9 Should the United States Adopt Universal Healthcare?
Hann Bingham Brunner and Eunhye Hess
Introduction
The healthcare system in the U.S. has been known for its high costs with the worst outcomes (Howard, 2023; Kumar et al., 2009). Despite being the least cost-effective model, the U.S. healthcare system has not been changed due to the complexity of the current system with multiple interest groups. With this complex healthcare system, many people do not have a clear understanding of the current healthcare model and other models that many other countries take (Shmerling, 2021). Living in the post-COVID-19 pandemic era, the voice for a better healthcare system has been increasing, which further seeks an active discussion for possible solutions.
Part of this active discussion starts with understanding the healthcare system. In this simulation, you will explore the U.S. healthcare system model as well as a few other models that many other countries take. You will compare and contrast those models to figure out the most suitable model that would work in the U.S. In the next section of this chapter, you will learn how the UNIVERSAL HEALTHCARE simulation works in practical terms and about the important skills you will gain participating in this simulation.
Overview
This simulation engages you in critical discussions about the healthcare system in the U.S. as well as social justice in the healthcare context. The chapter begins with an opportunity for you to discuss how the themes of the simulation relate to your own lived experience. You will also engage with reading, listening, and research activities to help build your knowledge of debates around implementing the universal healthcare system in the U.S. You will advocate one of the healthcare systems for the U.S. healthcare system by adopting a person in the role-play phase. After reflecting on the role-play, you will either create an infographic, podcast, or write a problem/solution essay. As shown below, the simulation has five distinct phases.
How the simulation works
| Phase | Phase Description | Activities |
| 1 | Activation | Discussion 1 |
| 2 | Comprehension | Listening 1 & 2
Reading 1 & 2 |
| 3 | Simulation | Role Assignment & Role Preparation
Role Play |
| 4 | Reflection | Debriefing Activity
Critical Reflections |
| 5 | Application | Infographic, Podcast, or Essay |
You will gain a number of important skills as you participate in the simulation. These skills are sequenced from simple tasks such as defining and describing to more complex tasks such as synthesizing and evaluating.
After completing this simulation, you will be able to:
- make connections between your own lived experiences and economic equity.
- define key terms relating to the U.S. healthcare system and well-being.
- describe the central arguments around the U.S. healthcare system.
- make predictions about the key factors that influence the U.S. healthcare system.
- summarize issues related to the U.S. healthcare system.
- synthesize knowledge on the U.S. healthcare system.
- evaluate the positions taken in the simulation.
Phase 1: Activation
In this phase of the simulation, you will draw on your background knowledge of wages and the cost of living. This will help prepare you for the listening, reading and research activities in Phase 2 of the simulation. It will also allow you to share your experiences and ideas with your classmates.
Discussion Activity 1
Work in a small group. Discuss the following questions and be ready to share your responses with the class.
- Are you familiar with another country that offers a universal healthcare system? How does it work?
- What do you know about healthcare in the US?
- What insurance do you have in the US? How does your student insurance work?
- Have you seen a doctor for any major health concerns? What was your visit like? How might such visits differ for individuals with different health insurance coverages?
- Do you think the government is responsible for offering health insurance? Why or why not?
Phase 2: Comprehension
The purpose of this phase is to help you expand your knowledge of the debates around raising the minimum wage. You will watch one short video and read two texts. The video will provide you with some background information on how the healthcare system is set in the U.S. and how this compares with other countries. Review the questions below before watching the video. For Reading 1, you will define some key terms and answer a series of comprehension questions. For Reading 2, you will write a descriptive summary of the text.
Listening Activity 1
Watch the Vox Video Medicaid, explained: why it’s worse to be sick in some states than others and answer the following questions:
- Pre-reading Key Terms: Obamacare, Medicaid, Medicare
- Comprehension Questions (Timestamp – 00-2:14)
-
- When did Matthew start to get sick?
- What state does Matthew live in?
- What kind of insurance helps Matthew get treatment?
- Comprehension Questions (Timestamp – 5:12-6:59)
-
- Medicare covers all Americans age ______ and older
- Medicaid is a health insurance plan for _________ and disabled adults, and ______.
- Each state has the same coverage criteria in Medicaid (True / False)
- Comprehension Questions (Timestamp – 9:15-end)
-
- What would happen if Matthew was not on Medicaid?
- Why does Matthew say healthcare is like public school?
Listening Activity 2
Watch the Vox Video How single-payer health care works, in 2 minutes and answer the following questions:
- What does single payer healthcare mean?
- What US state tried to set up single payer healthcare?
- Massachusetts’ healthcare system led to what federal health insurance program?
Reading Activity 1
Reading: Health Care Reform: Learning From Other Major Health Care Systems | Princeton Public Health Review
- Pre-reading Key Terms: Universal healthcare, single-payer, social health insurance, national health insurance
- Comprehension Table Completion.
- Below is a description of the three universal healthcare models. Match (a), (b), and (c) to its model in the table below.
- There is one national insurance plan in which citizens pay. The plan specifies the medical costs.
- The government provides healthcare for everyone, paid for by taxes. The hospitals are owned by the government, and doctors are government employees.
- Everyone in the country is required to buy health insurance, often through their jobs. Doctors and hospitals are private and not owned by the government.
Fill out the table using information from the reading.
| Universal Healthcare Models | |||
| Beveridge
Single-payer model |
Bismarck Social health insurance model | National health insurance single-payer model | |
| Description | (1) | (2) | (3) |
| Advantages | |||
| Disadvantages | |||
| Example countries |
Reading Activity 2
Reading: Zief et al. (2020) Universal Healthcare in the United States of America: A Healthy Debate
- Comprehension Questions
- What is SES?
- Why does the author say that starting universal healthcare would be difficult to apply in the US?
- According to the article, what other Western countries have universal healthcare?
- What are the author’s reasons for supporting universal healthcare in the US?
- What is the importance of preventative measures for a universal healthcare model?
- Summary Prompt: Summarize the author’s arguments for and against universal healthcare in the United States (150-200 words).
Phase 3: Simulation
In this phase, you will be given a role to play in a simulated discussion event (e.g., 45 -minute panel discussion). It is important that you understand the context and your role to prepare for the role playing.
The Context
A recent surge in public health concerns at the local hospital has forced the hospital Board of Directors to re-evaluate its healthcare system. The Board will be hearing suggestions from different groups in the community in order to decide how to move forward.
Agenda: Should the U.S. have universal healthcare? What model of universal healthcare would be the best fit for the US?
Roles
You will be assigned a role to play in this phase of the simulation. There are five participant roles and one moderator role.
Moderator: Hospital Medical Board of Directors
Description
- Your task is to introduce the issue at the beginning of the presentation, welcome the participants, and moderate the presentation.
- Allow every participant (role) about 3-5 minutes to talk and make sure that everyone gets a turn to express their opinion.
- Develop one question for each group’s presentation and ask the question after their presentation
Role 1. The Beveridge model: single-payer national health service (e.g., UK)
Description
- You are arguing for the Beveridge model (a single-payer national health service model), in which the government is the main payer, like the NHS in the United Kingdom. This would mean the US would expand our existing programs like Medicare, Medicaid, or Veterans Affairs to cover all Americans instead of only qualified groups.
- In this model, everyone in the country has the exact same right to medical care as anyone else, regardless of money. This would get rid of high costs of medical care in the United States.
Role 2. The Bismarck Model: social health insurance model (e.g., Germany)
Description
- You are arguing for the Bismarck Model (a social health insurance model), which is used in Germany, and is what the Affordable Care Act is modeled on. In this system, everyone must purchase coverage, without exemptions, to ensure that everyone in the country has healthcare.
- Employers take out a health insurance tax that goes to help the government pay for healthcare, and the government keeps health and insurance costs from becoming too high.
Role 3. The National Health Insurance Model: single-payer national health insurance (e.g., Canada)
Description
- You are arguing for the national health insurance model (a single-payer national health insurance model), which has been used in many countries like Canada, Taiwan, and South Korea. This model offers one national insurance plan for citizens, and the medical costs are controlled by the government. Thus, this model will lower administrative costs and medical costs.
Role 4. Private healthcare (maintaining the current system)
Description
- You are arguing for the US to keep its current system which is made up of mostly private healthcare which people can get through their jobs.
- You believe that the US has some of the most advanced medical care in the world because of the economic competition that we currently have in the medical industry. Universal healthcare would get rid of this kind of economic freedom and stifle medical innovations.
- In addition, doctors would make less money in a universal healthcare system, making it harder to pay off medical debt.
Role 5. Out-of-pocket model (current US model for uninsured)
Description
- You are in favor of the out-of-pocket model, the current model for uninsured people in the US. This model helps people be more careful about how much they spend on healthcare, and encourages people to look for the best price before they make a decision. This model also gives doctors and hospitals motivation to provide the best care at the best price, which helps create a system where doctors must provide top-notch care.
Phase 4: Reflection
Debriefing Activity: In small groups, discuss the following questions. Be prepared to share your thoughts with the whole class.
- What did you think about the topic for this simulation? Were you already familiar with it?
- Was it easy or difficult to create an argument for your side of the issue? Why?
- What did you think of your role in the simulation? Did you personally agree or disagree with your role’s required stance on the issue?
Critical Reflection Activity
- Did any of the participants/ groups make particularly persuasive arguments? If so, which one/s? What made the arguments more persuasive?
- Did any of the participants/groups make arguments that you thought were weak? If so, what were the arguments? What made them weak?
- Which individual participant did you find the most knowledgeable / most persuasive in the role play? Why?
- Which group did you find most persuasive? Why?
Phase 5: Application
OPTION 1: Infographic
Prompt: Create an Infographic visualizing key facts of the current U.S. healthcare system model as well as two other models from foreign countries. Use effective texts, visuals, icons, colors, etc., to highlight the key information.
OPTION 2: Podcast
You are the host of a weekly podcast for your university newspaper, where each week you focus on one campus issue to talk about and give your perspective on.
Prompt: Using the sources from your role, others roles, and sources you find on your own, write, create and record a 8-10 minute podcast episode (with a written transcript) about which healthcare model the U.S. should adopt, and argue for how that model would solve problems with the U.S.’s current healthcare system.
Option 3: Essay (Problem/Solution)
Prompt: Describe two key problems of the healthcare system in the United States. Choose a healthcare model as a solution that the US should adopt, and argue for how that model would solve the key problems you discussed.
References
Chung, M. (2017, December 2). Health Care Reform: Learning from other major health care systems – Princeton Public Health Review. Princeton Public Health Review. Retrieved from https://pphr.princeton.edu/2017/12/02/unhealthy-health-care-a-cursory-overview-of-major-health-care-systems/
Vox. (2014). How single-payer health care works, in 2 minutes. YouTube. Retrieved from https://youtube.com/watch?v=u9x4cRWqPPM&si=EnSIkaIECMiOmarE.
Vox. (2017). Medicaid, explained: why it’s worse to be sick in some states than others. YouTube. Retrieved from https://youtube.com/watch?v=sOo_aw-xgHQ&si=EnSIkaIECMiOmarE.
Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of America: A healthy debate. Medicina (Kaunas), 56(11), 1–7. https://doi.org/10.3390/medicina56110580
About the authors
name: Hann Bingham Brunner
institution: Oklahoma State University
Hann Bingham Brunner is a PhD Candidate in Applied Linguistics at Oklahoma State University with a focus on disability and identity. They are Associate Director of the International Composition program and Assistant Director of First Year Composition.
name: Eunhye Hess