The US needs equitable and accessible healthcare reform

Healthcare should be integrated with other basic services provided free of charge by the government.

By Clara Silvestri

Roughly 15 million people are expected to lose health coverage by 2034 as a direct result of Medicaid cuts in President Trump’s Big Beautiful Bill, signed into law in July of this year. The law is also expected to increase the cost of health insurance for many Americans. This threatens to reverse much of the progress made by former President Obama’s Affordable Care Act (Obamacare) in expanding healthcare access.

Yet the percentage of Americans who agree that the government should provide healthcare coverage for all has been steadily on the rise since 2019, reaching 62 percent in 2024 according to Gallup’s 2024 Health and Healthcare survey. This number expresses the underlying politics of the issue with the same survey reporting 90 percent of Democrats supporting a universal healthcare system versus only 32 percent of Republicans. So, the question remains: what is the most effective way to reach those 38 percent of Americans in the opposition and continue the push for policy actions supporting universal healthcare?

Today, the United States is the only high-income country without a system of universal healthcare. We also spend considerably more on healthcare than other comparably high-income countries according to a 2023 report by the Organisation for Economic Co-operation and Development, though our health outcomes remain relatively worse. Achieving a healthcare system that is free at point-of-service such as that offered by Britain’s National Health Service may seem at odds with our defining cultural trait of individualism.

However, many things in our society are already universal. If a person is arrested and charged with a crime, legal defense is provided to them free at point-of-service. If parents cannot pay for private education for their child, public schooling is provided to them free at point-of-service. Yet there are no mainstream politicians who take stances against the existing frameworks of public defense or public education.

Americans are about to face historic rises in health insurance costs due to the Big Beautiful Bill passed by the current Congress. Policymakers who support universal healthcare should seize this opportunity to mount a campaign based on the core insight that healthcare is one of the only basic services in the U.S. that is not already guaranteed.

Most arguments both for and against universal healthcare adopt either an economic or moral perspective on the issue. Supporters argue that universal healthcare is more cost-effective for the government, while critics oppose higher taxes for the American people. Supporters argue that providing unconditional access to healthcare is the moral responsibility of a government to its citizens, while critics take the standpoint that the government should have as little involvement as possible in healthcare.

These opposing views on financing and government responsibility are unlikely to ever move beyond their partisan lines. They are already so deeply entrenched in whichever party one chooses to identify with, and staunch Democrats and Republicans tend to apply these general right-and-left views to every topical political issue. Rather than preaching to the choir of their own party, policymakers should instead adopt an approach based on logical reasoning, household cost realities, and approachable options in order to spur public opinion toward a higher favorability of universal healthcare.

Researchers Fardin Quazi and Nandhakumar Raju examined the question of the readiness of Americans for a universal healthcare system in their article published in the Asia-Pacific Journal of Health Management in August 2025. They explain that a core aspect of the debate is the question of healthcare as either a right or a privilege.

Proponents of healthcare as a privilege emphasize personal responsibility and limited government involvement. Under this logic, if your child breaks their arm during recess at school, and they do not have healthcare coverage, the hospital may send you a bill for hundreds of dollars after they put the cast on. However, this same logic becomes ridiculous when applied to other real-world scenarios. If your house catches on fire, it is not your personal responsibility to put the fire out. Instead, the government provides fire-fighting services to maintain your well-being.

No respectable political debate moderator would ask candidates whether firefighting services or education or legal defense is a right or a privilege. The established importance of and trust in these existing societal safety-nets reframes the question of healthcare as a right or privilege in a way that exposes its inconsistency. Our lack of a universal healthcare system is an illogical exception, not the norm, to the way our society functions.

Financial stress among Americans is an acute issue. Roughly three-in-ten adults predict that their personal financial situation will be worse one year from now according to a survey conducted by the Pew Research Center earlier this year. The idea of raising taxes on American households to fund a universal healthcare system may appear undesirable at first, but this must be repackaged into the more personal context of overall costs per individual. In fact, a proposed plan that would as much as triple taxes while providing universal healthcare coverage with no premiums or copays still predicted that the average household would actually save money.

Another hypothetical described in 2024 by Sarah Welch, a health policy researcher at Northwestern University, estimated an average annual saving of $2400. “The messaging that overall out-of-pocket costs per individual person could go down could be incredibly effective,” Welch says.

Policymakers must adopt a message that goes beyond divided partisan stances on raising taxes. Focusing instead on the forecasted potential to save money with a universal healthcare system will resonate greater with the average American anxious about their year-to-year financial situation. Universal healthcare begins to sound like a more sensible approach when comparing the potential money saved to the amount that, say, parents save each year because of public education.

Certain aspects of universal health coverage do already exist in the United States. Medicare and Medicaid are both either free or with very small costs and funded largely by taxpayers. In June of this year, U.S. Representatives Jimmy Gomez and Don Beyer introduced the Choose Medicare Act. This bill would add a section to Medicare which gives all Americans the option to be on a public insurance plan with minimal out-of-pocket costs. The key word here is option–there would be no sweeping change to force people off their current insurance plans and into a new and unfamiliar system.

Dr. Ellen Ider, a sociology professor at Emory University and the director of Emory’s Religion and Public Health Collaborative, sees clear benefits in this plan. “If you had a public option that people could migrate to, then you could get people into a single-payer system over time,” Idler says. “It wouldn’t be a mandate that everybody has to go to this now; it could just be offered and then people could choose to move to it.”

Making universal healthcare more palatable for Americans must be a part of its potential implementation process as well as the arguments we employ for it. “Gradual change would be most effective,” Idler says. Any bottom-up shift in how Americans understand the absence of universal healthcare in relation to their personal annual expenses must be accompanied by policy reforms that progress at a similar, incremental pace. Candidates should push for policy reforms that build trust through familiarity and gradualism.

Critics will argue that urgent, sweeping reform is needed to address the deep structural inequities of our current healthcare system. In practice, however, there may be great strategic value in meeting voters where they are and framing universal healthcare as entirely consistent with other public services Americans already know, trust, and are willing to fund through taxes.

The path toward universal healthcare in the United States is not likely to result from a single ideological victory. Rather, it depends on reshaping the way Americans see the systems they already rely on. We can make universal healthcare seem like a logical continuation of the American social infrastructure that we often take for granted by grounding the conversation in familiar societal structures, personal financial realities, and realistic policy steps.

A great deal of trust in politicians and policymakers will be required to move the country toward a system that is more equitable and more aligned with values we already affirm in other areas of public life. This trust can only be achieved through reforms that echo the stability and support of the public systems Americans know by heart.