essay on why healthcare should not be free

Persuasive Essay Example on Why Healthcare Should Not Be Free

Healthcare is a big issue in the U.S. and it affects many people that live there.  Most people think it should be provided by the government so people don’t have to worry about paying for it.  While everyone is so concerned about their lives no one even considers that healthcare being free would affect way too many lives to even count.  

Healthcare being free would overall just ruin the economy.  In order to even have healthcare there needs to be money to pay for all of the medical machines and tools to determine what is wrong with patients. Studies also show that “The all-payer system relies on an overall healthy population, as a greater prevalence of sick citizens will drain the “sickness fund” at a much faster rate”. Say someone comes in with an injury, the hospital won’t have the proper technology machines to actually tell what is wrong and how they can make it better.   If they can’t tell what is wrong with the patient then why is there even a hospital?  Also without patients paying for their care, which goes into the hospital they won’t be able to pay off the bills to keep the building open.  So basically without the right amount of money and income there will be no healthcare.  

Healthcare has been around since 1750 when it all started with hospitals.  Since then you have always had to pay for the care that you get because the people that help you put in hard work hours in their days just to keep you safe.  All of the healthcare facilities around the U.S. need people to work there.  That hasn’t changed since then.  If the employees are not going to get paid what they need then they would have no reason to be there.  Sure helping people is the point of their job but if they are not making money for their time and labor then they are not going to be able to pay off their own taxes and bills.  People work so that they can pay for what they need to live, including a house, food, water, clothes, etc.  If healthcare was free there would be no way to pay the doctors, nurses, receptionist, etc.  If they are not getting the salary they deserve and need to live then they would probably want to find a new job so they can provide for themselves and if they have families.  What are the healthcare facilities going to do if there is no one working there to help and care for people?  There wouldn’t be any hospitals or urgent cares with not enough  workers.  So at this point free healthcare would be useless to the country and the people in it. 

A lot of people can’t afford health care when they really need it and they would probably be homeless if they had to pay off their medical bills, but that is exactly what jobs are for.  I think I am right that Healthcare should not be free because there are so many employees and doctors that work so they can live. If healthcare is free the doctors and nurses won’t make enough money.  Why should the employees suffer because people can't afford to pay their bills. 

Overall free healthcare sounds nice, but when you think about the outcome and what will happen overtime it gets you thinking.  You can’t rely on the government for everything, sometimes you need to take responsibility and work for what you want.  Free healthcare is just going to make the country worse.  Life is not supposed to be easy and you're not supposed to get everything handed to you, there are going to be challenges and you need to work through those.  Why are we not thinking about others and what would happen to them?  We want to make the U.S. better, not worse, so make it better.

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Why Healthcare Should Not Be Free

Table of contents, quality and accessibility: striking a balance, financial sustainability: the burden of costs, personal responsibility: encouraging accountability, incentives for medical innovation: sustaining progress.

• Rice, T., & Buchmueller, T. (2018). The Economics of Health Reconsidered (4th ed.). Health Administration Press.
• Arrow, K. J. (1963). Uncertainty and the Welfare Economics of Medical Care. American Economic Review, 53(5), 941-973.
• Pauly, M. V. (2002). Should Medical Care be Rationed by Age? Medical Care Research and Review, 59(1_suppl), 31S-52S.
• Triggle, N., & New, B. (2016). UK Health Spending: Past, Present, Future. BMJ, 353, i2533.
• Feldstein, P. J. (2005). Health Care Economics (6th ed.). Cengage Learning.

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Free Healthcare in the United States: A Possible Solution to Public Health Disparities

Nov 23, 2020 | Author Hala Atassi , Public Health Policy

Access to healthcare is one of the remarkable indicators that defines the quality of people’s lives. Despite the thousands of advanced technologies and countless healthcare clinics and hospitals, many people still cannot afford healthcare or health insurance. This has been a global concern for years, which many countries have resolved. However, the United States has yet to significantly progress towards making healthcare more accessible to low-income communities. There are many solutions to this problem that can be implemented today, upon which millions of suffering Americans depend.

Some studies have shown over the years that expensive health care is due to the high cost of defensive medicine, or in other words, physicians ordering expensive tests that may be unnecessary, as a way to deflect legal responsibility from themselves. Deviating from defensive medicine in the healthcare industry might impact physicians economically, but more importantly, it will help achieve affordable healthcare. 

Obamacare (the Affordable Care Act of 2010) is one program that focuses on extending healthcare to Americans and reducing public health disparities. This program lays down a foundation that people under the age of 26 will receive accessible care from their parent or guardian’s health care plans. Afterward, they must pay for their health care plan. Also, the program stipulates that the government provides free healthcare to retired adults from age 55 to 64, to avoid any insurance plan complications. Essentially, Obamacare seeks to expand access to healthcare care, regardless of the scale of one’s medical diagnosis, to ultimately save lives that would have been lost due to the inability to pay expensive medical bills.

Easier access to healthcare will result in a healthier nation. The healthcare system is one of the most important components in life, as the United States’ economy cannot be fully efficient and benefit all people until everyone can access quality, affordable healthcare. Free healthcare (or at least cheaper healthcare) would be the most effective system for America, which other countries like Switzerland and Singapore have demonstrated. The money spent by citizens on their healthcare could be redirected to other social support systems in America, like expanding access to nutritious foods as well. Although free healthcare has many perks, it also has disadvantages. Most notably, overloading health services with a large number of patients would overwhelm already busy healthcare systems. Patients may overuse the perk of free healthcare, leaving not taxpayers to suffer, but rather medical professionals and healthcare systems. Even so, the perceptible advantages of affordable healthcare outweigh the disadvantages. As it is, years of attempts to ameliorate the United States healthcare system have failed the American people, and the situation remains devastating and life-threatening for low-income communities. There should be no debate though as to whether America needs to redesign the public health system, as healthcare is a human right, and nobody should be dying because they cannot afford to live, especially when the government has the economic means to take care of them.

Bibliography:

Gerisch, Mary. “Health Care As a Human Right.” American Bar Association , www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/health-care-as-a-human-right/. 

“Free Health Care Policies.” World Health Organization , World Health Organization, 2020, www.who.int/news-room/fact-sheets/detail/free-health-care-policies. 

Gologorsky, Beverly. “Health Care in the US Should Be Affordable and Accessible.” The Nation , 9 May 2019, www.thenation.com/article/archive/tom-dispatch-health-care-should-be-affordable-and-accessible/. 

Luhby, Tami. “Here’s How Obamacare Has Changed America.” CNN , Cable News Network, 8 July 2019, www.cnn.com/2019/07/08/politics/obamacare-how-it-has-changed-america/index.html.

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Is Health Care a Right?

By Atul Gawande

Is health care a right? The United States remains the only developed country in the world unable to come to agreement on an answer. Earlier this year, I was visiting Athens, Ohio, the town in the Appalachian foothills where I grew up. The battle over whether to repeal, replace, or repair the Affordable Care Act raged then, as it continues to rage now. So I began asking people whether they thought that health care was a right. The responses were always interesting.

A friend had put me in touch with a forty-seven-year-old woman I’ll call Maria Dutton. She lived with her husband, Joe, down a long gravel driveway that snaked into the woods off a rural road. “You may feel like you are in the movie ‘Deliverance,’ ” she said, but it wasn’t like that at all. They had a tidy, double-wide modular home with flowered wallpaper, family pictures on every surface, a vase of cut roses on a sideboard, and an absurdly friendly hound in the yard. Maria told me her story sitting at the kitchen table with Joe.

She had joined the Army out of high school and married her recruiter—Joe is eleven years older—but after a year she had to take a medical discharge. She had developed severe fatigue, double vision, joint and neck pains, and muscle weakness. At first, doctors thought that she had multiple sclerosis. When that was ruled out, they were at a loss. After Joe left the military, he found steady, secure work as an electrical technician at an industrial plant nearby. Maria did secretarial and office-manager jobs and had a daughter. But her condition worsened, and soon she became too ill to work.

“I didn’t even have enough energy to fry a pound of hamburger,” she said. “I’d have to fry half of it and then sit down, rest, and get up and fry the rest. I didn’t have enough energy to vacuum one room of the house.” Eventually, she was diagnosed with chronic-fatigue syndrome and depression. She became addicted to the opioids prescribed for her joint pains and was started on methadone. Her liver began to fail. In 2014, she was sent two hundred miles away to the Cleveland Clinic for a liver-transplant evaluation. There, after more than two decades of Maria’s deteriorating health, doctors figured out what the problem was: sarcoidosis, an inflammatory condition that produces hardened nodules in organs throughout the body. The doctors gave her immunosuppressive medication, and the nodules shrank away. Within a year, she had weaned herself off the methadone.

“It was miraculous,” she said. In middle age, with her daughter grown up and in the Army Reserves herself, Maria got her life back and returned to school. All along, she’d had coverage through her husband’s work. “They have amazing insurance,” she said. “I think one year the insurance paid out two hundred thousand dollars. But we paid out, too.”

This was an understatement. Between a six-thousand-dollar deductible and hefty co-pays and premiums, the Duttons’ annual costs reached fifteen thousand dollars. They were barely getting by. Then one day in 2001 Joe blacked out, for no apparent reason, at a Girl Scout meeting for their daughter and fell down two flights of stairs, resulting in a severe concussion. It put him out of work for six months. Given the health-care costs and his loss of income, the couple ran out of money.

“We had to file for bankruptcy,” Joe said. He told me this reluctantly. It took them more than five years to dig out of the hole. He considered the bankruptcy “pretty shameful,” he said, and had told almost no one about it, not even his family. (This was why they didn’t want me to use their names.) He saw it as a personal failure—not the government’s. In fact, the whole idea that government would get involved in the financing of health care bothered him. One person’s right to health care becomes another person’s burden to pay for it, he said. Taking other people’s money had to be justified, and he didn’t see how it could be in cases like this.

“Everybody has a right to access health care,” he allowed, “but they should be contributing to the cost.” He pointed out that anyone could walk into a hospital with an emergency condition, get treated, and be billed afterward. “Yes, they may have collectors coming after them,” he said. “But I believe everybody should contribute for the treatment they receive.”

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Like her husband, Maria leans conservative. In the 2016 election, Joe voted for Donald Trump. Maria voted for Gary Johnson, the Libertarian candidate. But on health care she was torn. Joe wanted Obamacare repealed. She didn’t.

“I am becoming more liberal,” she said. “I believe that people should be judged by how they treat the least of our society.” At her sickest, she had been one of them. But she was reluctant to say that health care is a right. “There’s where the conservative side comes in and says, ‘You know what? I work really hard. I deserve a little more than the guy who sits around.’ ”

A right makes no distinction between the deserving and the undeserving, and that felt perverse to Maria and Joe. They both told me about people they know who don’t work and yet get Medicaid coverage with no premiums, no deductibles, no co-pays, no costs at all—coverage that the Duttons couldn’t dream of.

“I see people on the same road I live on who have never worked a lick in their life,” Joe said, his voice rising. “They’re living on disability incomes, and they’re healthier than I am.” Maria described a relative who got disability payments and a Medicaid card for a supposedly bad back, while taking off-the-books roofing jobs.

“Frankly, it annoys the crap out of me—they’re nothing but grasshoppers in the system,” Joe said, recalling the fable about the thriftless grasshopper and the provident ant.

The Duttons were doing all they could to earn a living and pay their taxes—taxes that helped provide free health care for people who did nothing to earn it. Meanwhile, they faced thousands of dollars in medical bills themselves. That seemed wrong. And in their view government involvement had only made matters worse.

“My personal opinion is that anytime the government steps in and says, ‘You must do this,’ it’s overstepping its boundaries,” Joe said. “A father, mother, two kids working their asses off—they’re making minimum wage and are barely getting by—I have no problem helping them. If I have someone who’s spent his whole life a drunk and a wastrel, no, I have no desire to help. That’s just the basics.”

Such feelings are widely shared. They’re what brought the country within a single vote of repealing major parts of President Obama’s expansion of health-care coverage. Some people see rights as protections provided by government. But others, like the Duttons, see rights as protections from government.

Tim Williams, one of my closest childhood friends, disagreed with the Duttons. Tim is a quiet fifty-two-year-old with the physique of a bodybuilder—he once bench-pressed me when we were in high school—and tightly cropped gray hair that used to be flame red. He survived metastatic melanoma, in the nineties, and losing his job selling motorcycles, during the great recession. He went through a year of chemotherapy and, later, three years without a job. He can figure out how to fix and build almost anything, but, without a college degree, he had few employment options. Hundreds of job applications later, though, he was hired as an operator at our town’s water-treatment plant, where I visited him.

The plant was built in the nineteen-fifties. We walked among giant pipes and valves and consoles that controlled the flow of water from local ground wells through a series of huge pools for filtration, softening, and chlorination, and out to the water towers on the tallest ridges surrounding the town. The low hum of the pump motors churned in the background.

People don’t think about their water, Tim said, but we can’t live without it. It is not a luxury; it’s a necessity of human existence. An essential function of government, therefore, is to insure that people have clean water. And that’s the way he sees health care. Joe wanted government to step back; Tim wanted government to step up. The divide seemed unbridgeable. Yet the concerns that came with each viewpoint were understandable, and I wondered if there were places where those concerns might come together.

Before I entered the field of public health, where it’s a given that health care is a right and not a privilege, I had grown up steeped in a set of core Midwestern beliefs: that you can’t get something for nothing, and that you should be reluctant to impose on others and, likewise, to be imposed upon. Here self-reliance is a totemic value. Athens, Ohio, is a place where people brew their own beer, shoot their own deer, fix their own cars (also grow their own weed, fight their own fights, get their own revenge). People here are survivors.

Monna French was one. She was fifty-three years old and the librarian at Athens Middle School. She’d been through a lot in life. She had started a local taxi company with her first husband, but they couldn’t afford health insurance. When she gave birth to her daughter Maggie and then to her son, Mac, the couple had to pay cash, pray that there’d be no unaffordable complications, and try to leave the hospital the next morning to avoid extra charges. When Monna and her husband divorced, litigation over the business left her with no income or assets.

“I had twenty-six dollars, two kids, and a cat,” she said.

She held down five part-time jobs, working as a teaching assistant for three different schools during the day, bartending at night, and selling furniture at Odd Lots department store on weekends, while her parents helped with the kids. Finally, she got the librarian job. It was classified as clerical work and didn’t pay well. But it meant that her family had health insurance, and a roof over their heads. She also met Larry, an iron worker and Vietnam veteran, who became her second husband. He had two children, but he was older and they were grown. Together, Monna and Larry had a child of their own, named Macie. Then, thirteen years ago, Maggie, at age sixteen, was killed in a car accident. Seven years ago, Larry’s son, Eric, who had spina bifida and multiple medical needs, died suddenly in his sleep, at the age of forty.

After twenty-two years as a librarian, Monna still makes only sixteen dollars and fifty cents an hour. Her take-home pay is less than a thousand dollars a month, after taxes and health-insurance contributions. Her annual deductible is three thousand dollars. Larry, now seventy-four, has retired, and his pension, military benefits, and Medicare helped keep them afloat.

For all her struggles, though, Monna is the kind of person who is always ready to offer a helping hand. When I visited her, there were stacks of posters on her porch, printed for a fund-raiser she was organizing for her daughter’s high-school marching band. She raised money for her township’s volunteer fire brigade. She was the vice-president of her local union, one of the largest in the county, which represents school-bus drivers, clerical staff, custodians, and other non-certified workers. She’d been deeply involved in contract negotiations to try to hold on to their wages and health benefits in the face of cutbacks.

“I don’t know anything about health care,” she protested when I asked her for her thoughts on the subject. In fact, she knew a lot. And, as she spoke, I thought I glimpsed a place where the health-care divide might just allow a bridge.

Monna considered herself a conservative. The notion of health care as a right struck her as another way of undermining work and responsibility: “Would I love to have health insurance provided to me and be able to stay home?” Of course, she said. “But I guess I’m going to be honest and tell you that I’m old school, and I’m not really good at accepting anything I don’t work for.”

She could quit her job and get Medicaid free, she pointed out, just as some of her neighbors had. “They have a card that comes in the mail, and they get everything they need!” she said. “Where does it end? I mean, how much responsibility do tax-paying people like me have? How much is too much?” She went on, “I understand that there’s going to be a percentage of the population that we are going to have to provide for.” When she was a young mother with two children and no home, she’d had to fall back on welfare and Medicaid for three months. Her stepson, Eric, had been on Medicaid and Social Security Disability Insurance before he died. Her eighty-three-year-old mother, who has dementia and requires twenty-four-hour care, was also on Medicaid. “If you’re disabled, if you’re mentally ill, fine, I get it,” Monna said. “But I know so many folks on Medicaid that just don’t work. They’re lazy.” Like the Duttons, she felt that those people didn’t deserve what they were getting.

But then we talked about Medicare, which provided much of her husband’s health care and would one day provide hers. That was different, Monna told me. Liberals often say that conservative voters who oppose government-guaranteed health care and yet support Medicare are either hypocrites or dunces. But Monna, like almost everyone I spoke to, understood perfectly well what Medicare was and was glad to have it.

I asked her what made it different.

“We all pay in for that,” she pointed out, “and we all benefit.” That made all the difference in the world. From the moment we earn an income, we all contribute to Medicare, and, in return, when we reach sixty-five we can all count on it, regardless of our circumstances. There is genuine reciprocity. You don’t know whether you’ll need more health care than you pay for or less. Her husband thus far has needed much less than he’s paid for. Others need more. But we all get the same deal, and, she felt, that’s what makes it O.K.

“I believe one hundred per cent that Medicare needs to exist the way it does,” she said. This was how almost everyone I spoke to saw it. To them, Medicare was less about a universal right than about a universal agreement on how much we give and how much we get.

Understanding this seems key to breaking the current political impasse. The deal we each get on health care has a profound impact on our lives—on our savings, on our well-being, on our life expectancy. In the American health-care system, however, different people get astonishingly different deals. That disparity is having a corrosive effect on how we view our country, our government, and one another.

The Oxford political philosopher Henry Shue observed that our typical way of looking at rights is incomplete. People are used to thinking of rights as moral trump cards, near-absolute requirements that all of us can demand. But, Shue argued, rights are as much about our duties as about our freedoms. Even the basic right to physical security—to be free of threats or harm—has no meaning without a vast system of police departments, courts, and prisons, a system that requires extracting large amounts of money and effort from others. Once costs and mechanisms of implementation enter the picture, things get complicated. Trade-offs now have to be considered. And saying that something is a basic right starts to seem the equivalent of saying only, “It is very, very important.”

Shue held that what we really mean by “basic rights” are those which are necessary in order for us to enjoy any rights or privileges at all. In his analysis, basic rights include physical security, water, shelter, and health care. Meeting these basics is, he maintained, among government’s highest purposes and priorities. But how much aid and protection a society should provide, given the costs, is ultimately a complex choice for democracies. Debate often becomes focussed on the scale of the benefits conferred and the costs extracted. Yet the critical question may be how widely shared these benefits and costs are.

Arnold Jonas is another childhood friend of mine. Blond, ruddy-faced, and sporting a paunch at fifty-two, he has rarely had a nine-to-five job and isn’t looking for one. The work he loves is in art and design—he once designed a project for the Smithsonian—but what usually pays the bills is physical labor or mechanical work. He lives from paycheck to paycheck. (“Retirement savings? Ha! You’re funny, Atul.”) Still, he has always known how to take care of himself. “I own my house,” he told me. “I have no debts.”

This is a guy who’s so handy that the cars he drives are rehabbed wrecks rebuilt from spare parts—including the old Volvo that he drove to the strip-mall Mexican restaurant near my family’s house, where we were catching up. But when I asked him about health care he could only shake his head.

“I just try not to think about it,” he said. He hadn’t seen a doctor in at least a decade. He got a health-care plan through an insurance-agent friend, but could only afford one with minimal benefits. He wasn’t sure whether he’d got an Obamacare subsidy. “I don’t read the fine print, because it’s going to be completely confusing anyway.” All he knew was that the plan cost him a hundred and ten dollars a month, and the high deductible (however many thousands of dollars it was, it was well beyond his savings account) made doctors’ visits almost out of the question.

“I am lucky I can get my teeth looked at because I’m dating a dental hygienist. But”—here he showed me his white-toothed grin—“I can’t date a dental hygienist and a cardiologist.”

Arnold, with his code of self-reliance, had eliminated nearly all sources of insecurity from his life. But here was one that was beyond his control. “The biggest worry I have would be some sort of health-care need,” he said. A serious medical issue would cost him his income. As an independent contractor, he isn’t eligible for unemployment benefits. And, having passed the age of fifty, he was just waiting for some health problem to happen.

So did he feel that he had a right to health care? No. “I never thought about it as a matter of rights,” he said. “A lot of these things we think are rights, we actually end up paying for.” He thinks that the left typically plays down the reality of the costs, which drives him crazy. But the right typically plays down the reality of the needs, which drives him crazy, too.

In his view, everyone has certain needs that neither self-reliance nor the free market can meet. He can fix his house, but he needs the help of others if it catches fire. He can keep his car running, but he needs the help of others to pave and maintain the roads. And, whatever he does to look after himself, he will eventually need the help of others for his medical care.

“I think the goal should be security,” he said of health care. “Not just financial security but mental security—knowing that, no matter how bad things get, this shouldn’t be what you worry about. We don’t worry about the Fire Department, or the police. We don’t worry about the roads we travel on. And it’s not, like, ‘Here’s the traffic lane for the ones who did well and saved money, and you poor people, you have to drive over here.’ ” He went on, “Somebody I know said to me, ‘If we give everybody health care, it’ll be abused.’ I told her that’s a risk we take. The roads are abused. A lot of things are abused. It’s part of the deal.”

He told me about a friend who’d undergone an emergency appendectomy. “She panicked when she woke up in the hospital realizing it would cost her a fortune,” he said. “Think about that. A lot of people will take a crappy job just to get the health benefits rather than start an entrepreneurial idea. If we’re talking about tax breaks for rich people to create jobs and entrepreneurialism, why not health care to allow regular people to do the same thing?”

As he saw it, government existed to provide basic services like trash pickup, a sewer system, roadways, police and fire protection, schools, and health care. Do people have a right to trash pickup? It seemed odd to say so, and largely irrelevant. The key point was that these necessities can be provided only through collective effort and shared costs. When people get very different deals on these things, the pact breaks down. And that’s what has happened with American health care.

The reason goes back to a seemingly innocuous decision made during the Second World War, when a huge part of the workforce was sent off to fight. To keep labor costs from skyrocketing, the Roosevelt Administration imposed a wage freeze. Employers and unions wanted some flexibility, in order to attract desired employees, so the Administration permitted increases in health-insurance benefits, and made them tax-exempt. It didn’t seem a big thing. But, ever since, we’ve been trying to figure out how to cover the vast portion of the country that doesn’t have employer-provided health insurance: low-wage workers, children, retirees, the unemployed, small-business owners, the self-employed, the disabled. We’ve had to stitch together different rules and systems for each of these categories, and the result is an unholy, expensive mess that leaves millions unprotected.

No other country in the world has built its health-care system this way , and, in the era of the gig economy, it’s becoming only more problematic. Between 2005 and 2015, according to analysis by the economists Alan Krueger and Lawrence Katz, ninety-four per cent of net job growth has been in “alternative work arrangements”—freelancing, independent contracting, temping, and the like—which typically offer no health benefits. And we’ve all found ourselves battling over who deserves less and who deserves more.

The Berkeley sociologist Arlie Russell Hochschild spent five years listening to Tea Party supporters in Louisiana, and in her masterly book “ Strangers in Their Own Land ” she identifies what she calls the deep story that they lived and felt. Visualize a long line of people snaking up a hill, she says. Just over the hill is the American Dream. You are somewhere in the middle of that line. But instead of moving forward you find that you are falling back. Ahead of you, people are cutting in line. You see immigrants and shirkers among them. It’s not hard to imagine how infuriating this could be to some, how it could fuel an America First ideal, aiming to give pride of place to “real” Americans and demoting those who would undermine that identity—foreigners, Muslims, Black Lives Matter supporters, feminists, “snowflakes.”

Our political debates seem to focus on what the rules should be for our place in line. Should the most highly educated get to move up to the front? The most talented? Does seniority matter? What about people whose ancestors were cheated and mistreated?

The mistake is accepting the line, and its dismal conception of life as a zero-sum proposition. It gives up on the more encompassing possibilities of shared belonging, mutual loyalty, and collective gains. America’s founders believed these possibilities to be fundamental. They held life, liberty, and the pursuit of happiness to be “unalienable rights” possessed equally by all members of their new nation. The terms of membership have had to be rewritten a few times since, sometimes in blood. But the aspiration has endured, even as what we need to fulfill it has changed.

When the new country embarked on its experiment in democracy, health care was too primitive to matter to life or liberty. The average citizen was a hardscrabble rural farmer who lived just forty years. People mainly needed government to insure physical security and the rule of law. Knowledge and technology, however, expanded the prospects of life and liberty, and, accordingly, the requirements of government. During the next two centuries, we relied on government to establish a system of compulsory public education, infrastructure for everything from running water to the electric grid, and old-age pensions, along with tax systems to pay for it all. As in other countries, these programs were designed to be universal. For the most part, we didn’t divide families between those who qualified and those who didn’t, between participants and patrons. This inclusiveness is likely a major reason that these policies have garnered such enduring support.

Health care has been the cavernous exception. Medical discoveries have enabled the average American to live eighty years or longer, and with a higher quality of life than ever before. Achieving this requires access not only to emergency care but also, crucially, to routine care and medicines, which is how we stave off and manage the series of chronic health issues that accumulate with long life. We get high blood pressure and hepatitis, diabetes and depression, cholesterol problems and colon cancer. Those who can’t afford the requisite care get sicker and die sooner. Yet, in a country where pretty much everyone has trash pickup and K-12 schooling for the kids, we’ve been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that’s open to all. Some even argue that such a system is un-American, stepping beyond the powers the Founders envisioned for our government.

In fact, in a largely forgotten episode in American history, Thomas Jefferson found himself confronting this very matter, shortly after his Inauguration as our third President, in 1801. Edward Jenner, in England, had recently developed a smallpox vaccine—a momentous medical breakthrough. Investigating the lore that milkmaids never got smallpox, he discovered that material from scabs produced by cowpox, a similar condition that afflicts cattle, induced a mild illness in people that left them immune to smallpox. Smallpox epidemics came with a mortality rate of thirty per cent or higher, and wiped out upward of five per cent of the population of cities like Boston and New York. Jefferson read Jenner’s report and arranged for the vaccination of two hundred relatives, neighbors, and slaves at Monticello. The President soon became vaccination’s preëminent American champion.

But supplies were difficult to produce, and the market price was beyond the means of most families. Jefferson, along with his successor, James Madison, believed in a limited role for the federal government. They did not take expanding its power and its commitments lightly. By the time Jefferson finished his two terms as President, however, city and state governments had almost entirely failed to establish programs to provide vaccines for their citizens. Thousands of lives continued to be lost to smallpox outbreaks. Meanwhile, vaccination programs in England, France, and Denmark had dramatically curbed the disease and measurably raised the national life expectancy. So, at Jefferson’s prompting, and with Madison’s unhesitating support, Congress passed the Vaccine Act of 1813 with virtually no opposition. A National Vaccine Agent was appointed to maintain stocks of vaccine and supply it to any American who requested it. The government was soon providing free vaccine for tens of thousands of people each year. It was the country’s first health-care entitlement for the general population. And its passage wasn’t in the least controversial.

Two centuries later, the Affordable Care Act was passed to serve a similar purpose: to provide all Americans with access to the life-preserving breakthroughs of our own generation. The law narrowed the yawning disparities in access to care, levied the taxes needed to pay for it, and measurably improved the health of tens of millions. But, to win passage, the A.C.A. postponed reckoning with our generations-old error of yoking health care to our jobs—an error that has made it disastrously difficult to discipline costs and insure quality, while severing care from our foundational agreement that, when it comes to the most basic needs and burdens of life and liberty, all lives have equal worth. The prospects and costs for health care in America still vary wildly, and incomprehensibly, according to your job, your state, your age, your income, your marital status, your gender, and your medical history, not to mention your ability to read fine print.

Few want the system we have, but many fear losing what we’ve got. And we disagree profoundly about where we want to go. Do we want a single, nationwide payer of care (Medicare for all), each state to have its own payer of care (Medicaid for all), a nationwide marketplace where we all choose among a selection of health plans (Healthcare.gov for all), or personal accounts that we can use to pay directly for health care (Health Savings Accounts for all)? Any of these can work. Each has been made to work universally somewhere in the world. They all have their supporters and their opponents. We disagree about which benefits should be covered, how generous the financial protection should be, and how we should pay for it. We disagree, as well, about the trade-offs we will accept: for instance, between increasing simplicity and increasing choice; or between advancing innovation and reducing costs.

What we agree on, broadly, is that the rules should apply to everyone. But we’ve yet to put this moral principle into practice. The challenge for any plan is to avoid the political perils of a big, overnight switch that could leave many people with higher costs and lower benefits. There are, however, many options for a gradual transition. Just this June, the Nevada legislature passed a bill that would have allowed residents to buy into the state’s Medicaid plan—if the governor hadn’t vetoed it. A similar bill to allow people to buy into Medicare was recently introduced in Congress. We need to push such options forward. Maintaining the link between health coverage and jobs is growing increasingly difficult, expensive, and self-defeating. But deciding to build on what’s currently working requires overcoming a well of mistrust about whether such investments will really serve a shared benefit.

My friend Betsy Anderson, who taught eighth-grade English at Athens Middle School for fifteen years, told me something that made me see how deep that well is. When she first started out as a teacher, she said, her most satisfying experiences came from working with eager, talented kids who were hungry for her help in preparing them for a path to college and success. But she soon realized that her class, like America as a whole, would see fewer than half of its students earn a bachelor’s degree. Her job was therefore to try to help all of her students reach their potential—to contribute in their own way and to pursue happiness on their own terms.

But, she said, by eighth grade profound divisions had already been cemented. The honors kids—the Hillary Clintons and Mitt Romneys of the school—sat at the top of the meritocratic heap, getting attention and encouragement. The kids with the greatest needs had special-education support. But, across America, the large mass of kids in the middle—the ones without money, book smarts, or athletic prowess—were outsiders in their own schools. Few others cared about what they felt or believed or experienced. They were the unspecial and unpromising, looked down upon by and almost completely separated from the college-bound crowd. Life was already understood to be a game of winners and losers; they were the designated losers, and they resented it. The most consistent message these students had received was that their lives were of less value than others’. Is it so surprising that some of them find satisfaction in a politics that says, essentially, Screw ’em all?

I met with Mark, a friend of Arnold’s, at the Union Street Diner, uptown near the campus of Ohio University, which makes Athens its home. The diner was a low-key place that stayed open twenty-four hours, with Formica tables and plastic cups, and a late-night clientele that was a mixture of townies and drunken students. I ordered a cheeseburger and onion rings. Mark ordered something healthier. (He asked me not to use his last name.) The son of a state highway patrolman, he had graduated from Athens High School five years ahead of me. Afterward, he worked as a cable installer, and got married at twenty-three. His wife worked at the Super Duper grocery store. Their pay was meagre and they were at the mercy of their bosses. So, the next year, they decided to buy a convenience store on the edge of town.

Mark’s father-in-law was a builder, and he helped them secure a bank loan. They manned the register day and night, and figured out how to make a decent living. It was never a lot of money, but over time they built up the business, opening gas pumps, and hiring college students to work the counter part time. They were able to make a life of it.

They adopted a child, a boy who was now a twenty-five-year-old graduate of the local university. Mark turned fifty-seven and remained a lifelong conservative. In general, he didn’t trust politicians. But he felt that Democrats in particular didn’t seem to recognize when they were pushing taxes and regulations too far. Health-care reform was a prime example. “It’s just the whole time they were coming up with this idea from copying some European model,” he said. “And I’m going, ‘Oh shit. This is not going to end up good for Mark.’ ” (Yes, he sometimes talks about himself in the third person.)

For his health coverage, Mark trusted his insurance agent, whom he’d known for decades, more than he trusted the government. He’d always chosen the minimum necessary, a bare-bones, high-deductible plan. He and his wife weren’t able to conceive, so they didn’t have to buy maternity or contraceptive coverage. With Obamacare, though, he felt forced to pay extra to help others get benefits that he’d never had or needed. “I thought, Well, here we go, I guess I’m now kicking in for Bill Gates’s daughter’s pregnancy, too.” He wanted to keep government small and taxes low. He was opposed to Obamacare.

Then, one morning a year ago, Mark’s back started to hurt. “It was a workday. I grabbed a Tylenol and I go, ‘No, this isn’t going to work, the pain’s too weird.’ ” It got worse, and when the pain began to affect his breathing he asked his wife to drive him to the emergency room.

“They put me in a bed, and eight minutes later I’m out,” he recalled. “I’m dying.” Someone started chest compressions. A defibrillator was wheeled in, and his heart was given a series of shocks. When he woke up, he learned that he’d suffered cardiac arrest. “They said, ‘Well, you’re going to Riverside’ ”—a larger hospital, in Columbus, eighty miles away. “And I went back out again.”

He’d had a second cardiac arrest, but doctors were able to shock him back to life once more. An electrocardiogram showed that he’d had a massive heart attack. If he was going to survive, he needed to get to Columbus immediately for emergency cardiac catheterization. The hospital got him a life-flight helicopter, but high winds made it unsafe to fly. So they took him by ground as fast as an ambulance could go. On the procedure table, a cardiologist found a blockage in the left main artery to his heart—a “widow-maker,” doctors call it—and stented it open.

“The medicine is just crazy good,” Mark said. “By twelve-thirty, I was fixed.”

After that, he needed five days in the hospital and several weeks at home to recover. Although he had to take a pile of drugs to reduce the chance of a recurrence, he got his strength back. He was able to resume work, hang out with his buddies, live his life.

It was only after this experience that Mark realized what the A.C.A. had given him. Like twenty-seven per cent of adults under sixty-five, he now had a preëxisting condition that would have made him uninsurable on the individual market before health-care reform went into effect. But the A.C.A. requires insurers to accept everyone, regardless of health history, and to charge the healthy and the less healthy the same community rate.

“This would have been a bad story for Mark,” he said. “Because the same time you’re being life-flighted is the same time you lose value to an employer. Your income is done.”

He no longer opposed the requirement that people get insurance coverage. Fire insurance wouldn’t work if people paid for it only when their house was on fire, and health insurance wouldn’t work if people bought it only when they needed it. He was no longer interested in repealing protections for people like him.

In this, he was like a lot of others. In 2013, before the implementation of the A.C.A., Americans were asked whether it was the government’s responsibility to make sure that everyone had health-care coverage, and fifty-six per cent said no. Four years after implementation, sixty per cent say yes.

“But that doesn’t mean I have to sign on for full-blown socialism—cradle-to-grave everything,” Mark said. “It’s a balance.” Our willingness to trust in efforts like health reform can be built on experience, as happened with Mark, though we must recognize how tenuous that trust remains. Two sets of values are in tension. We want to reward work, ingenuity, self-reliance. And we want to protect the weak and the vulnerable—not least because, over time, we all become the weak and vulnerable, unable to get by without the help of others. Finding the balance is not a matter of achieving policy perfection; whatever program we devise, some people will put in more and some will take out more. Progress ultimately depends on whether we can build and sustain the belief that collective action genuinely results in collective benefit. No policy will be possible otherwise.

Eight years after the passage of the Vaccine Act of 1813, a terrible mistake occurred. The Agent accidentally sent to North Carolina samples containing smallpox, instead of cowpox, causing an outbreak around the town of Tarboro that, in the next few months, claimed ten lives. The outrage over the “Tarboro Tragedy” spurred Congress to repeal the program, rather than to repair it, despite its considerable success. As a consequence, the United States probably lost hundreds of thousands of lives to a disease that several European programs had made vanishingly rare. It was eighty years before Congress again acted to insure safe, effective supplies of smallpox vaccine.

When I told this story to people in Athens, everyone took the repeal to be a clear mistake. But some could understand how such things happen. One conservative thought that the people in North Carolina might wonder whether the reports of lives saved by the vaccine were fake news. They saw the lives lost from the supposed accident. They knew the victims’ names. As for the lives supposedly saved because of outbreaks that didn’t occur—if you don’t trust the government’s vaccines, you don’t necessarily trust the government’s statistics, either.

These days, trust in our major professions—in politicians, journalists, business leaders—is at a low ebb. Members of the medical profession are an exception; they still command relatively high levels of trust. It does not seem a coincidence that medical centers are commonly the most culturally, politically, economically, and racially diverse institutions you will find in a community. These are places devoted to making sure that all lives have equal worth. But they also pride themselves on having some of the hardest-working, best-trained, and most innovative people in society. This isn’t to say that doctors, nurses, and others in health care fully live up to the values they profess. We can be condescending and heedless of the costs we impose on patients’ lives and bank accounts. We still often fail in our commitment to treating equally everyone who comes through our doors. But we’re embarrassed by this. We are expected to do better every day.

The repeal of the Vaccine Act of 1813 represented a basic failure of government to deliver on its duty to protect the life and liberty of all. But the fact that public vaccination programs eventually became ubiquitous (even if it took generations) might tell us something about the ultimate direction of our history—the direction in which we are still slowly, fitfully creeping.

On Mark’s last day in the hospital, the whole team came in to see him. He thanked them. “But I didn’t thank them for taking care of me,” he said. “I thanked them for when I was smoking, drinking, and eating chicken wings. They were all here working and studying, and I appreciated it.”

“That’s what you thanked them for?”

“Yeah,” he said. “Because if Mark wasn’t going to stop this, they were going to have to keep working hard. Something had to happen because Mark was clogging up.” And those people did keep working hard. They were there getting ready for Mark, regardless of who he would turn out to be—rich or poor, spendthrift or provident, wise or foolish. “I said, I am glad they do this every day, but I’m hoping to do it only once.” ♦

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By Malcolm Gladwell

By Neal Katyal

Exploring what works, what doesn’t, and why.

Healthcare is a human right – but not in the United States

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The Supreme Court’s ruling on Dobbs v. Jackson in June is just the latest blow to health rights in the United States. National medical associations in the U.S. agree that abortion is essential to reproductive healthcare. So why would abortion not be protected as such? Because the U.S. does not, and never has, protected a right to health.  

Good health is the foundation of a person’s life and liberty. Injury and disease are always disruptive, and sometimes crippling. We might have to stop working, cancel plans, quarantine, hire help, and in cases of long-term disability, build whole new support systems to accommodate a new normal.

The U.S. remains the only high-income nation in the world without universal access to healthcare. However, the U.S. has signed and ratified one of the most widely adopted international treaties that includes the duty to protect the right to life. Under international law, the right to life simply means that humans have a right to live, and that nobody can try to kill another. Healthcare, the United Nations says, is an essential part of that duty. In 2018, the U.N. Committee on Civil and Political Rights said the right to life cannot exist without equal access to affordable healthcare services (including in prisons), mental health services, and notably, access to abortion. The U.N. committee mentioned health more than a dozen times in its statement on the right to life.

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The bottom line is: the U.S. can’t claim to protect life if it fails to protect health. And it has consistently failed on all three of the U.N.’s measures— the latest being access to abortion.

In the U.S., our debates around healthcare, and especially abortion, are hampered by a lack of right to health. Instead, the Supreme Court in 1973 protected access to abortion through the rights to privacy and due process, not health. Privacy is mentioned only twice by the U.N. committee commentary on the right to life.

Since Dobbs, several state legislatures have declared it fair game to criminalize abortion procedures even in cases where pregnancy threatens maternal health or life. Despite ample evidence that restrictive abortion laws lead to spikes in maternal mortality and morbidity—core public health indicators—the Court prior to the Dobb’s decision has defended abortion as merely a matter of privacy, not health or life. We know this is a myth. Abortion is deeply tied to the ability to stay healthy and in some cases, alive.

Regardless, our political parties remain deeply polarized on access to healthcare, including abortion. But lawmakers should know there is historical backing in the U.S. for elevating a right to health. None other than U.S. president Franklin D. Roosevelt, first proposed healthcare as a human right in his State of the Union address in 1944, as part of his ‘Second Bill of Rights.’ His list featured aspirational economic and social guarantees to the American people, like the right to a decent home and, of course, the right to adequate medical care.

Eleanor Roosevelt later took the Second Bill of Rights to the U.N., where it contributed to the right to health being included in the Universal Declaration of Human Rights in 1948. The right to health is now accepted international law, and is part of numerous treaties, none of which the U.S. Senate has seen fit to ratify. The U.S. conservative movement has historically declared itself averse to adopting rights that might expand government function and responsibility. In contrast, state legislatures in red states are keen to expand government responsibility when it comes to abortion. The conservative movement condemns government interference in the delivery of healthcare—except when it comes to reproductive health. The American Medical Association has called abortion bans a “direct attack” on medicine, and a “brazen violation of patients’ rights to evidence-based reproductive health services.”

Excepting access to abortion, U.S. lawmakers have largely left healthcare to the markets, rather than government. True, the government funds programs like Medicaid and Medicare but these programs vary significantly in quality and access by state, falling far short of providing fair, equitable, universal access to good healthcare.

The only two places where the U.S. government accepts some responsibility for the provision of healthcare are 1) in prisons and mental health facilities; and 2) in the military. While healthcare services in the U.S. prison system are notoriously deficient, they nevertheless exist and are recognized as an entitlement, underpinning the right to life. As an example, in 2005 a federal court seized control of the failing healthcare system in California’s Department of Corrections citing preventable deaths. In the military, free healthcare is an entitlement, and the quality of that care is deemed good enough even for the U.S. president.

So why doesn’t everyone in the U.S. have the same rights?

It is an uphill battle in a country that sees health and healthcare as a private matter for markets and individuals to navigate. But if we want to improve public health in the U.S. we need to start legislating healthcare as a right—and recognize that achieving the highest possible standards of public health is a legitimate government function.

photo: Tony Gutierrez / AP Photo

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Knowledge at Wharton Podcast

Does the u.s. need universal health care, december 8, 2020 • 11 min listen.

Wharton's Robert Hughes explains the moral and social benefits of universal health care and how such a system might look in the U.S.

• Public Policy

Wharton’s Robert Hughes speaks with Wharton Business Daily on SiriusXM about the need for universal health care in the U.S.

Nothing quite exposes the inequalities that exist in American society more than the health care system. It’s a complex combination of private insurance, public programs and politics that drives up costs, creating significant barriers to lifesaving medical treatment for large segments of the population. In America, access to quality health care often depends on income, employment and status.

Why Should Healthcare Be Free?

Robert Hughes, professor of business ethics and legal studies at Wharton, is an advocate for universal health care coverage. Drawing deeply on his research in philosophy, Hughes believes that equal access to medical care is beneficial for both liberty and social stability. Health, he says, should not be tied to wealth.

“I think it’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance,” he said, referring to the crowdsourcing platform used to help raise money for patient bills. “That’s why I say that truly universal health care would be good for people’s liberty. Because you’re not really free if you’re depending on charity, especially discretionary charity like the kind you see on GoFundMe, for a basic need like health care.”

Hughes recently joined the Wharton Business Daily radio show on SiriusXM to discuss universal health care in the context of the presidential election. (Listen to the podcast at the top of this page.) President-elect Joe Biden has said he will protect and rebuild the Affordable Care Act , which has been under attack since it was enacted in 2010 under President Barack Obama.

Does the U.S. Hhave Universal Healthcare Now That Obamacare Exists?

The ACA, commonly referred to as Obamacare, brought the U.S. closer to providing universal health care through subsidized private health insurance, but Hughes said there’s still a wide gap. He believes policymakers should ensure that everyone has coverage and access to the same needed treatments.

“It’s very disturbing that people have to go to GoFundMe in order to get their medical treatments paid for. It creates a power imbalance.”

“I think it’s totally feasible for us to change the health care system, if we all were willing to do the right thing. But we’re not all willing to do the right thing,” Hughes said.

The professor argued the case for universal health care in a paper titled “ Egalitarian Provision of Necessary Medical Treatment ,” which was published last year in the Journal of Ethics. (The author-accepted version is  here .) He examined the health care systems of the U.K., Australia and Canada, concluding that Canada’s single-payer system is the most advantageous for the U.S.

Private insurance would still exist under such a setup, but it could not be used to pay for treatments already covered under universal health care. This provision would eliminate wealth as the controlling factor in health.

Why Doesn’t the U.S. Have Free Healthcare?

“I don’t understand why there’s so much resistance to the idea of truly universal health insurance in the United States, given that this is something that other industrial countries just do,” Hughes said.

He acknowledged that the U.S. doesn’t have the “political will” to change a system that’s been entrenched since the end of World War II, when employers began offering health insurance to their workers instead of higher wages.

“We can’t wave a magic wand and go back to 1946,” he said. “I don’t see the United States completely uprooting all these insurances. And that means we might need to create a model that keeps a lot of what we have, making it more accessible to more people, rather than creating all new institutions from scratch.”

Knowledge at Wharton interviewed Hughes in 2019 about his paper. For an in-depth look into his research and advocacy, read the interview here .

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High quality, affordable health care is the right of every American

As the number of uninsured americans rises, aamc president and ceo darrell g. kirch, md, urges policymakers to push forward..

As I approach the end of my tenure at the AAMC, I’m often asked about the high point of my 13 years as president and CEO. Without reservation, I reply that it was when the AAMC made its final push to endorse and secure passage of the Affordable Care Act (ACA). I was proud that the AAMC Board of Directors stepped up to take a strong public stand on this legislation while many other organizations stayed on the sidelines waiting to see how the politics would play out.

As the voice of academic medicine, the AAMC has long held that high quality, affordable health care is the right of every American. The AAMC released a document in 2008, Principles for U.S. Health Care Reform: A Guide for Policy Makers , underscoring the crisis of access, cost, and quality in the nation’s health care system, well before the ACA was passed in 2010.

The evidence is overwhelming that people with health insurance have a huge advantage . People without coverage are more likely to suffer declines in overall health — the result of little or no preventive care and delays in care that cause more severe problems or hospitalizations. Other studies have shown improvements in self-reported health and certain health outcomes measures in individuals who live in states that expanded their Medicaid program .

Given our commitment to the well-being of our patients, supporting the ACA was an ethical, not a partisan, decision. It was gratifying to see the numbers of uninsured Americans decline to historically low levels after the ACA took effect in January 2014. The number of uninsured nonelderly Americans dropped from over 44 million in 2013 to just below 27 million in 2016 .

Given this impressive success, it is distressing to see our progress show signs of regressing. The Kaiser Family Foundation reported that the number of uninsured people jumped by nearly 700,000 people in 2017 . This was the first increase in uninsured Americans since the ACA first extended insurance coverage to millions more people. In addition, another study found that the number of children in the United States without health insurance increased in 2017 for the first time in more than a decade .

Without access to affordable coverage, we will see more Americans forego or delay necessary medical care, putting millions of lives at risk and driving up costs to the system.

And the decline continued last year. A Gallup survey showed that by the close of 2018, 13.7% of adults in the country had no health insurance, up from 10.9% at the end of 2016. This marked the highest uninsured rate since 2014, when the major provisions of the ACA went into effect. The greatest increase in the uninsured occurred among women, younger adults, and low income persons.

The impact on people who have lost their insurance has even greater implications today than before the ACA. Health care costs are the highest they have ever been, compounded by a dramatic rise in pharmaceutical costs. We have seen an uptick in media stories about tragedies resulting from families unable to afford treatment or prescriptions. In 2017, more than 1 in 4 uninsured adults said they delayed or went without health care due to cost factors .

Teaching hospitals have been on the front line to help uninsured Americans. AAMC members provide 31% of all hospital charity care and 25% of all Medicaid inpatient services, while comprising only 5% of the acute care, general service hospitals in the country. But the safety net we provide is not enough to close the access gap for the uninsured. Only public policy intervention can do that.

A call for responsible health care legislation

In a report last year, the Commonwealth Fund attributed the declining uninsured rate largely to federal actions that reduced ACA outreach and enrollment funding, along with a failure to address health plan affordability in the individual market . Shorter open-enrollment periods also contributed to fewer individuals purchasing insurance.

A Kaiser Family Foundation analysis points to several factors behind the recent rise in people without insurance: 1) their state did not expand Medicaid; 2) they are subject to immigrant eligibility restrictions; 3) their income makes them ineligible for financial assistance; 4) they are eligible but the insurance options are unaffordable; or 5) they lack the knowledge to obtain coverage.

As of January, Americans no longer have to pay a penalty if they don’t carry insurance, which has resulted in rising premiums. The Congressional Budget Office estimated that this will lead to about 8 million more uninsured people in 2027 . In addition, state policy changes are precipitating declines in people covered by Medicaid, and 14 states still have not opted for any Medicaid expansion.

Watching our efforts unravel to improve health care accessibility is beyond troubling. We took a strong stand on the Texas federal court’s effort to declare the ACA unconstitutional and will follow this case closely through the appeals process. The AAMC is committed to supporting policies that seek to increase coverage, as was intended when the ACA was passed.

The AAMC is urging the federal government to enact policies that extend ACA coverage gains and improve cost protections on individual market and employer plans.

Dismantling any of its provisions is a disaster for the health care system, unless it is part of another comprehensive reform package providing equal or better coverage. We have yet to see such a package, including during the “repeal and replace” debate.

Now 20 months away from the next presidential election, health care continues to be a top issue for voters, as it was in the 2018 midterms. Without access to affordable coverage, we will see more Americans forego or delay necessary medical care, putting millions of lives at risk and driving up costs to the system.

As such, the AAMC is urging the federal government to enact policies that extend ACA coverage gains and improve cost protections on individual market and employer plans. Or if legislators come up with alternate strategies in the interest of our patients, we would consider supporting that as well.

With the 2020 election in sight, I am hopeful that health care will remain in the spotlight. We must stand by our guiding principles to avoid going backward. The AAMC will continue to work with policymakers to ensure that all Americans receive the comprehensive insurance coverage and high-quality health care they need and deserve.

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Argumentative Essay Should Health Care Be Free

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Published: Mar 5, 2024

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Why Healthcare Should Be Free? Research Paper

Introduction, works cited.

• Specific Purpose: To persuade my audience that health care should be free for everyone.
• Thesis Statement: Given the current state of health care, the US should adopt a system that covers all citizens.
• Organizational Pattern: Monroe’s Motivated Sequence.
• Has anyone here ever been uncovered by health insurance when seeking a new workplace or working part-time?
• In a time when it feels something has gone wrong, what we rely on is health care that is affordable – why not make it free?
• Think about how much risk you take with no health insurance, especially when an average visit to a doctor costs you more than $60 (Fay par. 8).
• Today, I would like to speak about the reasons a free health care system is the solution to the situation we are witnessing.

The current health care issues in the US are drastic and affect us all

• In 2007, the percentage of bankrupt persons due to uncovered medical bills was 62% (Tamkins par. 2).
• Many of them were insured but lost their money due to coverage gaps.
• Health insurance can take, e.g., $150 a month.
• One of the reasons for it is that top health insurance CEOs’ salaries sum up to tens of millions (Eastwood par. 1).
• Other reasons are excess lab testing and malpractice (Wagner par. 17).
• The ACA was aimed at reducing the percentage of uninsured (“Key Facts About the Uninsured Population” par. 1).
• Still, many people remain uninsured because they still cannot afford it.

Transition: Surely our health care system needs improvement, but there is a tangible solution to it.

Let us see how we can benefit from a free health care system

• The system would not be entirely free, but the costs would be reduced (Nicholson par. 2-6).
• It would also concern tests and prescription drugs.
• Every citizen would be covered by health care.
• Health care would be provided when you seek a new job or do not suffer chronically.

Transition: The benefits of free health care being observed, let us see how free health care has been applied to practice.

Massachusetts health program provides health care to nearly all citizens

• Free insurance was given to those beyond the poverty level (Pallarito par. 1-4).
• Young adults seeking a job were insured.
• Death rates were declined by 4.5%.

Transition: A free health care system can literally save lives.

• Today, I have discussed why the US needs free health care, the benefits of it and how it was implemented by Massachusetts.
• The unaffordability and uninsuredness make your fellow citizens suffer.
• You will probably live longer if you are a Massachusetts resident – but the reform should cover the entire country.
• Honest health care that is affordable for everyone is the step that will unite us on the way to our dream.

Eastwood, Brian. Top health insurance CEO pay exceeds $10 million in 2014 . 2015. Web.

Fay, Bill. Doctor Visit Costs . n.d. Web.

“ Key Facts about the Uninsured Population. ” The Henry J. Kaiser Family Foundation . Kaiser Family Foundation. 2015. Web.

Nicholson, David. “ The world needs free healthcare for all, says the ex-NHS boss. ” The Guardian . Guardian News and Media Limited. 2014. Web.

Pallarito, Karen. “ Massachusetts health care reform law lowered death rates, study finds. ” CBSNews . CBS Interactive Inc. 2014. Web.

Tamkins, Theresa. Medical bills prompt more than 60 percent of U.S. bankruptcies . 2009. Web.

Wagner, Neil. Health Insurance: Millions Spent on Salaries, Not Care . 2010. Web.

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1. IvyPanda . "Why Healthcare Should Be Free?" July 8, 2020. https://ivypanda.com/essays/why-healthcare-should-be-free/.

Bibliography

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Is Health Care a Right? Health Reforms in the USA and their Impact Upon the Concept of Care

Mahiben maruthappu.

1 Green Templeton College, University of Oxford, Oxford, UK

Rele Ologunde

2 Imperial College London, London, UK

Ayinkeran Gunarajasingam

3 New York University, New York, USA

In 2008 United States President Barack Obama declared that health care “should be a right for every American”. 1 This statement, although noble, does not reflect US healthcare statistics in recent times, with the number of uninsured reaching over 50 million in 2010. 2 Such disparity has sparked a political drive towards change, and the introduction of the Patient Protection and Affordable Care Act (PPACA). 3 These changes have been highly polemical, raising the fundamental question of whether health care is a right; a contract between the nation and its inhabitants granted at birth, or an entitlement; a privilege that must be earned as opposed to universally provided.

Access to healthcare in the US is mediated by insurance coverage, either in the form of private or employer based cover, which may be government based for public sector employees or private for private sector employees. The majority of spending on healthcare however, comes from government expenditure on health programs such as Medicare, Medicaid, Tricare, and the State Children's Health Insurance Program (SCHIP). 4 Medicare is a federal government funded social insurance program that provides health insurance to people aged 65 and older, younger people with disabilities, and those with end stage renal failure requiring dialysis. Medicaid is a means tested insurance coverage program for individuals with low incomes and their families, and is jointly funded by state and federal governments. Tricare is a healthcare program that provides healthcare insurance for military personnel, retirees, and their dependents. The SCHIP provides states with federal government funding to provide health insurance to children from families with modest incomes that do not qualify for Medicaid. As such, although the majority of the US population is insured by federal, state, employer, or private health insurance, the remainders go uninsured.

A US census bureau report suggested that 16.3% of the population, 49.9 million people, did not have health insurance in 2010. 5 Households with an income of $25,000 or less made up the largest proportion of the uninsured. 6 Lack of access to healthcare has also been shown to be associated with increased mortality; a 2009 study found that there were 44,800 deaths annually in the US that were directly associated with lack of healthcare insurance. 7

This article presents the argument that health care should be a human right, drawing upon: i) the political grounds for health care provision, and ii) ethical and moral frameworks supporting its introduction. These points are illustrated using the Medicare, Medicaid and SCHIP programs, in addition to assessing the extent to which the PPACA will convert health care from an entitlement to a right in this USA.

Should Health Care Be Considered a Right?

When examining the concept of health care as a ‘right’, one may consider it as either a legal or a moral one. Few would object to the proposition that accessible healthcare for all is in essence a moral right, 8 however, less would be of the opinion that it is a universally legal one. In the buildup to the 2008 presidential election, when questioned about whether health care was a right, a privilege, or a responsibility, then-Senator Obama asserted that health care should be a right. In Obama's argument he cited the case of his mother's struggle with cancer, he suggested that there was a fundamental injustice with a country not entitling it's sick to healthcare due to their inability to pay. 1 The Affordable Care Act, discussed in the 2012 presidential campaign, is projected to substantially reduce the number of uninsured in every age, income group and state, and thus increase access to care. 9

A system that distributes healthcare unevenly, on the basis of any determining factor other than necessity, raises numerous questions about how ethical that system is. In a society where disparity in the level of care or access to care exists, inevitably there will be individuals who fail to receive the care for which they desperately need. Failure to access care early on will undoubtedly lead to individuals consuming a greater proportion of healthcare resources, should the degree of their morbidity escalate, and therefore increase the burden on health provision. 10

Some may suggest that enshrining health care as a right in law may lead to over-utilisation of healthcare resources, 11 however the consumption of these resources does not result in fiscal or otherwise measurable gain for the individual seeking them. Although, one could argue that there may be personal satisfaction in over-utilisation. Healthcare is an essential requirement for well-being, conferring on one the ability to do other activities; it is, therefore, a condition upon which many other factors are determined.

Another fundamental difficulty with considering healthcare as a right is that this right, unlike many others, is dependent upon the resources of a society, 12 and the ability to meet the demands of the population without disparity in distribution and allocation of medical care. As such, even if this right were to be upheld universally, there would still be a gulf in care provision for individuals between different societies. To address this apparent gulf we need to assess what exactly constitutes a fair system of distribution. 13 One could consider establishing a minimum level of health care provision. 10 However, given that the health needs of different communities and vulnerable groups vary, defining this minimal level is challenging.

The World Health Organisation (WHO) defines health as “a state of complete physical, mental and social well-being”. 14 Healthcare, in turn, can be described as the provision of services necessary to treat disease and promote health. Several lines of political evidence support the concept of health care as a right:

First, in 1943, President Roosevelt proposed a ‘Second Bill of Rights’ that included: “The right to adequate medical care and the opportunity to achieve and enjoy good health”. 15

Second, the Universal Declaration of Human Rights published by the United Nations provided: “Everyone has the right to a standard of living adequate for the health and well-being…including…medical care”. 16

Third, the International Covenant on Economic, Social, and Cultural Rights (signed by the US in 1977) stated that it is “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” in addition to: “the creation of conditions which would assure to all medical service”. 17

Undermining the utility of these statements is the unclear definition of healthcare that could include a wide range of social, economic, organisational, and scientific issues, making the allocation of responsibility challenging. 18 Moreover, the achievement and enjoyment of good health by all may be perceived as an unrealistic aspiration in the context of today's economic austerity, rising healthcare costs, and aging population.

Ethical frameworks further support the notion of healthcare as a human right; Peter Singer adopts a utilitarian standpoint – the greatest good for the greatest number, arguing that:

• i) Suffering from a lack of medical care is harmful.
• ii) If it is within our power to prevent something harmful from happening, without sacrificing anything nearly as important, it is wrong not to do so.
• iii) By improving health care, suffering can be prevented without making significant personal losses.
• iv) Therefore, by not improving health care, and to an extent, by not introducing health care as a right, we are doing something wrong. 19 , 20

There are limitations to this: it applies to individual actions rather than governmental change. Further, it assumes that health care can be improved without significant personal loss when in actual fact the introduction of, for example, the PPACA has been estimated by some to be of significant cost to the US, let alone the implementation of universal care. 21

Another supportive framework is the Capabilities Approach, 22 whereby health care is fundamental to the capacity of a person to conduct all other individual rights, making it of primary importance. However, it could be argued that although people need health care, food, and shelter, this does not necessarily obligate others to make such provisions available. 18 Food, for example, is not considered a right; companies are permitted to sell it, and it can be withheld from those who cannot afford it.

The difficulty in introducing health care as a right also lies in the fact that care, unlike other goods, cannot be simply quantified and allocated equally to members of a society. Thus, there comes a point where the lack of responsibility of one person must be compensated by an increase in another, where the healthy pay for the unhealthy.

We, therefore, find that the question of whether health care should be offered as a right is complex, with ethical, judicial and financial tensions.

Consequences of the PPACA

The PPACA was introduced in 2010, and included a number of changes to US healthcare such as reducing pre-existing condition exclusions, and restricting annual dollar limits on coverage, in turn expanding insurance coverage to over 30 million Americans. 23 This has moved the US towards offering universal care.

However, it must be noted that the quality of this care is worse compared with that received by the majority of the population. For example, although Medicaid has been expanded, it has been associated with the longest length of stay and the highest risk of deaths for a number of surgical procedures compared with those under private insurance. 24

Therefore, the health reform will simply rebrand those with poor access to care to those covered by Medicaid, Medicare, or SCHIP, whereby they still receive substandard health care.

When the PPACA was enacted by congress it was broadly received with skepticism. Many opponents of the act challenged the constitutionality of the individual mandate and the Medicaid expansion, citing that it is illegal, under US constitution, to require individuals to buy health insurance. 25 Indeed, twenty-six states and the National Federation of Independent Business opposed this act in federal district court. The case was taken to the US Supreme Court, which on 28 th June 2012 upheld the core of this new health care legislation that requires all US citizens to hold health insurance or be subject to a tax if failing to do so. The Supreme Court held that the tax levied on those who failed to provide minimum or adequate health coverage was permissible under congress's power to tax under article 1 of the US constitution. 26

Other health related stipulations require that health insurers can no longer discriminate the sale of insurance on the basis of health status, that individuals in the same age group are charged the same premium, and that organisations with a workforce of greater than 50 employees provide affordable health insurance. 27 The legislation also introduced a subsidy for low- to middle-income individuals and families in an effort to reduce the financial impact of accessible healthcare to those who can least afford it. 27

The successful supreme court ruling culminates the efforts by the US government to overhaul the nation's health care system. Most recent efforts to implement change to the US system have fallen victim to opposition, but this landmark ruling paves the way to improving accessibility of care to all on the basis of need. The US has some of the highest survival rates for diseases such as prostate and breast cancer, 28 yet despite advancements in medical treatment there has been significantly less progress in medical coverage, such that those suffering from simple treatable ailments elude care. Following this Supreme Court ruling however, the US is set to bring about a paradigm shift in their approach to healthcare.

Like the 2012 Supreme Court ruling, the 2012 presidential election represented a major milestone for the PPACA. President Obama's re-election ensures that the law's major provisions remain unscathed and will go into effect by January 2014. Despite the President's campaign promises to implement the PPACA, and his subsequent re-election, many Republican governors refuse to create the state-based health insurance exchanges required by the law. The PPACA, however, obviates such opposition. In the event that state governments refuse to create healthcare exchanges, the federal government has the right to create an exchange for it. Despite the specificity of its provisions, the full impact of the PPACA on the US healthcare system remains uncertain. The only certainty is the impact the PPACA will have in ameliorating the suffering of some of the most disadvantaged citizens in the United States. The PPACA will bring American health policy more in line with the access-for-all vision of European and Canadian health systems. In the wake of President Obama's re-election, it seems that the American people agree, despite its complex implications, with candidate Obama's declaration that “healthcare should be a right for every American”.

Conclusions

US health care has gained significant attention in recent years, with a strong drive towards a right-based system. This movement is not simple, but rather burdened with complexities of funding, logistics, ethics, and rationality. The US remains one of the few industrialised nations in the world that does not guarantee universal healthcare access. 29 In the current framework of healthcare provision, concerted efforts to ensure universal health insurance coverage or entitlement need to be made in order to achieve universal access to healthcare. Ensuring access to healthcare is a compulsory requirement of healthcare as a right. 30 Recent US healthcare reforms have gone some way to achieving this. However, continued concerted efforts are required in order to achieve a comprehensive solution. It is also important to continue to pursue the aspiration of rights-based health care, but it should also be appreciated that the journey will take time, persistence, and a deep understanding of the system to navigate its inherent complexities.

Ethical approval

No ethical approval required for this study.

Conflicts of interest

No conflicts of interest have been declared by the authors.

Author contributions

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No funding source declared by the author.

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Unsolicited and peer reviewed

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Why writing by hand beats typing for thinking and learning

Jonathan Lambert

If you're like many digitally savvy Americans, it has likely been a while since you've spent much time writing by hand.

The laborious process of tracing out our thoughts, letter by letter, on the page is becoming a relic of the past in our screen-dominated world, where text messages and thumb-typed grocery lists have replaced handwritten letters and sticky notes. Electronic keyboards offer obvious efficiency benefits that have undoubtedly boosted our productivity — imagine having to write all your emails longhand.

To keep up, many schools are introducing computers as early as preschool, meaning some kids may learn the basics of typing before writing by hand.

But giving up this slower, more tactile way of expressing ourselves may come at a significant cost, according to a growing body of research that's uncovering the surprising cognitive benefits of taking pen to paper, or even stylus to iPad — for both children and adults.

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In kids, studies show that tracing out ABCs, as opposed to typing them, leads to better and longer-lasting recognition and understanding of letters. Writing by hand also improves memory and recall of words, laying down the foundations of literacy and learning. In adults, taking notes by hand during a lecture, instead of typing, can lead to better conceptual understanding of material.

"There's actually some very important things going on during the embodied experience of writing by hand," says Ramesh Balasubramaniam , a neuroscientist at the University of California, Merced. "It has important cognitive benefits."

While those benefits have long been recognized by some (for instance, many authors, including Jennifer Egan and Neil Gaiman , draft their stories by hand to stoke creativity), scientists have only recently started investigating why writing by hand has these effects.

A slew of recent brain imaging research suggests handwriting's power stems from the relative complexity of the process and how it forces different brain systems to work together to reproduce the shapes of letters in our heads onto the page.

Your brain on handwriting

Both handwriting and typing involve moving our hands and fingers to create words on a page. But handwriting, it turns out, requires a lot more fine-tuned coordination between the motor and visual systems. This seems to more deeply engage the brain in ways that support learning.

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"Handwriting is probably among the most complex motor skills that the brain is capable of," says Marieke Longcamp , a cognitive neuroscientist at Aix-Marseille Université.

Gripping a pen nimbly enough to write is a complicated task, as it requires your brain to continuously monitor the pressure that each finger exerts on the pen. Then, your motor system has to delicately modify that pressure to re-create each letter of the words in your head on the page.

"Your fingers have to each do something different to produce a recognizable letter," says Sophia Vinci-Booher , an educational neuroscientist at Vanderbilt University. Adding to the complexity, your visual system must continuously process that letter as it's formed. With each stroke, your brain compares the unfolding script with mental models of the letters and words, making adjustments to fingers in real time to create the letters' shapes, says Vinci-Booher.

That's not true for typing.

To type "tap" your fingers don't have to trace out the form of the letters — they just make three relatively simple and uniform movements. In comparison, it takes a lot more brainpower, as well as cross-talk between brain areas, to write than type.

Recent brain imaging studies bolster this idea. A study published in January found that when students write by hand, brain areas involved in motor and visual information processing " sync up " with areas crucial to memory formation, firing at frequencies associated with learning.

"We don't see that [synchronized activity] in typewriting at all," says Audrey van der Meer , a psychologist and study co-author at the Norwegian University of Science and Technology. She suggests that writing by hand is a neurobiologically richer process and that this richness may confer some cognitive benefits.

Other experts agree. "There seems to be something fundamental about engaging your body to produce these shapes," says Robert Wiley , a cognitive psychologist at the University of North Carolina, Greensboro. "It lets you make associations between your body and what you're seeing and hearing," he says, which might give the mind more footholds for accessing a given concept or idea.

Those extra footholds are especially important for learning in kids, but they may give adults a leg up too. Wiley and others worry that ditching handwriting for typing could have serious consequences for how we all learn and think.

What might be lost as handwriting wanes

The clearest consequence of screens and keyboards replacing pen and paper might be on kids' ability to learn the building blocks of literacy — letters.

"Letter recognition in early childhood is actually one of the best predictors of later reading and math attainment," says Vinci-Booher. Her work suggests the process of learning to write letters by hand is crucial for learning to read them.

"When kids write letters, they're just messy," she says. As kids practice writing "A," each iteration is different, and that variability helps solidify their conceptual understanding of the letter.

Research suggests kids learn to recognize letters better when seeing variable handwritten examples, compared with uniform typed examples.

This helps develop areas of the brain used during reading in older children and adults, Vinci-Booher found.

"This could be one of the ways that early experiences actually translate to long-term life outcomes," she says. "These visually demanding, fine motor actions bake in neural communication patterns that are really important for learning later on."

Ditching handwriting instruction could mean that those skills don't get developed as well, which could impair kids' ability to learn down the road.

"If young children are not receiving any handwriting training, which is very good brain stimulation, then their brains simply won't reach their full potential," says van der Meer. "It's scary to think of the potential consequences."

Many states are trying to avoid these risks by mandating cursive instruction. This year, California started requiring elementary school students to learn cursive , and similar bills are moving through state legislatures in several states, including Indiana, Kentucky, South Carolina and Wisconsin. (So far, evidence suggests that it's the writing by hand that matters, not whether it's print or cursive.)

Slowing down and processing information

For adults, one of the main benefits of writing by hand is that it simply forces us to slow down.

During a meeting or lecture, it's possible to type what you're hearing verbatim. But often, "you're not actually processing that information — you're just typing in the blind," says van der Meer. "If you take notes by hand, you can't write everything down," she says.

The relative slowness of the medium forces you to process the information, writing key words or phrases and using drawing or arrows to work through ideas, she says. "You make the information your own," she says, which helps it stick in the brain.

Such connections and integration are still possible when typing, but they need to be made more intentionally. And sometimes, efficiency wins out. "When you're writing a long essay, it's obviously much more practical to use a keyboard," says van der Meer.

Still, given our long history of using our hands to mark meaning in the world, some scientists worry about the more diffuse consequences of offloading our thinking to computers.

"We're foisting a lot of our knowledge, extending our cognition, to other devices, so it's only natural that we've started using these other agents to do our writing for us," says Balasubramaniam.

It's possible that this might free up our minds to do other kinds of hard thinking, he says. Or we might be sacrificing a fundamental process that's crucial for the kinds of immersive cognitive experiences that enable us to learn and think at our full potential.

Balasubramaniam stresses, however, that we don't have to ditch digital tools to harness the power of handwriting. So far, research suggests that scribbling with a stylus on a screen activates the same brain pathways as etching ink on paper. It's the movement that counts, he says, not its final form.

Jonathan Lambert is a Washington, D.C.-based freelance journalist who covers science, health and policy.

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How Biden Adopted Trump’s Trade War With China

The president has proposed new barriers to electric vehicles, steel and other goods..

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

From “The New York Times,” I’m Sabrina Tavernise, and this is “The Daily.”

[MUSIC PLAYING]

Donald Trump upended decades of American policy when he started a trade war with China. Many thought that President Biden would reverse those policies. Instead, he’s stepping them up. Today, my colleague, Jim Tankersley, explains.

It’s Monday, May 13.

Jim, it’s very nice to have you in the studio.

It’s so great to be here, Sabrina. Thank you so much.

So we are going to talk today about something I find very interesting and I know you’ve been following. We’re in the middle of a presidential campaign. You are an economics reporter looking at these two candidates, and you’ve been trying to understand how Trump and Biden are thinking about our number one economic rival, and that is China.

As we know, Trump has been very loud and very clear about his views on China. What about Biden?

Well, no one is going to accuse President Biden of being as loud as former President Trump. But I think he’s actually been fairly clear in a way that might surprise a lot of people about how he sees economic competition with China.

We’re going after China in the wrong way. China is stealing intellectual property. China is conditioning —

And Biden has, kind of surprisingly, sounded a lot, in his own Joe Biden way, like Trump.

They’re not competing. They’re cheating. They’re cheating. And we’ve seen the damage here in America.

He has been very clear that he thinks China is cheating in trade.

The bottom line is I want fair competition with China, not conflict. And we’re in a stronger position to win the economic competition of the 21st century against China or anyone else because we’re investing in America and American workers again. Finally.

And maybe the most surprising thing from a policy perspective is just how much Biden has built on top of the anti-China moves that Trump made and really is the verge of his own sort of trade war with China.

Interesting. So remind us, Jim, what did Trump do when he actually came into office? We, of course, remember Trump really talking about China and banging that drum hard during the campaign, but remind us what he actually did when he came into office.

Yeah, it’s really instructive to start with the campaign, because Trump is talking about China in some very specific ways.

We have a $500 billion deficit, trade deficit, with China. We’re going to turn it around. And we have the cards. Don’t forget —

They’re ripping us off. They’re stealing our jobs.

They’re using our country as a piggy bank to rebuild China, and many other countries are doing the same thing. So we’re losing our good jobs, so many.

The economic context here is the United States has lost a couple of million jobs in what was called the China shock of the early 2000s. And Trump is tapping into that.

But when the Chinese come in, and they want to make great trade deals — and they make the best trade deals, and not anymore. When I’m there, we turn it around, folks. We turn it around. We have —

And what he’s promising as president is that he’s going to bring those jobs back.

I’ll be the greatest jobs president that God ever created. I’ll take them back from China, from Japan.

And not just any jobs, good-paying manufacturing jobs, all of it — clothes, shoes, steel, all of these jobs that have been lost that American workers, particularly in the industrial Midwest, used to do. Trump’s going to bring them back with policy meant to rebalance the trade relationship with China to get a better deal with China.

So he’s saying China is eating our lunch and has been for decades. That’s the reason why factory workers in rural North Carolina don’t have work. It’s those guys. And I’m going to change that.

Right. And he likes to say it’s because our leaders didn’t cut the right deal with them, so I’m going to make a better deal. And to get a better deal, you need leverage. So a year into his presidency, he starts taking steps to amass leverage with China.

And so what does that look like?

Just an hour ago, surrounded by a hand-picked group of steelworkers, President Trump revealed he was not bluffing.

It starts with tariffs. Tariffs are taxes that the government imposes on imports.

Two key global imports into America now face a major new barrier.

Today, I’m defending America’s national security by placing tariffs on foreign imports of steel and aluminum.

And in this case, it’s imports from a lot of different countries, but particularly China.

Let’s take it straight to the White House. The president of the United States announcing new trade tariffs against China. Let’s listen in.

This has been long in the making. You’ve heard —

So Trump starts, in 2018, this series of tariffs that he’s imposing on all sorts of things — washing machines, solar panels, steel, aluminum. I went to Delaware to a lighting store at that time, I remember, where basically everything they sold came from China and was subject to the Trump tariffs, because that’s where lighting was made now.

Interesting.

Hundreds of billions of dollars of Chinese goods now start falling under these Trump tariffs. The Chinese, of course, don’t take this lying down.

China says it is not afraid of a trade war with the US, and it’s fighting back against President Trump with its own tariffs on US goods.

They do their own retaliatory tariffs. Now American exports to China cost more for Chinese consumers. And boom, all of a sudden, we are in the midst of a full-blown trade war between the United States and Beijing.

Right. And that trade war was kind of a shock because for decades, politicians had avoided that kind of policy. It was the consensus of the political class in the United States that there should not be tariffs like that. It should be free trade. And Trump just came in and blew up the consensus.

Yeah. And Sabrina, I may have mentioned this once or 700 times before on this program, but I talk to a lot of economists in my job.

Yeah, it’s weird. I talk to a lot of economists. And in 2018 when this started, there were very, very, very few economists of any political persuasion who thought that imposing all these tariffs were a good idea. Republican economists in particular, this is antithetical to how they think about the world, which is low taxes, free trade. And even Democratic economists who thought they had some problems with the way free trade had been conducted did not think that Trump’s “I’m going to get a better deal” approach was going to work. And so there was a lot of criticism at the time, and a lot of politicians really didn’t like it, a lot of Democrats, many Republicans. And it all added up to just a real, whoa, I don’t think this is going to work.

So that begs the question, did it?

Well, it depends on what you mean by work. Economically, it does not appear to have achieved what Trump wanted. There’s no evidence yet in the best economic research that’s been done on this that enormous amounts of manufacturing jobs came back to the United States because of Trump’s tariffs. There was research, for example, on the tariffs on washing machines. They appear to have helped a couple thousand jobs, manufacturing jobs be created in the United States, but they also raised the price of washing machines for everybody who bought them by enough that each additional job that was created by those tariffs effectively cost consumers, like, $800,000 per job.

There’s like lots of evidence that the sectors Trump was targeting to try to help here, he didn’t. There just wasn’t a lot of employment rebound to the United States. But politically, it really worked. The tariffs were very popular. They had this effect of showing voters in those hollowed-out manufacturing areas that Trump was on their team and that he was fighting for them. Even if they didn’t see the jobs coming back, they felt like he was standing up for them.

So the research suggests this was a savvy political move by Trump. And in the process, it sort of changes the political economic landscape in both parties in the United States.

Right. So Trump made these policies that seemed, for many, many years in the American political system, fringe, isolationist, economically bad, suddenly quite palatable and even desirable to mainstream policymakers.

Yeah. Suddenly getting tough on China is something everyone wants to do across both parties. And so from a political messaging standpoint, being tough on China is now where the mainstream is. But at the same time, there is still big disagreement over whether Trump is getting tough on China in the right way, whether he’s actually being effective at changing the trade relationship with China.

Remember that Trump was imposing these tariffs as a way to get leverage for a better deal with China. Well, he gets a deal of sorts, actually, with the Chinese government, which includes some things about tariffs, and also China agreeing to buy some products from the United States. Trump spins it as this huge win, but nobody else really, including Republicans, acts like Trump has solved the problem that Trump himself has identified. This deal is not enough to make everybody go, well, everything’s great with China now. We can move on to the next thing.

China remains this huge issue. And the question of what is the most effective way to deal with them is still an animating force in politics.

Got it. So politically, huge win, but policy-wise and economically, and fundamentally, the problem of China still very much unresolved.

Absolutely.

So then Biden comes in. What does Biden do? Does he keep the tariffs on?

Biden comes to office, and there remains this real pressure from economists to roll back what they consider to be the ineffective parts of Trump’s trade policy. That includes many of the tariffs. And it’s especially true at a time when almost immediately after Biden takes office, inflation spikes. And so Americans are paying a lot of money for products, and there’s this pressure on Biden, including from inside his administration, to roll back some of the China tariffs to give Americans some relief on prices.

And Biden considers this, but he doesn’t do it. He doesn’t reverse Trump’s tariff policy. In the end, he’s actually building on it.

We’ll be right back.

So Jim, you said that Biden is actually building on Trump’s anti-China policy. What exactly does that look like?

So Biden builds on the Trump China policy in three key ways, but he does it with a really specific goal that I just want you to keep in mind as we talk about all of this, which is that Biden isn’t just trying to beat China on everything. He’s not trying to cut a better deal. Biden is trying to beat China in a specific race to own the clean-energy future.

Clean energy.

Yeah. So keep that in mind, clean energy. And the animating force behind all of the things Biden does with China is that Biden wants to beat China on what he thinks are the jobs of the future, and that’s green technology.

Got it. OK. So what does he do first?

OK. Thing number one — let’s talk about the tariffs. He does not roll them back. And actually, he builds on them. For years, for the most part, he just lets the tariffs be. His administration reviews them. And it’s only now, this week, when his administration is going to actually act on the tariffs. And what they’re going to do is raise some of them. They’re going to raise them on strategic green tech things, like electric vehicles, in order to make them more expensive.

And I think it’s important to know the backdrop here, which is since Biden has taken office, China has started flooding global markets with really low-cost green technologies. Solar panels, electric vehicles are the two really big ones. And Biden’s aides are terrified that those imports are going to wash over the United States and basically wipe out American automakers, solar panel manufacturers, that essentially, if Americans can just buy super-cheap stuff from China, they’re not going to buy it from American factories. Those factories are going to go out of business.

So Biden’s goal of manufacturing jobs in clean energy, China is really threatening that by dumping all these products on the American market.

Exactly. And so what he wants to do is protect those factories with tariffs. And that means increasing the tariffs that Trump put on electric vehicles in hopes that American consumers will find them too expensive to buy.

But doesn’t that go against Biden’s goal of clean energy and things better for the environment? Lots of mass-market electric vehicles into the United States would seem to advance that goal. And here, he’s saying, no, you can’t come in.

Right, because Biden isn’t just trying to reduce emissions at all costs. He wants to reduce emissions while boosting American manufacturing jobs. He doesn’t want China to get a monopoly in these areas. And he’s also, in particular, worried about the politics of lost American manufacturing jobs. So Biden does not want to just let you buy cheaper Chinese technologies, even if that means reducing emissions.

He wants to boost American manufacturing of those things to compete with China, which brings us to our second thing that Biden has done to build on Trump’s China policy, which is that Biden has started to act like the Chinese government in particular areas by showering American manufacturers with subsidies.

I see. So dumping government money into American businesses.

Yes, tax incentives, direct grants. This is a way that China has, in the past decades, built its manufacturing dominance, is with state support for factories. Biden is trying to do that in particular targeted industries, including electric vehicles, solar power, wind power, semiconductors. Biden has passed a bunch of legislation that showers those sectors with incentives and government support in hopes of growing up much faster American industry.

Got it. So basically, Biden is trying to beat China at its own game.

Yeah, he’s essentially using tariffs to build a fortress around American industry so that he can train the troops to fight the clean energy battle with China.

And the troops being American companies.

Yes. It’s like, we’re going to give them protection — protectionist policy — in order to get up to size, get up to strength as an army in this battle for clean energy dominance against the Chinese.

Got it. So he’s trying to build up the fortress. What’s the third thing Biden does? You mentioned three things.

Biden does not want the United States going it alone against China. He’s trying to build an international coalition, wealthy countries and some other emerging countries that are going to take on China and try to stop the Chinese from using their trade playbook to take over all these new emerging industrial markets.

But, Jim, why? What does the US get from bringing our allies into this trade war? Why does the US want that?

Some of this really is about stopping China from gaining access to new markets. It’s like, if you put the low-cost Chinese exports on a boat, and it’s going around the world, looking for a dock to stop and offload the stuff and sell it, Biden wants barriers up at every possible port. And he wants factories in those places that are competing with the Chinese.

And a crucial fact to know here is that the United States and Europe, they are behind China when it comes to clean-energy technology. The Chinese government has invested a lot more than America and Europe in building up its industrial capacity for clean energy. So America and its allies want to deny China dominance of those markets and to build up their own access to them.

And they’re behind, so they’ve got to get going. It’s like they’re in a race, and they’re trailing.

Yeah, it’s an economic race to own these industries, and it’s that global emissions race. They also want to be bringing down fossil-fuel emissions faster than they currently are, and this is their plan.

So I guess, Jim, the question in my mind is, Trump effectively broke the seal, right? He started all of these tariffs. He started this trade war with China. But he did it in this kind of jackhammer, non-targeted way, and it didn’t really work economically. Now Biden is taking it a step further. But the question is, is his effort here going to work?

The answer to whether it’s going to work really depends on what your goals are. And Biden and Trump have very different goals. If Trump wins the White House back, he has made very clear that his goal is to try to rip the United States trade relationship with China even more than he already has. He just wants less trade with China and more stuff of all types made in the United States that used to be made in China. That’s a very difficult goal, but it’s not Biden’s goal.

Biden’s goal is that he wants America to make more stuff in these targeted industries. And there is real skepticism from free-market economists that his industrial policies will work on that, but there’s a lot of enthusiasm for it from a new strain of Democratic economists, in particular, who believe that the only chance Biden has to make that work is by pulling all of these levers, by doing the big subsidies and by putting up the tariffs, that you have to have both the troops training and the wall around them. And if it’s going to work, he has to build on the Trump policies. And so I guess you’re asking, will it work? It may be dependent upon just how far he’s willing to go on the subsidies and the barriers.

There’s a chance of it.

So, Jim, at the highest level, whatever the economic outcome here, it strikes me that these moves by Biden are pretty remarkably different from the policies of the Democratic Party over the decades, really going in the opposite direction. I’m thinking of Bill Clinton and NAFTA in the 1990s. Free trade was the real central mantra of the Democratic Party, really of both parties.

Yeah, and Biden is a real break from Clinton. And Clinton was the one who actually signed the law that really opened up trade with China, and Biden’s a break from that. He’s a break from even President Obama when he was vice president. Biden is doing something different. He’s breaking from that Democratic tradition, and he’s building on what Trump did, but with some throwback elements to it from the Roosevelt administration and the Eisenhower administration. This is this grand American tradition of industrial policy that gave us the space race and the interstate highway system. It’s the idea of using the power of the federal government to build up specific industrial capacities. It was in vogue for a time. It fell out of fashion and was replaced by this idea that the government should get out of the way, and you let the free market drive innovation. And now that industrial policy idea is back in vogue, and Biden is doing it.

So it isn’t just a shift or an evolution. It’s actually a return to big government spending of the ‘30s and the ‘40s and the ‘50s of American industrialism of that era. So what goes around comes around.

Yeah, and it’s a return to that older economic theory with new elements. And it’s in part because of the almost jealousy that American policymakers have of China and the success that it’s had building up its own industrial base. But it also has this political element to it. It’s, in part, animated by the success that Trump had making China an issue with working-class American voters.

You didn’t have to lose your job to China to feel like China was a stand-in for the forces that have taken away good-paying middle-class jobs from American workers who expected those jobs to be there. And so Trump tapped into that. And Biden is trying to tap into that. And the political incentives are pushing every future American president to do more of that. So I think we are going to see even more of this going forward, and that’s why we’re in such an interesting moment right now.

So we’re going to see more fortresses.

More fortresses, more troops, more money.

Jim, thank you.

You’re welcome.

Here’s what else you should know today. Intense fighting between Hamas fighters and Israeli troops raged in parts of Northern Gaza over the weekend, an area where Israel had declared Hamas defeated earlier in the war, only to see the group reconstitute in the power vacuum that was left behind. The persistent lawlessness raised concerns about the future of Gaza among American officials. Secretary of State Antony Blinken said on “Face the Nation” on Sunday that the return of Hamas to the North left him concerned that Israeli victories there would be, quote, “not sustainable,” and said that Israel had not presented the United States with any plan for when the war ends.

And the United Nations aid agency in Gaza said early on Sunday that about 300,000 people had fled from Rafah over the past week, the city in the enclave’s southernmost tip where more than a million displaced Gazans had sought shelter from Israeli bombardments elsewhere. The UN made the announcement hours after the Israeli government issued new evacuation orders in Rafah, deepening fears that the Israeli military was preparing to invade the city despite international warnings.

Today’s episode was produced by Nina Feldman, Carlos Prieto, Sidney Harper, and Luke Vander Ploeg. It was edited by M.J. Davis Lin, Brendan Klinkenberg, and Lisa Chow. Contains original music by Diane Wong, Marion Lozano, and Dan Powell, and was engineered by Alyssa Moxley. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for “The Daily.” I’m Sabrina Tavernise. See you tomorrow.

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Hosted by Sabrina Tavernise

Produced by Nina Feldman ,  Carlos Prieto ,  Sydney Harper and Luke Vander Ploeg

Edited by M.J. Davis Lin ,  Brendan Klinkenberg and Lisa Chow

Original music by Diane Wong ,  Marion Lozano and Dan Powell

Engineered by Alyssa Moxley

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Donald Trump upended decades of American policy when he started a trade war with China. Many thought that President Biden would reverse those policies. Instead, he’s stepping them up.

Jim Tankersley, who covers economic policy at the White House, explains.

On today’s episode

Jim Tankersley , who covers economic policy at the White House for The New York Times.

Background reading

Mr. Biden, competing with Mr. Trump to be tough on China , called for steel tariffs last month.

The Biden administration may raise tariffs on electric vehicles from China to 100 percent .

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