Few issues expose the values and divisions of American politics more clearly than the idea of social welfare. Critics argue that welfare programs create dependency and force citizens to subsidize others against their will. Supporters counter that it provides the necessities of life, prevents poverty, and builds national strength. These ideas are especially relevant in health care, where a sudden accident or illness can leave people financially devastated. While free-market advocates argue that deregulation ultimately lowers costs and expands access, the broader evidence suggests that guaranteeing a universal baseline of care, while allowing for private options, reduces poverty, promotes stability, and fulfills the moral obligation that every human deserves health care.
The biggest difference between health care and standard consumer goods is that one is a matter of life or death. The United Nations’ Universal Declaration of Human Rights affirms that every person has the right to “a standard of living adequate for [their] health and well-being… including medical care.” [1] Several aspects of society are funded and utilized by taxpayers. Public education, policing, and national defense are several examples of goods paid for by the public and also used by the public. Health care belongs in that same category: a shared responsibility and human right that everyone contributes to and benefits from.
The financial consequences of inadequate health care access are real. In 2023, nearly half of US adults (44%) said it was difficult to afford health care costs, and about one in four (23%) reported that they or a family member had problems paying for care in the past year. [2] This burden fell heaviest on uninsured adults under age 65 (55%), Hispanic adults (33%), and Black adults (30%). [2] About one-third (36%) said they skipped or postponed needed care due to cost, and nearly one in five (18%) reported that their health worsened as a result. The year prior, in 2022, four in ten adults (41%) reported having debt due to medical bills. [2]
The US spends more on health care than any other developed nation in the world. [3] Total national health care expenditures, which include government programs, private insurance, and out-of-pocket household spending, reached $4.9 trillion in 2023, or about $14,570 per person. This represents 17.6% of the nation’s total GDP, meaning nearly one-fifth of the entire US economy is devoted to health care. [4] This is nearly double the average spending of comparable countries, yet Americans have lower life expectancy and higher rates of preventable hospitalizations. [5] According to a 2016 Georgetown University study, Medicaid is among the most effective anti-poverty social welfare programs in the US. It reduced overall poverty by 3.8 percentage points and child poverty by 5.3 points. For Hispanic families, the reduction was 6.1 points, and for Black families, 4.9 points. In total, Medicaid expansion has lowered poverty among its beneficiaries by 17%. [6] This data demonstrates that expanding coverage improves access to care and prevents families from falling deeper into poverty.
Critics are correct, however, when saying that universal systems carry negative consequences. Canada’s average wait time from referral to treatment was 30 weeks in 2024, the longest ever recorded. [7] In the UK, the health care system faces a backlog of 7.4 million open cases, with nearly three million patients waiting longer than 18 weeks for care. [8] Universal coverage also requires higher taxation to subsidize the cost: Canada’s tax-to-GDP ratio is about 35% as of 2024, compared to 27-28% in the US. [9]
While these costs are significant, they do not outweigh the benefits. Hybrid systems offer ways to manage the trade-offs. For example, Germany and the Netherlands guarantee universal coverage, while allowing private insurance for faster access and added services. [10] Australia has a tax-funded universal baseline with optional, supplemental private plans. [11] These models show that universal care can be effectively paired with free market options to control costs and mitigate long waits. This approach differs from the Affordable Care Act (ACA), which widened coverage primarily by subsidizing private insurance and expanding Medicaid. [12] While this was effective in expanding access, it did not establish the universal baseline that hybrid countries guarantee. Unlike the ACA, hybrid designs begin by guaranteeing universal access, while providing optional private coverage, rather than relying on private insurance subsidies as the foundation.
Ultimately, the debate over health care is indicative of deeper questions about the role of government and the definition of human rights. People often argue that health care is a “positive right,” which would require the government to provide the good or service, as opposed to a “negative right,” which protects individuals from any interference. Americans already accept positive rights through many different government programs, and without provision, the negative right to life loses meaning for those who cannot afford care. The evidence suggests that hybrid systems can balance equal access and efficiency. Medicaid demonstrates the effectiveness of reducing poverty, while international hybrid systems show that universal access paired with private options delivers better results. Universal health care is neither dependency nor theft; it is a shared investment that secures a healthier, more stable future for all.
