The pros of universal health care include fewer overhead costs, wider access, greater standardization, and less anxiety around the financial impact for individuals.
The cons of such a system include the potential for an unnecessarily large bureaucracy, possible brain drain of medical professionals heading overseas for higher pay, critical quality of care issues in cases of mismanagement, and the potential for corruption and waste.
Of course, many of these pros and cons are highly subjective, so the points below attempt to view the issue from a range of competing and contradictory perspectives.
Pros and Cons of Universal Health Care
Pro 1: Lower Health Care Costs Overall
Research into the cost of universal healthcare is inconclusive, but some research demonstrates that costs may be lower under a universal model. For example, Galvani and Fitzpatrick (2020) demonstrate that a dollar in the universal model tends to go farther than a dollar in a fully privatized model.
A more expensive healthcare system is not necessarily a better one. The more for-profit organizations that a private or semi-private health care system has involved in it, the more money will be spent in transactions between them.
This money is not just limited to overhead but also includes as many profit margins as there are private for-profit companies involved in any project.
A universal health care system may depend on private companies for parts of its services, but most of it will be managed by the government.
This means that logistics can remain internal and pricing structures do not need to factor in business costs. There are also no profits that need to be paid out.
Pro 2: Simplified Administration
As large numbers of health care providers work with large numbers of insurance companies, a very complicated administration needs to be established for this to function.
This increases the cost of health care, but the extra money does not go to providing more or better care.
Under a universal health care system, there is only one payer with only one set of administrative rules. Even if the hospitals remain private and only need to bill the government, this will require much less administrative overhead on the providers’ part.
Thus, some argue that bureaucracy is lower under a universal healthcare system. Later, in the cons section, we’ll see that others disagree.
Pro 3: Increased Life Expectancy
Universal health care has been found to correlate with higher life expectancy (Ranhabat et al., 2018).
This difference is found even when comparing with countries who have a private health care system but offer government-funded care to the elderly.
The reason for the increased life expectancy is believed to be because of the care that people receive before retirement. This care acts as a preventative measure for potential health problems in old age.
Pro 4: Economic Stimulation
A universal health care system can improve certain elements of the economy.
These are achieved by increased productivity from a healthier workforce, a reduction in missed working days, and the continued creation of jobs even when the economy does not make it practical for the private sector to expand.
The first two goals are possible because workers are less likely to put off seeking health care, which means that problems are less likely to worsen and lead to longer illnesses.
The third goal – job creation at any point in an economic cycle – is possible because the government has a lot more leeway with deficit spending than even a large business does.
However, in a contradictory point, it’s notable that in the USA, the enormous private healthcare workforce may be shrunk if the nation simplified healthcare and took its administration into public hands to achieve universalism.
Pro 5: Easier Paths to Innovation
A universal healthcare system will not need to paywall any of its data or protect it as an industry secret.
Even if it chooses not to publish its data to the public, it will be the largest healthcare system in the country, so internal use of this data will have the greatest impact.
Any researchers working within the system or clinicians who are open to expanding on experimental treatments will be able to build upon all of the system’s existing data without interorganizational barriers.
Nevertheless, contrarians may argue that making healthcare innovations for-profit can stimulate a race to find those innovations with a clear financial incentive for the first company to generate viable health products that consumers demand.
Pro 6: Better Quality of Life
The health benefits that a universal health care system may bring do not only have to be for the economy and the workplace. Because people are more likely to seek care early on in suspected cases of illness, the outcomes may, on average, be better.
This means both that people spend a smaller percentage of their lives ill and that there will be fewer emergences of long-term medical conditions. Healthier people are on average happier, live longer, and have more free time for social and leisure activities.
Pro 7: Equality of Access
A unitary system means that even in the cases of rationing of services, everyone will have access to the same basic and fundamental health care regardless of wealth or location.
This standardization is both financial and geographic. Families of lower socioeconomic status will not lose out on essential care, nor will people who live in regions that may have used poorer practices before standardization on a national level.
Pro 8: Long-Term Social Investment
Although people seeking care more frequently may create a short-term increase in healthcare spending, it may lead to much larger savings in the long term.
This can be direct, like a person in the very early stages of cancer having a simpler surgery instead of the more long, complex, and expensive treatment for advanced cancer.
It can also be an indirect saving, like an elderly person with a healthier early life not needing residential care.
Pro 9: Less Stress and Anxiety
By removing the potential for large medical bills, a universal healthcare system can eliminate much of the non-health anxiety and stresses around seeking health care.
In the most extreme examples, this eliminates the potential for medical bankruptcy or people allowing themselves to die because they cannot afford health care.
Speaking from personal experience, being from a nation with universal care, the most stressful health experience I ever had was when I was traveling and had to use private travel insurance. The stress involved with worrying whether I would be covered was very, very real.
Pro 10: Promotion of Human Rights
Many people believe that access to health care is a human right. The United Nations and the World Health Organization have made declarations to state this.
A universal health care system is the only way for a government to ensure that no one is locked out of receiving care or feels like they have to decline it because they cannot afford it.
Pro 11: Promotes Entrepreneurship
Ironically, removing healthcare from the public sector can encourage people to start private businesses.
Take the USA as an example. If a person quits their job in the USA to start their own business, they lose their employer-funded healthcare. They will have to buy their own healthcare from the individual healthcare exchange at high personal cost.
This makes them feel like they have to stick with their employer and discourages them from striking out on their own to start their own business.
Con 1: Increased Government Spending
History has shown that public healthcare systems balloon in cost at a faster rate than public revenues. This is because newer and cutting-edge medications and treatments tend to be more expensive than treatments of the past.
This creates a problem when growing healthcare costs go on for too long and increases government deficits and debt. This may lead to higher taxes or unstable public finances (Rashford, 2007).
The problem can be further exacerbated by people overusing health care services because there is no barrier to doing so, leading to spending that far exceeds projections, and unnecessary use of a public system.
Con 2: Bloated Bureaucracy
Government bureaucracies are infamous, and the regulations that they create and enforce can be more frustrating to individuals than helpful.
A government system that encompasses an entire country’s health care would need a tremendous bureaucracy. This may lead to not only a lot of red tape that no one wants to deal with but also a large degree of waste.
Of course, this is the case when mismanagement occurs.
However, contrarians would argue that there is also tremendous bureaucracy in the private healthcare sector. Unlike the public sector, in the private sector doctors need to fill out insurance forms, insurers need to go through checks and balances, and at the end of the day, the insurance company might deny coverage for silly bureaucratic reasons.
Con 3: Lower Quality of Care
While many may argue that the USA’s privatized healthcare system demonstrates the society’s lack of care for the poor and needy, few deny that the rich can get excellent care.
Of course, if you have the money in a private system, you will always be able to buy the best healthcare on the planet. A fully universal system, however, may offer a lower level of care to all, and deny those who can afford it the opportunity to pay for better care.
Furthermore, budget cuts or poor preparedness have made many universal health care systems infamous for long wait times and, in more extreme cases, rationing of care. This leads to people being denied health care temporarily or permanently, respectively.
Con 4: Brain Drain
Because of the lack of competitive business practices, salaries for medical professionals working for a universal health care system tend to be lower.
This can disincentivize people from training to work in the health care sector, which can create problems with recruitment and staffing down the line.
In more severe cases, it can lead to a country’s existing medical professionals emigrating to countries where they will receive higher salaries. This happens, for example, when Canadian doctors move south to the USA where the pay is far higher.
Con 5: Less Incentive for Innovation
The lack of competitive business practices in a country with a universal health care system can also lead to less innovation and development of new and more effective medical treatments.
Entrepreneurs in the private sector may feel like there is little potential reward in creating or researching something new in the medical field even if they are successful.
If the cost for undertaking the project is larger than this reward, then the financial incentive for these kinds of innovations disappears.
Con 6: Lower Aversion to Risk in the Population
The knowledge that any medical problems or injuries that a person could sustain will be treated without extra cost may lead some people to take less care with their health and safety.
This can lead to more cases that need medical attention.
An increase in use of health care services due to this is a completely unnecessary additional expense.
There is also a moral problem around what some people may view as a system that incentivizes this kind of dangerous behavior.
Con 7: Higher Taxes
Universal healthcare isn’t free. Generally, it is paid for through general taxation revenue.
This means that, if a country decides to implement a universal system, they will need to dramatically increase the rate of taxation.
For example, when Australia implemented their universal healthcare system (medicare) in the 1980s, they put in place a general taxation increase for everyone. The did this once again when they implemented their national disability insurance scheme in the 2000s.
Indeed, the fight over higher taxation is the key reason why the United States hasn’t implemented a universal healthcare program.
Con 8: Corruption and Waste
Although corruption is not unique to the public sector, it is very easy for corruption to develop within public programs. This is because they tend not to have the same incentives to account for every dollar as private corporations.
Corruption in a universal health care system has the potential to lead to a large level of waste since a system that big has control over a huge quantity of resources.
In addition to the financial cost, the mismanagement that the corruption causes can lower the quality of care provided.
Con 9: Large-Scale Opposition
Because of the large and sometimes absolute loss in revenue for certain interest groups, a universal health care system can face very powerful and well-funded opposition.
In the implementation stage, this can come from insurance companies.
Once the system is active, it can continue to receive opposition and obstruction from organizations like pharmaceutical companies and medical unions, who are still operating but would prefer to do so under a private health care model.
Con 10: Erosion of Freedoms
A universal health care system requires everyone to buy into it, regardless of whether they want to or not.
Some systems implement this through a mandatory premium while others simply increase existing taxes to cover the additional expenses.
Many people argue that because this can be done voluntarily through the private sector, making it mandatory goes against personal freedom and individual liberty.
Furthermore, freedoms are limited because people can be compelled to participate in public health orders under the premise that it is society – not them – who is paying for their healthcare.
We have learned today about 10 pros and 10 cons of universal health care. By examining the similarities between these points, we can see that such a system is only as good as its implementation and gain an understanding of why there continues to be no consensus.
Galvani, A. P., & Fitzpatrick, M. C. (2020). Cost-effectiveness of transitional US plans for universal health care. The Lancet, 395(10238), 1692-1693.
Rashford, M. (2007, January). A universal healthcare system: is it right for the United States?. In Nursing Forum (Vol. 42, No. 1, pp. 3-11). Malden, USA: Blackwell Publishing Inc.
Ranabhat, C. L., Atkinson, J., Park, M. B., Kim, C. B., & Jakovljevic, M. (2018). The influence of universal health coverage on life expectancy at birth (LEAB) and healthy life expectancy (HALE): a multi-country cross-sectional study. Frontiers in pharmacology, 9, 960. Doi: https://doi.org/10.3389%2Ffphar.2018.00960
Dr. Chris Drew is the founder of the Helpful Professor. He holds a PhD in education and has published over 20 articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education. [Image Descriptor: Photo of Chris]