Healthcare, Reproductive Rights, and Dying with Dignity

The Peoples’ Union has a comprehensive platform around healthcare, reproductive freedom, prescription drugs, and dying with dignity.

As federal government spending on healthcare increases precipitously, millions of Americans continue to struggle to afford quality care. The federal government, and states, cannot continue to increase healthcare spending indefinitely. We need to change the system beyond what President Obama was able to achieve with the Affordable Care Act. Continuing in the same way is simply not sustainable, nor humane.

The graph below shows per capita spending (employer, government, and consumer costs) on healthcare across wealthy countries. The U.S. is an outlier in that we spend much more on healthcare to achieve worse outcomes than peer countries (Commonwealth Fund, 2023). We are also an outlier in prescription drug costs (see graph). The high cost of care and prescription drugs in the U.S. is the result of an inefficient system with private and public coverage options, for-profit hospitals, systemic inequality, profit-driven drug companies, among other anomalies.

The cost of basic healthcare, including dental and mental healthcare, is out of reach for too many Americans. Medical debt drives 67% of personal bankruptcies in this country (Himmelstein et al., 2019). According to Turner (2023), 17% of adults with health care debt declared bankruptcy or lost their home. By the end of 2021, approximately 6% of adults (14 million people) in the U.S. owed more than $1,000 in medical debt, 2% (6 million people) owed more than $5,000, and 1% of adults (3 million people) owed more than $10,000 (Rakshit et al., 2024).

Universal Healthcare

Federal spending on healthcare continues to increase precipitously. According to the Centers for Medicare and Medicaid Services (CMS) “national health spending is projected to grow at an average rate of 5.5 percent per year for 2018-27 and to reach nearly $6.0 trillion by 2027.”

A universal healthcare system will curb costs in the long-run and be effective in preventing disease and chronic disorders due to everyone having access to regular, preventive care. Despite the advances of Obamacare, many of which continue to be under threat, we need to keep working toward a more progressive healthcare system.

Whether called ‘Medicare for All’ or Universal Healthcare, we believe it is the government’s responsibility to make healthcare available and accessible to all Americans. By drawing additional revenue through tax increases on the wealthy we can create a sustainable and robust healthcare fund. Galvani et al. (2020) have found that a universal healthcare system will quite literally, save tens of thousands of lives.

“Universal healthcare could have alleviated the mortality caused by a confluence of negative COVID-related factors. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a Medicare for All system.”

Galvani et al., (2022)

The life-saving potential of Medicare for All compared to the present

Paying for Universal Healthcare

A universal healthcare plan will cost approximately $3.2 trillion dollars based on the average of estimates from experts and think tanks reported in the New York Times (Katz et al., 2019). This represents a 13% savings over the current system including individual out of pocket, employee, employer, and state and federal government expenditures (Galvani et al., 2020). Employee and employer contributions total $1.28 trillion under the current system (EBRI, 2022). These contributions will be replaced by a payroll tax, and by the copays indicated below. It is estimated that the lowest income families will see the most cost savings from the implementation of a universal healthcare plan (Galvani et al., 2020). A universal healthcare plan is also estimated to reduce current administrative costs by $600 billion dollars (Archer, 2020).

The plan will save billions in prescription drug costs by having the government negotiate directly with pharmaceutical companies to lower prescription costs, instead of the current system of insurance companies negotiating their own costs (Katz et al., 2019). The Veterans Administration already pays 50% less than Medicare for prescription drugs, providing an excellent model for lowering prices through direct negotiations (GAO, 2021). Between public and private costs, the U.S. spent approximately $378 billion for prescription drugs in 2021 (Peterson Foundation, 2023). We support a proposal to reduce brand name prescription drug and generics costs by 70%, below Medicare prices through price negotiation, compulsory licensing, and generic manufacturing where necessary (New York Times, 2019). It is estimated that $264 billion can be saved on prescription drug costs annually (a 70% reduction from current expenditures) (Peterson Foundation, 2023).

The following table describes most of the budgetary components of a universal healthcare plan and a list of taxes and savings that will help pay for the plan.

Item	Cost	Revenue	Explanation
Medicare	$944.3 billion (CMS.gov, 2022)		Integrated into new system
Prescription drugs	$264 billion	$17.71 billion (KFF, 2019)	3 tiers of copays at $2, $,3 and $7; revenue based on average copay X number of prescriptions filled by Americans annually
Medicaid	$824 billion (KFF, FY 2022)		Integrated into new system
Workers Compensation	$52 billion (OSHA)		Integrated into new system
Emergency room visit copays		$2.8 billion (CDC, 2022)	$20 copay for ER visit
Office visit copays		$10 billion (CDC, 2022)	$10 copay for office visit
Veterans’ healthcare	$126.84 billion (Peterson Foundation, 2024)		Integrated into new system
Administrative costs	$500 billion (Chernew & Mintz, 2021)		Current system administrative costs are approximately $1 trillion dollars. Universal healthcare will reduce administrative costs by approximately 50%.
Total costs	$2.561 trillion

New taxes and savings that will help pay for universal healthcare include:

• $300 billion – Ultra Millionaire Tax (Warren, 2024)
• $156.25 billion speculation tax on stock trades (Trading Economics, 2024)
• $3.78 billion – speculation tax on bonds (World Economic Forum, 2023)
• $5 billion year – tax on wealth sheltered by partners (Boak & Hussein, 2024)
• $221.5 billion – cutting defense spending by 25% (White House Historical Tables)
• $85 billion – IRS modernization revenue (Katz, 2024)
• $100.6 billion – 2% across the board income tax increase
• $1 billion – Dying with Dignity healthcare savings (Smith, 2017)

Mental Healthcare

We believe it is particularly urgent to have a universal healthcare system that prevents, detects early, and treats mental health conditions, especially serious illness such as bipolar disorder and schizophrenia. Once drugs like cannabis, psilocybin, mescaline, and MDMA are decriminalized, we are in favor of continuing federal research to explore their potential utilization in our healthcare system, particularly for mental health care. We are aware of the positive outcomes, observed by the Veterans Administration, of these drugs for depression, anxiety, and PTSD (Katz, 2024). Dosing guidelines must be established for physicians to follow.

We believe our mental healthcare systems needs to be rebuilt. Today, too many adults and children are placed on waiting lists as long as 8-10 months or more just to see a mental healthcare provider, such as an in-person therapist or a psychiatrist. Early preventive care can save taxpayers millions of dollars in institutional treatment and incarceration. We need to incentivize more mental healthcare providers to open practices in underserved areas and to provide online care. A universal healthcare system will help ensure that all Americans have access to early detection and care of mental health disorders.

We know that outpatient care is not adequate for some of the most severely ill patients, however, so we must invest in innovative programs and facilities on the city, county, state, and federal levels. Permanent care facilities should be established to provide a safe haven for individuals who have no support system or those who refuse help but pose a danger to the community. These facilities must be well staffed, follow evidence-based practices, pay sufficient salaries, and create community, unlike the dreary, abusive, and cruel mental institutions of the past.

Reproductive Rights

The Peoples’ Union is a harm reduction-oriented and pragmatic organization. We believe that abortions should be legal, safe, and rare. We are in favor of a national law allowing a 20-week span for a woman to elect to have an abortion. However, this time limit will be extended for circumstances such as ectopic pregnancies, danger to the mother’s life, or any other reasonable medical reason determined by a panel of medical professionals.

Dying with Dignity

We support death with dignity. As an organization we do not take this subject lightly, but we do believe a person should have the right to choose to die with dignity. Allowing this practice will save close to one billion dollars on unwanted end-of-life care (Smith, 2017). We need to give every citizen the opportunity to leave this Earth on their terms. Sweden has an excellent death with dignity program that we could implement in our country, in addition to the current method that is legalized in some states.