibited insurance companies from denying coverage based on pre-existing conditions. The uninsured rate plummeted, with large improvements among low-income populations and young adults who gained the right to remain on their parents’ insurance until the age of 26. The Affordable Care Act also made it so that marketplace plans were required to cover life-saving services such as emergency care, maternity care, mental health treatment, and prescription drugs. Shortly after the ACA was passed, 13 states sought action in National Federation of Independent Business v. Sebelius, claiming that the ACA was unconstitutional on multiple grounds. The plaintiffs believed that the ACA was an overextension of Congressional powers, interfering with state sovereignty. States such as Florida believed that the mandate of the ACA exceeded the powers enumerated by the Commerce Clause, claiming the Medicaid expansion was particularly unconstitutional. In the end, most of the law was left intact, but Medicaid expansion was ordered to remain a state decision. The Affordable Care Act represents a major shift towards the view that healthcare access is a public responsibility rather than a market-driven commodity.
Despite the presence of a legal framework supporting accessible healthcare, the United States continues to face major enforcement problems, structural limitations, and political obstacles that restrict the system’s effectiveness. The optional nature of Medicaid expansion following NFIB v. Sebelius (2012) results in varied coverage availability throughout the US. Millions of low-income adults earn too much to qualify for traditional Medicaid but too little to receive ACA subsidies. This undermines the ACA’s original goal of nationwide affordability. Although the EMTALA (Emergency Medical Treatment and Active Labor Act) guarantees emergency treatment regardless of ability to pay, it is an unfunded mandate, meaning that hospitals must absorb the cost of treating uninsured patients. This creates financial strain and reduces access to care in regions that already face provider shortages.
Looking beyond the U.S border, global implementations of universal or free healthcare reveal important legal implications for the American system. Countries such as the United Kingdom, Canada, and Denmark have established universal healthcare not only through policy but through binding legal commitments that define healthcare as a guaranteed right for all citizens. The United Kingdom’s National Health Service is legally obligated to provide comprehensive care free. Other nations, like Canada, have a Medicare system that establishes enforceable standards for health that provinces must meet in order to receive funding. As such, for the United States, the adoption of this would require redefining the federal government’s obligations towards its citizens and recognizing healthcare as a legal right.
The global landscape makes it clear that free or reduced-cost healthcare systems can succeed when supported by robust legal frameworks. While legislation such as the Affordable Care Act can move towards this goal, constitutional limitations and coverage gaps hinder the formation of a universal healthcare system. The United States faces a choice: it can remain tied to the market-based model or follow the example of other developed nations by denying access to healthcare as something that cannot be defined with a price tag.
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