27.5 million people in the United States (8.5% of the US population) do not have health insurance. Among the 91.5% who do have health insurance, 67.3% have private insurance while 34.4% have government-provided coverage through programs such as Medicaid or Medicare. Employer-based health insurance is the most common type of coverage, applying to 55.1% of the US population. The United States is the only nation among the 37 OECD (Organization for Economic Co-operation and Development) nations that does not have universal health care either in practice or by constitutional right.

Proponents of the right to health care say that no one in one of the richest nations on earth should go without health care. They argue that a right to health care would stop medical bankruptcies, improve public health, reduce overall health care spending, help small businesses, and that health care should be an essential government service.

Opponents argue that a right to health care amounts to socialism and that it should be an individual’s responsibility, not the government’s role, to secure health care. They say that government provision of health care would decrease the quality and availability of health care, and would lead to larger government debt and deficits. Read more background…

Pro & Con Arguments

Pro 1 The founding documents of the United States provide support for a right to health care. The Declaration of Independence states that all men have “unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness,” which necessarily entails having the health care needed to preserve life and pursue happiness. The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare” of the people. According to former Congressman Dennis Kucinich (D-OH), as part of efforts to “promote the general welfare,” health care “is a legitimate function of government.” Pro 2 Instituting a right to health care could lower the cost of health care in the United States. According to a study from the University of Massachusetts at Amherst, under a single-payer system, in which all citizens are guaranteed a right to health care, total public and private health care spending could be lowered by up to $1.8 trillion over the next 10 years due to lowered administrative and prescription drug costs. The American Medical Association reports that private health insurance plans spend 11.7% of premiums on administrative costs vs. 6.3% spent by public health programs. According to data by the Organisation for Economic Co-Operation and Development (OECD), Canada and the United Kingdom, two countries that provide universal health coverage, spend 47% and 42% of what the United States did per capita in 2017. South Korea, also with universal coverage, spent just 28%. Pro 3 A right to health care could save lives. According to a study from Harvard researchers, “lack of health insurance is associated with as many as 44,789 deaths per year,” which translates into a 40% increased risk of death among the uninsured. Another study found that more than 13,000 deaths occur each year just in the 55-64 year old age group due to lack of health insurance coverage. A Commonwealth Fund study found that due to a lack of timely and effective health care, the United States ranked at the bottom of a list of 16 rich nations in terms of preventable mortality and a further study published in the Lancet ranked the United States 29 out of 195 countries and territories in terms of preventable mortality. In Italy, Spain, France, Australia, Israel, and Norway, all countries with a right to health care, people live up to five years longer than people in the United States. Pro 4 The right to health care is an internationally recognized human right. On Dec. 10, 1948 the United States and 47 other nations signed the United Nations Universal Declaration of Human Rights. The document stated that “everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including… medical care.” In 2005 the United States and the other member states of the World Health Organization signed World Health Assembly resolution 58.33, which stated that everyone should have access to health care services and should not suffer financial hardship when obtaining these services. According to a peer-reviewed study in the Lancet, “[r]ight-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.” The United States is the only OECD nation which does not have universal health care either in practice or by constitutional right. According to the Comparative Constitutions Project, as of 2019, over 130 countries have a right to health care in their national constitutions. Pro 5 A right to health care could make medical services affordable for everyone. According to a Gallup Poll, paying for health care is the biggest financial problem for US households. A 2018 survey published by Becker’s Healthcare found that 22% of Americans found paying their deductible was “very difficult” or “impossible” and 64% reported that they delayed or did not seek medical care due to cost. The cost of US family health insurance premiums increased 80% in the United States between 2003 and 2013. The cost of health insurance premiums for people who do not get coverage through work increased 105% between 2013 and 2017. Pro 6 Providing all citizens the right to health care is good for economic productivity. When people have access to health care, they live healthier lives and miss work less, allowing them to contribute more to the economy. A study by researchers at the Universities of Colorado and Pennsylvania showed that workers with health insurance miss an average of 4.7 fewer work days than employees without health insurance. According to an Institute of Medicine report, the US economy loses $65-$130 billion annually as a result of diminished worker productivity, due to poor health and premature deaths, among the uninsured. In a speech, World Bank President Jim Yong Kim stated that all nations should provide a right to health care “to help foster economic growth.” Pro 7 A right to health care could improve public health. According to a study in the Lancet that looked at data from over 100 countries, “evidence suggests that broader health coverage generally leads to better access to necessary care and improved population health, particularly for poor people.” In the United States, people are 33% less likely to have a regular doctor, 25% more likely to have unmet health needs, and over 50% more likely to not obtain needed medicines compared to their Canadian counterparts who have a universal right to healthcare. According to a 2008 peer-reviewed study in the Annals of Internal Medicine, there were 11.4 million uninsured working-age Americans with chronic conditions such as heart disease and diabetes, and their lack of insurance was associated with less access to care, early disability, and even death. Pro 8 Because the United States is a very wealthy country, it should provide health care for all its citizens. Many European countries with a universal right to health care, such as France, Germany, Italy, and the United Kingdom, have a lower Gross Domestic Product (GDP) per capita than the United States, yet they provide a right to health care for all their citizens. As of 2017, 28.5 million people (8.8% of the US population) did not have health insurance and, according to a study by the Congressional Budget Office, as many as 35 million people will be uninsured by 2028. The United States spent $10,209 per person on health care in 2017, over 2.5 times the average spent by member countries of the OECD ($3,992 per person). With that level of spending, the United States should be able to provide a right to healthcare to everyone. Pro 9 Providing a right to health care could benefit private businesses. If the United States implemented a universal right to health care, businesses would no longer have to pay for employee health insurance policies. As of 2017, 56% of Americans were receiving health insurance through their employer. According to the Council on Foreign Relations, some economists believe the high costs of employee health insurance place US companies at a “competitive disadvantage in the international marketplace.” According to the Business Coalition for Single-Payer Healthcare, a right to healthcare under a single-payer-system could reduce employer labor costs by 10-12%. Pro 10 A right to health care could encourage entrepreneurship. After the introduction of Obamacare, which increased access to health insurance for Americans, the number of self-employed Americans increased 150,000 between 2014 and 2016. 6.1% percentage of job-seekers started their own businesses in 2016, marking a four-year high. A study published in Contemporary and Economic Policy found that providing universal health care in the United States could increase self-employment by 2 to 3.5 percent. Pro 11 A right to health care could stop medical bankruptcies. According to the National Bankruptcy Forum, medical debt is the #1 reason people file for bankruptcy in the United States. In 2017, about 33% of all Americans with medical bills reported that they “were unable to pay for basic necessities like food, heat, or housing.” If all US citizens were provided health care under a single-payer system medical bankruptcy would no longer exist, because the government, not private citizens, would pay all medical bills. Pro 12 A right to health care is a necessary foundation of a just society. The United States already provides free public education, public law enforcement, public road maintenance, and other public services to its citizens to promote a just society that is fair to everyone. Health care should be added to this list. Late US Senator Ted Kennedy (D-MA) wrote that providing a right to health care “goes to the heart of my belief in a just society.” According to Norman Daniels, PhD, Professor of Ethics and Population Health at Harvard University, “healthcare preserves for people the ability to participate in the political, social, and economic life of society. It sustains them as fully participating citizens.” Con 1 The founding documents of the United States do not provide support for a right to health care. Nowhere in the Declaration of Independence does it say there is a right to health care. The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare,” not to provide it. The Bill of Rights lists a number of personal freedoms that the government cannot infringe upon, not material goods or services that the government must provide. According to former Congressman Ron Paul (R-TX), “you have a right to your life and you have a right to your liberty and you have a right to keep what you earn in a free country… You do not have the right to services or things.” Con 2 A right to health care could increase the US debt and deficit. Spending on Medicare, Medicaid, and the Children’s Health Insurance Program, all government programs that provide a right to health care for certain segments of the population, totaled less than 10% of the federal budget in 1985, but by 2012 these programs took up 21% of the federal budget and are predicted to reach 30% of federal spending by 2028. According to former US House Budget Committee Chairman Paul Ryan (R-WI), government health care programs drive “the explosive growth in our spending and our debt.” Research from George Mason University concludes that providing government funded health care to all could increase federal spending by $32.6 trillion over the first ten years of implementation. The Committee for a Responsible Federal Budget calculates that universal health care coverage would result in an additional $19 trillion of federal debt “causing debt to rise from 74 percent of GDP in 2015… to 154 percent of GDP by 2026.” Con 3 A right to health care could increase the wait time for medical services. Medicaid is an example of a federally funded single-payer health care system that provides a right to health care for low-income people. According to a Government Accountability Office (GAO) report, 9.4% of Medicaid beneficiaries have had trouble obtaining necessary care due to long wait times, versus 4.2% of people with private health insurance. Countries with a universal right to health care have longer wait times than in the United States. In the average wait time to see a specialist in Canada was 60 days, versus 24 days in the United States. In the United States, only 25% of patients had to wait at least four weeks to see a specialist compared to 59% in Canada, 56% in Norway, and 43% in the United Kingdom – all countries that have some form of a universal right to health care. Con 4 Implementing a right to health care could lead the United States towards socialism. Socialism, by definition, entails government control of the distribution of goods and services. Under a single-payer system where everyone has a right to health care, and all health care bills are paid by the government, the government can control the distribution of health care services. According to Ronald Reagan, “one of the traditional methods of imposing statism or socialism on a people has been by way of medicine,” and once socialized medicine is instituted, “behind it will come other federal programs that will invade every area of freedom.” In Aug. 2013, when Senate Majority Leader Harry Reid (D-NV) was asked if Obamacare is a step towards a single-payer universal health care system, he answered “absolutely, yes.” The free market should determine the availability and cost of health care services, not the federal government. Con 5 Providing a right to health care could raise taxes. In European countries with a universal right to health care, the cost of coverage is paid through higher taxes. In the United Kingdom and other European countries, payroll taxes average 37% – much higher than the 15.3% payroll taxes paid by the average US worker. According to Paul R. Gregory, PhD, a Research Fellow at the Hoover Institution, financing a universal right to health care in the United States would cause payroll taxes to double. Con 6 Providing a right to health care could worsen a doctor shortage. The Association of American Medical Colleges (AAMC) predicts a shortfall of up to 104,900 doctors by 2030. If a right to health care were guaranteed to all, this shortage could be much worse. Doctor shortages in the United States have led to a 30% increase in wait times for doctors appointments between 2014 and 2017. Con 7 A right to health care could lead to government rationing of medical services. Countries with universal health care, including Australia, Canada, New Zealand, and the United Kingdom, all ration health care using methods such as controlled distribution, budgeting, price setting, and service restrictions. In the United Kingdom, the National Health Service (NHS) rations health care using a cost-benefit analysis. For example, in 2018 any drug that provided an extra one year of good-quality life for about $25,000 or less was generally deemed cost-effective while one that costs more might not be. In order to expand health coverage to more Americans, Obamacare created an Independent Payment Advisory Board (IPAB) to make cost-benefit analyses to keep Medicare spending from growing too fast. According to Sally Pipes, President of the Pacific Research Institute, the IPAB “is essentially charged with rationing care.” According to a Wall Street Journal editorial, “once health care is nationalized, or mostly nationalized, medical rationing is inevitable.” Con 8 A right to health care could lower the quality and availability of disease screening and treatment. In countries with a universal right to health care certain disease treatment outcomes are worse than the United States. The US 5-year survival rate for all cancers is 67%, compared to 60% in Canada and 54% in the United Kingdom. Annually, there are fewer cancer deaths per 100,000 people in the United States than in Australia, France, Germany, Norway, and the United Kingdom. Out of OECD nations, the United States is ranked at number two for breast cancer survival, behind only Sweden, and at number three for stroke survival, behind only Japan and South Korea. Statistics show that US cancer screening rates for cervical and colorectal (bowel) cancer are higher than those in Australia, Canada, and the United Kingdom. Con 9 A right to health care could lower doctors’ earnings. The Medicare system in the United States is a single-payer system where government pays for health care bills, and between 1998 and 2009 it reduced physician payments in three different years. In 2017, the Congressional Budget Office reported that private insurance payments were, on average, 200% higher than payments made by Medicare for certain treatments such as radiation therapy or MRI scans and 89% higher for hospital admissions. In Canada and the United Kingdom, where there is a universal right to health care, physicians have incomes 15-51% lower than US doctors. In the United States, the average physician income is $299,000 compared to $256,062 in Canada, and $147,778 in the United Kingdom. Con 10 A right to health care could cause people to overuse health care resources. When people are provided with universal health care and are not directly responsible for the costs of medical services, they may utilize more health resources than necessary, a phenomenon known as “moral hazard.” According to the Brookings Institution, just before Medicaid went into effect in 1964, people living below the poverty line saw physicians 20% less often than those who were not in poverty. But by 1975, people living in poverty who were placed on Medicaid saw physicians 18% more often than people who were not on Medicaid. A study published in Science found that of 10,000 uninsured Portland, Oregon residents who gained access to Medicaid, 40% made more visits to emergency rooms, even though they, like all US residents, already had guaranteed access to emergency treatment under federal law. Since Medicaid provides a right to health care for low-income individuals, expanding this right to the full US population could worsen the problem of overusing health care resources. Con 11 People should pay for their own health care, not have it given to them by the government. Under a single-payer system, the right to health care is paid for through taxes, and people who work hard and pay those taxes are forced to subsidize health care for those who are not employed. In the United States, people already have a right to purchase health care, but they should never have a right to receive health care free of charge. Health care is a service that should be paid for, not a right.