Folks, we’ve reached the end. I’d like to note that this is in no way an exhaustive list of the reasons we need universal healthcare—rather just an overview. When starting this series as a column, I considered writing 100 different reasons but realized that might be a bigger time commitment than I had to offer. The point is, there are endless reasons, and more will arise as we face further injustice, violence and climate catastrophes. Given the abundance of pre-health students at Case Western Reserve University, I hope this miniseries has been a window into why we need our healthcare workers to be educated, engaged and fighting for justice. Without further ado, I’ll leave you with my final four reasons. 

Last week, the Biden administration passed a $1.2 trillion infrastructure bill—including $550 billion in new federal investments—for highway repairs, high-speed broadband, lead pipe replacements and electric buses, leaving the social infrastructure bill—Build Back Better (BBB)—behind in Congress. The readers’ digest of the situation is that both bills were supposed to be voted on together as investments in the American people. But most Republicans and some Democrats are stalling BBB because, well, they have been bought out by corporations and aren’t interested in the health, well-being or opinions of their constituents (though the headlines will say it’s because they don’t want to increase the deficit). Many of the tenets of BBB have been slashed, but those which remain—including universal prekindergarten, reductions in insurance premiums and expansion on home health services for disabled and elderly people—are only “universal” for three years before federal coverage decreases, eventually to zero. This brings me to reason seven: 

7. Universal healthcare would provide universal federal coverage of health policies

This reason seems silly; of course, a universal program would provide universal services. Well, BBB illustrates why this isn’t always a given. The universal pre-K plan does not even provide 100% federal coverage in the first year; instead, there is just a lump sum apportioned—let’s hope it’s enough. By 2028, there will be zero federal dollars allocated to the program. Not only will this be devastating for all the families who cannot afford early childhood education—or take out loans and go into debt—but it will make the program fail, providing critics with ammunition to attack the efficacy of social programs. And they will be right: Social programs do not work unless we invest in them. The federal government must cover 100% of the costs; otherwise, injustice will continue to prevail. Although the state-run Medicaid insurance program was designed to cover healthcare costs for low-income Americans, the Supreme Court ruled that states didn’t need to expand coverage to everyone who needs it. As a result, people who live in states that have refused to expand Medicaid have a lower life expectancy and higher rates of unmedicated chronic diseases. We don’t need to continue testing whether states can be responsible enough to provide for their most vulnerable; we know they won’t. We need the federal government to step in and say that enough is enough. 

8. Racial equity must be a core tenet of universal healthcare 

Until the United States joins every other industrialized country in the world in recognizing healthcare as a human right, we will continue to have fatal rates of injustice. This is not to say that universal healthcare will cure all social and medical problems, but it will be a massive step towards equity. Many people know the graphic often used to help distinguish equality from equity: three people are standing outside a fence trying to watch a soccer game. One person can see well over the fence, another is one foot away from being able to watch and the last person is two feet under the edge of the fence. Equality provides all three people the same number of blocks to stand on; it might allow two of them to see the game, but the last person is still blocked. On the other hand, equity provides each individual with a different number of blocks to compensate for height so that all three people can see the game. 

But why is there a fence blocking the game in the first place? Justice would be removing the fence so that everyone can see without blocks. We can address equity—by investing in social programs—to reach justice, by removing the systemic barriers to access. 

Most people of color have poorer health outcomes even after factoring in education and income, suggesting that institutionalized racism accounts for many health disparities. Part of improving outcomes is ensuring we know these racial health disparities and address them. Universal healthcare would include provisions for education, housing, food, transit and safety because all of these intersect with health. When people have reliable public transit, care for their child, affordable co-payments, healthcare workers who look like them and only one, well-paying job, they have the time and energy to get preventive check-ups. Their symptoms and concerns are listened to, and they can receive cancer screenings in an appropriate time frame. 

Investing in a universal healthcare system would mean changing the medical school and residency process to ensure fair admission for Black, Indigenous and people of color (BIPOC) and low-income people. Between 2002 and 2012, the medical school dropout rate for Indigenous students was nearly four times that of their white counterparts. Do not be fooled into thinking this is an accident. 

9. Mental health is deserving of attention and financial support

The United States has a long, complex relationship with mental health. Mostly, we have incarcerated, shackled, abused and ignored people with mental health disorders, forcing them into environments that not only cause them physical and emotional trauma but also worsen their health. People with schizophrenia have better outcomes in countries where the community supports and cares for them instead of in developed countries where the status quo is institutionalization. 

A universal healthcare system would not mean that the hospital is the default solution to all health problems. The reality of healthcare is much more nuanced. The system would improve access to home healthcare to help relieve the current unpaid family caregivers. It would appropriately compensate mental health and social workers for their critical roles. The pandemic has highlighted the prevalence of mental health problems in our country, which requires addressing the shortage of therapists. It would reconsider the current medication distribution rules to ensure that bureaucracy does not keep people, especially students, from taking prescribed drugs. 

Incorporating mental health into our universal healthcare system would help decrease the stigma around psychiatric concerns and accessing support.

10. If reasons 1-9 haven’t done it for you, consider that it is cheaper to have universal healthcare than our current health system

Let’s pretend you have no interest in addressing health disparities and the reality of poor healthcare for low-income people, BIPOC or LGBTQIA+ people in the U.S. Universal healthcare is still the smarter option financially. 

We spend more money on health as a percent of our global domestic product than the rest of the developed world, yet we have worse health outcomes. We spend $3.8 trillion on healthcare annually—$12,000 per person—for poor to adequate results. Increasing with inflation, we spend $40 trillion over a decade for a few people to have excellent care, a lot of people to have mediocre care and too many to have no care. Nearly 30 million Americans are uninsured, and 40 million more are underinsured—their insurance covers only a fraction of the necessary costs—and both of these numbers have likely increased because of higher unemployment rates due to the pandemic. If we had a universal system, neither unemployment nor the desire to have better working conditions would threaten our healthcare access. 

A universal healthcare system, such as Medicare for All, would cost $28-40 trillion over a decade. That’s right—for the same amount as or less than in our current system, all Americans would have access to preventive appointments, hospitalizations, prescription drugs, home/nursing care, dental care, vision, hearing aids and so forth. And, as a fringe benefit to saving a few trillion, we would start chipping away at the outrageous levels of injustice in our country.