Medical technology in the United States is considered the best in the world, and U.S. residents spend more on health care than residents of any other nation.^1-4 In 2006, Americans spent more than $2.1 trillion on health care -- an average of $7,026 per person and 16 percent of Gross Domestic Product (GDP) -- up from $253 million (9.1 percent of GDP) in 1980.⁵ By 2018, health care spending in this country is projected to increase to $4.3 trillion -- $13,100 per person, and 20.3 percent GDP.⁶

Ironically, increased spending on health care has led to decreased access because a significant number of U.S. residents are no longer able to afford the high cost of care. The average cost of health insurance in Massachusetts is about $11,500 per year for a family, and the cost may even be higher in other states.⁷ More than 43 million U.S. residents (14.5 percent) went without health insurance in 2007.⁸

The lack of health insurance contributes to mortality. According to the 2004 Institute of Medicine report Insuring America's Health,18,000 unnecessary deaths per year are attributable to lack of health insurance.⁹ Another report estimates 22,000 unnecessary deaths in 2006.¹⁰

Approximately half of bankruptcies by individuals are a result of medical bills.¹¹ U.S. industries are finding it hard to stay competitive in the global marketplace because of skyrocketing health care costs.^12,13 The U.S. health care system is in crisis, and it has been described as "the most costly, inefficient, wasteful and inequitable system in the industrialized world."¹⁴

Other industrialized nations have provided universal access to health care for their citizens through government programs and have delivered comprehensive care at a fraction of the cost currently spent in the United States.^1,2,15 Universal access -- access to health care for all citizens, guaranteed by the government, regardless of mechanism of delivery -- is the ethical choice, and it is feasible to accomplish in this country. It would provide equality in health care, control health care costs and improve the health of residents.

Universal Access and Market Justice
Historically, Americans have opposed a strong centralized government and  so-called socialized medicine, opting for libertarian market justice over social justice.^1,14,16 Libertarian market justice philosophy embraces the ideas that individuals are free to live as they choose as long as their choices do not infringe on the rights of others, that all human relationships should be voluntary, that purchases are based on individuals' ability to pay, that a free marketplace with inherent competition works best with minimum interference from government, and that inequities are consequences of one's choices.^1,17 But this philosophy has resulted in a health care system that is inequitable, inaccessible and unaffordable.¹⁴

A right to health has been recognized since the 1940s by the World Health Organization (WHO).^18,19 In 2000, the United Nations, working in collaboration with the WHO and others, established a right to health. This right not only refers to access to health care, but also to underlying determinants of health such as clean water, sanitation and freedom from discrimination.

Many countries have adopted this right in their respective constitutions and provide universal access to healthcare.²⁰ The United States Constitution does not recognize this right, and the United States is the only industrialized nation that does not provide universal access.^1,13,20 Here the right to healthcare implies a negative right of noninterference for citizens to receive health care, but citizens are not entitled to or guaranteed such care.

Universal Access and Social Justice
Social justice is in sharp contrast to market justice. Principles of social justice require the equitable delivery of resources, through a central agency or government, that is not based on recipients' ability to pay, because society has an obligation to do so for the good of the community.¹ Health care is a social rather than an economic good. It would be unjust if one were unable to obtain needed healthcare as a result of his inability to pay.

Critics of viewing access to healthcare as a question of social justice are concerned that guaranteeing universal access will encourage dependency and irresponsible "free riding," that is, that some members of the community will receive a public good without taking on some of the costs of providing that good. But proponents of universal access have argued that corporations that fail to provide health care benefits are themselves free riders.¹³ These corporations shift costs of healthcare onto others when the costs of uncompensated care result in higher prices for everyone.

This cost shifting by employers is the result of the high cost of health care that businesses and industries incur when they provide employee health insurance. These costs are so high that businesses are finding it hard to stay competitive in the global market, where businesses in other countries do not pay for health care for their employees. National health insurance would encourage a program that prevents free riding, ensuring personal and corporate responsibility.

Barriers to self-employment are another reason to advocate universal access to healthcare.¹³ Middleclass Americans are now affected by the high cost of health insurance and healthcare.²¹ Those who are most in need of health care are the most adversely affected by the cost structure and are the least likely to obtain healthcare because of private insurance companies' policies of minimizing risks to maximize profit through patient selection. Many people may forgo self-employment opportunities as a result. Having access to a large population to spread out financial risks provided by mandatory national participation would make costs much more affordable.