Single-payer is not enough. We need an American NHS.
Healthcare has been a major issue in American politics for decades. Currently, the debate over increasing healthcare coverage and accessibility is between having a public option or having Medicare for All. A public option would allow people to buy a cheap government insurance that covers basic healthcare. Under Medicare for All, the government will be the single payer, and private health insurance companies would only cover supplemental care. However, neither of these options is the best for America.
A public option would not cover everyone, and millions will be underinsured. Medicare for All will cover everyone, and nobody will be underinsured. Healthcare under Medicare for All would be free at the point of service. While Medicare for All is far superior to a public option, it will not go far enough in improving healthcare access.
A better solution to our healthcare problems would be to have a system like the National Health Service (NHS) in the UK. Under Medicare for All, hospitals and clinics will continue to be privately-owned and operated. An NHS style system would also be a single payer system, but hospitals and clinics would be publicly owned and operated. Healthcare would be free for everyone at the point of service, but healthcare resources would be distributed to where they are needed most instead of where there is the most profit.
Residents of rural and poor urban communities face challenges to healthcare access that would not be affected by just expanding insurance coverage. Many who live in rural communities are too far away to have easy access to a physician. Physician density is considerably lower in rural areas than in urban and suburban ones. Most of rural America is currently designated as medically underserved. Even in urban areas, physician access is more difficult for residents of poor neighborhoods. Poor urban areas also face the threat of community hospitals closing, taking away physician access.
Medicare for All may cause new hospitals to open up in medically underserved areas because hospitals and clinics would no longer worry about uninsured patients. However, healthcare providers may still forgo setting up new hospitals and clinics in many of these areas due to concerns over profit.
Lack of healthcare access is very similar to the situation with food deserts. A food desert is an area which lacks access to a grocery store. Because grocery stores are too far away, residents of food deserts cannot access fresh healthy food despite being able to afford it. People in a “healthcare desert” cannot access healthcare resources, especially physicians, in a reasonable amount of time.
Under an American NHS, community hospitals serving low-income communities will have the same resources as private hospitals. The government would also have the power to direct healthcare resources so that all people have equal access to high quality healthcare. Hospitals and clinics would be strategically placed so that there can be an approximately equal number of physicians for a given number of people.
In the case of a national health emergency, such as a pandemic, an American NHS will be better mobilized to respond than our current healthcare system. Our disjointed healthcare system has been touted as a possible factor contributing to slow COVID-19 vaccine distribution. By having healthcare delivery under one system, there would no longer be a need to coordinate between different systems and different patient and resource databases. In the UK, having a nationalized health system is showing promise in the fight against a new strain of COVID-19 with regard to logistics.
An argument can be made that we cannot implement such a system in the US because the country is too big. However, each of the countries that make up the UK–England, Scotland, Wales, and Northern Ireland–have localized control in their nation, but they are all still part of one system. A similar setup could apply in the US– with the states having local control under one federal healthcare system.
