Notes and editing sheet:

Outline

I. Introduction A. Background information on universal healthcare B. Thesis statement: The

II. Cost Savings A. Barrier to healthcare access: High healthcare costs B. Analysis of cost savings under
universal healthcare 1. Reduction in prescription drug costs 2. Benefits of preventive care C. Impact of
cost savings on healthcare access

III. Improved Health Outcomes A. Prompt diagnoses, treatments, and disease management B. Prevention
of illnesses and long-term cost savings C. Enhanced accountability within the healthcare system

IV. Mitigation of Financial Worries A. Alleviating financial stress through comprehensive coverage B.
Positive effects on individual well-being and health outcomes

V. Initiation of a Cycle of Health Improvement and Cost Reduction A. Business expenses reduction and
resource reallocation B. Expansion, innovation, and job creation opportunities

VI. Addressing Implementation Barriers A. Feasibility challenges 1. Geographical size, diverse population,
and cultural identities B. Upfront costs and financial sustainability 1. Financing options and concerns C.
Potential inefficiency and wait times 1. Efficient strategies to manage wait times 2. Planning, governance,
and system improvement

VII. Garnering Widespread Support A. Highlighting economic benefits and long-term savings B. Engaging
stakeholders through financial stability and efficiency

VIII. Access to Care and Healthy Aging A. Correlation between socioeconomic status and healthcare
access B. Grassroots initiatives for SES improvement C. Utilizing data for targeted interventions and
policy changes D. Impact of the Affordable Care Act on healthcare access E. Outreach enhancement for
older adults

IX. Conclusion A. Recap of main points B. Restatement of thesis C. Reinforcement of the necessity of
universal healthcare for improved public health, reduced costs, and a stable economy

Cai, Christopher, et al. "Projected costs of single-payer healthcare financing in the United States: A
systematic review of economic analyses." PLoS medicine 17.1 (2020): e1003013.
https://doi.org/10.1371/journal.pmed.1003013

Cost savings on prescription drugs and overall health care costs (Cai et al., 2020).

Reduced future costs as preventative services utilized by previously uninsured (Cai et al., 2020).

Greer, Scott L., Holly Jarman, and Peter D. Donnelly. "Lessons for the United States from single-payer
systems." American journal of public health 109.11 (2019): 1493-1496.
https://doi.org/10.2105/AJPH.2019.305312
Businesses will have less expenses (Greer, Jarman, & Donnelly, 2019).

Increases accountability for health outcomes (Greer et al., 2019).

Better health outcomes reduce costs on the system.

People worry less about health care costs when health care is covered (Greer et al., 2019).

Barriers include political bias, middle class flight due to disposable income and private options (Greer et
al., 2019).

Focusing on financial benefits instead of helping low-income and poor people will help gain widespread
support for single-payer health care (Greer et al., 2019).

McMaughan, Darcy Jones, Oluyomi Oloruntoba, and Matthew Lee Smith. "Socioeconomic status and
access to healthcare: interrelated drivers for healthy aging." Frontiers in public health 8 (2020): 231.
https://doi.org/10.3389/fpubh.2020.00231

Because financial resources are proportional to health status, efforts are needed to support older adults
and the burdened healthcare system with financial resources. This can be most effective with grassroots
approaches and interventions to improve SES among older adults and through data-driven policy and
systems change.

Policy change based on available data

Grassroot approach is preferable to promoting single-payer health care (McMaughan, Oloruntoba, &
Smith, 2020).

Healthy aging is related to access to care (McMaughan et al., 2020).

The ACA improved access to health care for older adults (McMaughan et al., 2020).

Must improve outreach for utilization (McMaughan et al., 2020).

Zieff, Gabriel et al. “Universal Healthcare in the United States of America: A Healthy
Debate.” Medicina (Kaunas, Lithuania) vol. 56,11 580. 30 Oct. 2020,
doi:10.3390/medicina56110580
“Though the majority of post-industrial Westernized nations employ a universal healthcare model, few—
if any—of these nations are as geographically large, populous, or ethnically/racially diverse as the U.S.
Different regions in the U.S. are defined by distinct cultural identities, citizens have unique religious and
political values, and the populace spans the socio–economic spectrum. Moreover, heterogenous
climates and population densities confer different health needs and challenges across the U.S. [8]. Thus,
critics of universal healthcare in the U.S. argue that implementation would not be as feasible—
organizationally or financially—as other developed nations [9]. There is indeed agreement that
realization of universal healthcare in the U.S. would necessitate significant upfront costs [10]. These costs
would include those related to: (i) physical and technological infrastructural changes to the healthcare
system, including at the government level (i.e., federal, state, local) as well as the level of the provider
(e.g., hospital, out-patient clinic, pharmacy, etc.); (ii) insuring/treating a significant, previously uninsured,
and largely unhealthy segment of the population; and (iii) expansion of the range of services provided
(e.g., dental, vision, hearing) [10].

The cost of a universal healthcare system would depend on its structure, benefit levels, and extent of
coverage. However, most proposals would entail increased federal taxes, at least for higher earners
[4,11,12]. One proposal for universal healthcare recently pushed included options such as a 7.5% payroll
tax plus a 4% income tax on all Americans, with higher-income citizens subjected to higher taxes [13].
However, outside projections suggest that these tax proposals would not be sufficient to fund this plan.
In terms of the national economic toll, cost estimations of this proposal range from USD 32 to 44 trillion
across 10 years, while deficit estimations range from USD 1.1 to 2.1 trillion per year [14].

Beyond individual and federal costs, other common arguments against universal healthcare include the
potential for general system inefficiency, including lengthy wait-times for patients and a hampering of
medical entrepreneurship and innovation [3,12,15,16]. Such critiques are not new, as exemplified by
rhetoric surrounding the Clinton Administration’s Health Security Act which was labeled as “government
meddling” in medical care that would result in “big government inefficiency” [12,15]. The ACA has been
met with similar resistance and bombast (e.g., the “repeal and replace” right-leaning rallying cry) as a
result of perceived inefficiency and unwanted government involvement. As an example of lengthy wait
times associated with universal coverage, in 2017 Canadians were on waiting lists for an estimated
1,040,791 procedures, and the median wait time for arthroplastic surgery was 20–52 weeks [17].
Similarly, average waiting time for elective hospital-based care in the United Kingdom is 46 days, while
some patients wait over a year (3). Increased wait times in the U.S. would likely occur—at least in the
short term—as a result of a steep rise in the number of primary and emergency care visits (due to
eliminating the financial barrier to seek care), as well as general wastefulness, inefficiency, and
disorganization that is often associated with bureaucratic, government-run agencies.”

Cai, Christopher, et al. "Projected costs of single-payer healthcare financing in the United States: A
systematic review of economic analyses." PLoS medicine 17.1 (2020): e1003013.
https://doi.org/10.1371/journal.pmed.1003013

Galvani, Alison P et al. “Universal healthcare as pandemic preparedness: The lives and costs that could
have been saved during the COVID-19 pandemic.” Proceedings of the National Academy of Sciences of
the United States of America vol. 119,25 (2022): e2200536119. doi:10.1073/pnas.2200536119

Greer, Scott L., Holly Jarman, and Peter D. Donnelly. "Lessons for the United States from single-payer
systems." American journal of public health 109.11 (2019): 1493-1496.
https://doi.org/10.2105/AJPH.2019.305312

McMaughan, Darcy Jones, Oluyomi Oloruntoba, and Matthew Lee Smith. "Socioeconomic status and
access to healthcare: interrelated drivers for healthy aging." Frontiers in public health 8 (2020): 231.
https://doi.org/10.3389/fpubh.2020.00231

Zieff, Gabriel et al. “Universal Healthcare in the United States of America: A Healthy Debate.” Medicina
(Kaunas, Lithuania) vol. 56,11 580. 30 Oct. 2020, doi:10.3390/medicina56110580