Pros and Cons of Government Healthcare

team of doctors walking in hospital hallway

Buero Monaco/Getty Images

"Government healthcare" refers to government funding of healthcare services via direct payments to doctors, hospitals and other providers.

In U.S. government healthcare, doctors, hospitals and other medical professionals are not employed by the government. Instead, they provide medical and health services, as normal, and are reimbursed by the government, just as insurance companies reimburse them for services.

An example of a successful U.S. government healthcare program is Medicare, established in 1965 to provide health insurance for people aged 65 and over, or who meet other criteria such as disability.

The U.S. is the only industrialized country in the world, democratic or non-democratic, without universal healthcare for all citizens provided by government-funded coverage.

50 Million Uninsured Americans in 2009

In mid-2009, Congress is working to reform U.S. healthcare insurance coverage which presently leaves more than 50 million men, women and children uninsured and without access to adequate medical and health services.

All healthcare coverage, except for some low-income children and those covered by Medicare, is now provided only by insurance companies and other private-sector corporations.

Private company insurers, though, have proven quite ineffective at controlling costs, and actively work to exclude healthcare coverage whenever feasible.

"The private insurance market is a mess. It's supposed to cover the sick and instead competes to insure the well. It employs platoons of adjusters whose sole job is to get out of paying for needed health care services that members thought were covered."

In fact, multi-million bonuses are awarded annually to top healthcare executives as incentive to deny coverage to policy holders.

As a result, in the United States today:

  • "Over a third of families living below the poverty line are uninsured. Hispanic Americans are more than twice as likely to be uninsured as white Americans while 21% of black Americans have no health insurance.
  • More than 9 million children lack health insurance in America.
  • Eighteen thousand people die each year because they are uninsured."
"The current system is increasingly inaccessible to many poor and lower-middle-class people... those lucky enough to have coverage are paying steadily more and/or receiving steadily fewer benefits."

Latest Developments

In mid-2009, several coalitions of Congressional Democrats are heatedly crafting competing healthcare insurance reform legislation. Republicans have generally not offered substantive healthcare reform legislation in 2009.

President Obama has voiced support for universal healthcare coverage for all Americans which would be provided by selecting among various coverage options, including an option for government-funded healthcare (aka a public plan option or public option).

However, the President has stayed safely on the political sidelines, thus far, forcing Congressional clashes, confusion, and setbacks in delivering on his campaign promise to "make available a new national health plan to all Americans."

Healthcare Packages Under Consideration

Most Democrats in Congress support universal healthcare coverage for all Americans which offers various options for insurance providers, and includes a low-cost, government-funded healthcare option.

Under the multi-option scenario, Americans satisfied with their present insurance can opt to keep their coverage. Americans dissatisfied, or without coverage, can opt for government-funded coverage.

Republicans complain that the free-market competition offered by a lower-cost public-sector plan would cause private-sector insurance companies to cut their services, lose customers, would inhibit profitability, or go entirely out of business.

Many progressive liberals and other Democrats believe strongly that the only fair, just U.S. healthcare delivery system would be a single payer system, such as Medicare, in which only low-cost government-funded healthcare coverage is provided to all Americans on an equal basis.

Americans Favor Public Plan Option

Per the Huffington Post about a June 2009 NBC/Wall Street Journal poll:

"... 76 percent of respondents said it was either 'extremely' or 'quite' important to 'give people a choice of both a public plan administered by the federal government and a private plan for their health insurance.'"

Likewise, a New York Times/CBS News poll found that "The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 — that would compete for customers with private insurers. Twenty percent said they were opposed."


Democrat Harry Truman was the first U.S. President to urge Congress to legislate government healthcare coverage for all Americans.

Per Healthcare Reform in America by Michael Kronenfield, President Franklin Roosevelt intended for Social Security to also incorporate healthcare coverage for seniors, but shied away for fear of alienating the American Medical Association.

In 1965, President Lyndon Johnson signed into law the Medicare program, which is a single payer, government healthcare plan. After signing the bill, President Johnson issued the first Medicare card to former President Harry Truman.

In 1993, President Bill Clinton appointed his wife, well-versed attorney, Hillary Clinton, to head a commission charged with forging a massive reform of U.S. healthcare. After major political missteps by the Clintons and an effective, fear-mongering campaign by Republicans, the Clinton healthcare reform package was dead by Fall 1994.

The Clinton administration never tried again to overhaul healthcare, and Republican President George Bush was ideologically opposed to all forms of government-funded social services.

Healthcare reform was a top campaign issue among 2008 Democratic presidential candidates. Presidential candidate Barack Obama promised that he will "make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress." See the entirety at Obama Campaign Promises: Health Care.


Pros of Government Healthcare

Iconic American consumer advocate Ralph Nader sums up the positives of government-funded healthcare from the patient's perspective:

  • Free choice of doctor and hospital;
  • No bills, no co-pays, no deductibles;
  • No exclusions for pre-existing conditions; you are insured from the day you are born;
  • No bankruptcies due to medical bills;
  • No deaths due to lack of health insurance;
  • Cheaper. Simpler. More affordable;
  • Everybody in. Nobody out;
  • Save taxpayers billions a year in bloated corporate administrative and executive compensation costs.

Other important positives of government-funded healthcare include:

  • 47 millions Americans lacked healthcare insurance coverage as of the 2008 presidential campaign season. Soaring unemployment since then have caused the the ranks of the uninsured to swell past 50 million in mid-2009.Mercifully, government-funded healthcare would provide access to medical services for all uninsured. And lower costs of government healthcare will cause insurance coverage to be significantly more accessible to millions of individuals and businesses.
  • Doctors and other medical professionals can focus on patient care, and no longer need to spend hundreds of wasted hours annually dealing with insurance companies.Patients, too, under government healthcare would never need to fritter inordinate amounts of frustrating time haggling with insurance companies.

Cons of Government Healthcare

Conservatives and libertarians oppose U.S. government healthcare mainly because they don't believe that it's a proper role of government to provide social services to private citizens.

Instead, conservatives believe that healthcare coverage should continue to be provided solely by private-sector for-profit insurance corporations or possibly by non-profit entities.

In 2009, a handful of Congressional Republicans have suggested that perhaps the uninsured could obtain limited medical services via a voucher system and tax credits for low-income families.

Conservatives also contend that lower-cost government healthcare would impose too great of a competitive advantage against for-profit insurers.

"In reality, equal competition between a public plan and private plans would be impossible. The public plan would inexorably crowd out private plans, leading to a single-payer system."

From the patient's perspective, negatives of government-funded healthcare could include:

  • A decrease in flexibility for patients to freely choose from among the vast cornucopia of drugs, treatment options, and surgical procedures offered today by higher-priced doctors and hospitals.
  • Existing patient confidentiality standards, which would likely be diluted by centralized government info that would necessarily be maintained.
  • Less potential doctors may opt to enter the medical profession due to decreased opportunities for highly compensated positions. Less doctors coupled with skyrocketing demand for doctors could lead to a shortage of medical professionals, and to longer waiting periods for appointments.

Where It Stands

As of late June 2009, the struggle to shape healthcare reform has only begun. The final form of successful healthcare reform legislation is anyone's guess.

The American Medical Association, which represents 29% of U.S. doctors, opposes any government insurance plan mainly because doctors' reimbursement rates will be less than those from most private sector plans. Not all doctors oppose government-funded healthcare, though.

Political Leaders on Healthcare Reform

On June 18, 2009, Speaker of the House Nancy Pelosi told the press

"I have every confidence that we will have a public option coming out of the House of Representatives — that will be one that is actuarially sound, administratively self-sufficient, one that contributes as to competition, does not eliminate competition."

Senate Finance Committee Chair Max Baucus, a centrist Democrat, admitted to the press:

"I think a bill that passes the Senate will have some version of a public option."

Moderate Blue Dog Democrats of the House "say the public plan should occur only as a fallback, triggered if private insurers aren't doing a good enough job on access and costs," per Rob Kall at OpEd News.

In contrast, Republican strategist and Bush advisor Karl Rove recently penned a harshly dire Wall Street Journal op-ed in which he warned that "... the public option is just phony. It's a bait-and-switch tactic... Defeating the public option should be a top priority for the GOP this year. Otherwise, our nation will be changed in damaging ways almost impossible to reverse."

The New York Times wisely summed up the debate in a June 21, 2009 editorial:

"The debate is really over whether to open the door a crack for a new public plan to compete with the private plans. Most Democrats see this as an important element in any health care reform, and so do we."