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The issue of private versus publicly funded health care remains controversial, with nations around the world employing a combination of these systems to varying degrees of success.
Regardless of the system in place, millions of people still have inadequate access to health care, which can lead to poor health outcomes and decreased quality of life. In order to regulate standard of care, governments should implement universal health care systems that allow all citizens, irrespective of socioeconomic status, to receive free and timely health services, thus removing the need for private health care. This notion is supported by well-known international standards and ethical principles, which assert that (1) access to health care is a fundamental human right, (2) wealthier individuals have a moral obligation to assist those in need, and (3) benefits would be widespread, leading to more prosperous societies.
Firstly, access to quality health care is a fundamental human right according to longstanding international codes and the ethical principle of justice. In December 1948, the United Nations General Assembly published their Universal Declaration of Human Rights, which outlined essential human rights for all people and all nations. Of interest, Article 25 of the Declaration states that “everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, medical care and necessary social services” (United Nations, 2020, para. 26). Therefore, as medical care is a universally acknowledged human right, governments have an obligation to uphold this decree and provide accessible services for all citizens. Similarly, the World Health Organisation has established Sustainable Development Goals to address global sustainability and human development issues. Goal 3 aims to “ensure healthy lives and promote wellbeing for all ages” (United Nations, 2020, para 1). In order to fulfil this goal, worldwide governments should look to implement universal health care, which would provide all people with high quality preventative and curative health services without financial burden. Universal health care is also underpinned by the ethical principle of justice. In health care ethics, justice refers to the fair and equitable allocation of resources and services amongst all people (Australian Catholic University [ACU], 2020, section 5.2). By providing much-needed health services to all people, rather than just those who can afford it, governments would be able to safeguard the physical and mental wellbeing of their citizens, and uphold not only the fundamental principle of justice, but also human dignity and respect. Evidently, governments have a great responsibility to work towards universal health care, and so too do certain individuals within society.
Secondly, according to the ethical principle of beneficence and the ethics of care theory, individuals in better health and financial situations have a duty to contribute to the health care of those with lower socio-economic statuses. Universal health care is funded with revenue from income taxes and therefore relies on wealthier individuals paying tax for the medical care of others (Paek, Meemon, & Wan, 2016). This is justified using the ethical principle of beneficence, which commonly refers to the moral obligation to act for the benefit of others “by preventing or removing possible harms” (Ashcroft, Dawson, Draper, & McMillan, 2007). One such harm includes the significant financial burden that private health insurance can pose on low-income earners. Universal health care aims to spread the financial burden among the entire community so that it is not fully borne on an individual who falls ill (Mathauer, Vinyals Torres, Kutzin, Jakab, & Hanson, 2020). The ethics of care theory also encourages others to assist those in need. This theory suggests that decisions be made based on compassion, empathy and a sincere concern for the vulnerable members of society (Schuchter & Heller, 2018; ACU, 2020). In accordance with this theory, healthier people should be motivated to contribute to the health care of others, understanding that it is morally and ethically right. Whilst those in better life circumstances would bear the majority of the financial burden associated with universal health care, the benefits of this system would be widespread.
Finally, universal health care has the potential to benefit entire communities, in line with the ethical principle of utilitarianism. Utilitarianism was originally developed by philosophers Bentham and Mills in the 19th century to encourage followers to “act in such a way to generate the maximum quantum of well-being, happiness or utility” (Marseille & Kahn, 2019). Universal health care promotes utilitarianism as it enables more people to secure benefits than the privatised schemes currently employed in many countries. Furthermore, by providing access to free, high quality health services, individuals would likely recover from illnesses/injuries faster (and possibly avoid illness in the first place due to preventative health care measures). As a result, these individuals would require less time away from work and would have increased productivity, enabling them to be active members of society. Improved quality of care via a universal system would also help to build trust and solidarity from the public (Sumriddetchkajorn et al., 2019). Benefits of this nature have been achieved in Thailand, where universal health care has been implemented since 2002. The Thai government provides all citizens with free essential health services including annual physician check-ups, health promotion strategies and chronic disease management in all stages of life (Paek et al., 2016). Since its introduction, this preventative and curative health care scheme has increased Thailand’s life expectancy from 71.8 to 74.2 years, and has led to better utilisation of outpatient services and improved health-related quality of life (Sumriddetchkajorn et al., 2019). As demonstrated in Thailand, universal health care is a feasible, successful system that is capable of producing wide ranging benefits for entire communities.
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