INTRODUCTION

The United States is the most industrialized nation in the world. We, as Americans, enjoy more

freedom than other nations. However, there is a tragic darkness that continues to permeate our

society. Over 28.5 million Americans do not have any form of health insurance. If this is the

freest country in the world, then everyone living on this land should have access to free

healthcare. In this essay, we will be discussing Universal Health Care and why it is necessary to

the safety and protection of our most vulnerable citizens. We will examine both sides of this

crucial issue: What are the pros and cons of Universal Health Care? Is it even possible? How

would we go about achieving this? This essay will be arguing in favor of Universal Health Care

as a fundamental right that should be granted to every American.

 Table of Contents

Page

Introduction I

Basic Table of Contents II

When the going gets weird III V

Fear and Loathing in the healthcare industry VI XVI

Its all well and good for children and acid freaks to believe in Santa Claus XVII-XXVII

A restless idealism on one hand and a sense of impending doom on the other XXVIII- XXXIV

So much for Objective Journalism XXXV-XXXVI

Bibliography XXXVII-XXXVIIII
 When the going gets weird: A brief retrospective overview of universal healthcare

When the World Health Organization was founded as a sub body within the United

Nations, it outlined the idea that,

UHC (universal healthcare) is firmly based on the WHO constitution of

1948 declaring health a fundamental human right and on the Health for All

agenda set by the Alma Ata declaration in 1978. UHC cuts across (all of) the

health-related Sustainable Development Goals (SDGs) and brings hope of better

health and protection for the worlds poorest. Universal health coverage (UHC)

means that all people and communities can use the promotive, preventive,

curative, rehabilitative and palliative health services they need, of sufficient

quality to be effective, while also ensuring that the use of these services does not

expose the user to financial hardship. This definition of UHC embodies three

related objectives: Equity in access to health services - everyone who needs

services should get them, not only those who can pay for them; The quality of

health services should be good enough to improve the health of those receiving

services; and People should be protected against financial-risk, ensuring that the

cost of using services does not put people at risk of financial harm. (WHO)

Taking this model into account, we can delineate that the goals outlined by W.H.O have

not been met in the United States. The issues surrounding the creation, implementation and

sustainability of universal healthcare are multidimensional and must be addressed to provide

context to this essay. In an article written by Dell P. Champlin and Janet T. Knoedler for the

Journal of Economic Issues entitled Universal health care and the economics of responsibility,

In the American health care system the cost of health insurance is underwritten

by all three sectors of the economy: I) households; 2) employers; and 3) government.

However, while costs are shared, responsibility is not. The retreat of private firms and

government from assuming a substantial share of the burden of health care costs is

based on the presumption that health care is an individual's responsibility, while the

contributions of government and the private sector are basically optional--a matter

of benevolence rather than responsibility. The outcome of the current debates

over health care reform will depend on this issue of responsibility. Who should pay for

health care? Is it a collective responsibility or an individual one? The presumption that

health care costs are the responsibility of individuals is supported by orthodox

economics, which treats health care as a consumer good. (1) In this framework, there is

no shared responsibility for health care. There is only individual demand for health care

with employers and governments in a supporting and, ultimately, market-distorting role.

It is difficult to see how universal health care can be built upon such a philosophy. On the

other hand, institutional economics views health care very differently. As Dennis Chasse

(1991) notes, John R. Commons, John Andrews and other early institutionalists

understood that the social and economic structure of modern capitalism left workers with

little bargaining power. As a result, workers bore an unreasonable share of the costs of

economic growth and financial speculation--instability, unemployment, hazardous

working conditions, and low pay (Chasse 1991, 805). J.M. Clark also recognized that

problems like poverty, unemployment and industrial accidents are systemic in nature and
 beyond the reach of individual choice and personal responsibility (Clark 1936). Clark

also stressed that the benefits of good health accrue not only to individuals but to

employers and the community as well: there is a minimum of maintenance of the

laborer's health and working capacity which must be borne by someone, whether the

laborer works or not, or else the community suffers a loss through the deterioration of

its working power (Clark 1923, 16, quoted in Stabile 1993, 173). More recently,

institutional economists and others have questioned the applicability of the choice

theoretic framework to health care, since the choice of health care services is, at best, a

joint decision, and is often made by others (Bownds 2003; Keaney 1999; 2002). In short,

in the institutionalist view health care is treated as a social good that is fundamentally a

matter of collective responsibility. (Champlin;Knoedler)

With this, we see the warrant in arguing for and against universal health care is based on

economic vantages and that, if we are to achieve universal healthcare, it must become a shared

responsibility of the employer, individual and the state. To the employer: it is cost effective to

not pay for an employees health insurance. However, as noted, the workers who bear an

unreasonable amount of burden due to the cost of not having health insurance and factors beyond

their immediate control caused deterioration of working powers, which leads to a loss of

productivity and collective bargaining power to the everyday working citizen.

Since the early 90s when universal healthcare was being formulated by the Clinton

administration, many politicians underwent a schism in opposing national healthcare reform.

What president Clinton was proposing then wasnt enough,

 On September 22, 1993, President Bill Clinton, in a televised address, introduced

the Health Security Act (HSA) (H.R. 3600, 1993), which would have

provided universal health care coverage, or as Clinton (1993) put it, "comprehensive

health benefits that can never be taken away" (p. vi). Clinton's speech received wide

acclaim, and polls showed broad support for health care reform(Skocpol, 1995). A year

later the HSA was dead without having ever come to a voteAlthough the

congressional Democrats had enough votes to enact the HSA, they did not do so.

Liberals believed the HSA did not go far enough, and many supported the McDermott

single-payer bill - American Health Security Act (H.R. 3960, 1994) (McClure, 1994).

Conservatives thought the HSA went too far and supported the Cooper bill - Managed

Competition Act of 1993 (H.R. 3222), which did not provide universal coverageHealth

care advocates, particularly supporters of a single-payer system, were also divided

(McClure, 1994; McKenzie & Bilofsky, 1993; Rasell & Lillie-Blanton, 1994). The

administration had in part designed the HSA to appeal to advocates (Zelman, 1994). The

act included universal coverage, comprehensive benefits, and a range of supportive

services and allowed the states to create single-payer systems of their own (NASW,

1993a). Despite this, single-payer backers were ambivalent. Although some viewed the

HSA as a path to universal coverage and perhaps a single-payer system, others

dismissed it as a sell-out to the insurance industry (McClure, 1994). Advocates

continually pressured Clinton to change the act, threatening to withhold support if he

refused. These demands usually had merit, but many advocates spent more time

criticizing or ignoring the act than supporting it. In California single-payer supporters

focused on the state's single-payer ballot initiative and failed to respond when Sen.
 Dianne Feinstein (D-CA) withdrew support for universal coverage. Feinstein's switch

"fatally wounded" Sen. George Mitchell's (D-ME) attempt "to build a majority for a

revised version of Clinton's plan" (Rothstein, 1995, p. 36). (Gorin 2)

Fear and Loathing in the Healthcare industry

Due to the malfeasance of our Congress in the 1990s in failing to enact a single-payer

system like the one we have in place currently, our cost of healthcare has skyrocketed,

In 2014, the United States (U.S.) spent more on health care than any other

country in the world, approximately $3 trillion or $9,543 per person (Marshall 1)

More on this later. For now, lets focus our attention to the outlying debts incurred by the

healthcare industry for several reasons, which has created the immense stumbling block

preventing the passage of universal healthcare in the United States. We start with our capitalist

system, which permits carnivorous vultures to thrive on the suffering of others through the

quintessential lifeblood of our healthcare industry: Medicine. World-reviled price fixer

aficionado (and infamously opprobrious Pruritus ani) Martin Shkreli made headlines back in

2015 with his 5000% price hike of Daraprim, a lifesaving medicine used to treat rare, deadly

toxoplasmosis infections in AIDS patients (Herper 1.) Controlling drug prices and the cost of

prescription drugs is part of the reason why we dont have UHC: the government does not

command prices for prescription drugs,

The current system is almost guaranteed to cause price increases, because it

completely lacks the transparency good markets need. Drug companies are forced to

focus on expensive drugs for smaller patient populations, because for many common
diseases--diabetes, heart disease, depression--there are now highly effective and

incredibly cheap generic medications available (80% of drugs dispensed in the U.S. are

generic). Moreover, the customers who pay for drugs are not the patients who

consume them but employers and insurance companies--and nobody knows the real

price. The negotiating power is in the hands of insurers or pharmacy-benefits managers

like Express Scripts (annual sales: $100 billion) and CVS Caremark ($140 billion); they

decide which drugs are covered and how much patients pay in copays. Sometimes drug

companies give discounts of as much as 60% to these firms [in order to] get better

placement for their medicines. But this also forces companies to take what price increases

they can, [in order to] make up for those discountsAll drug companies take price

increases in the U.S. on their medicines, often at rates much higher than inflation.

Biogen's Avonex, a multiple sclerosis drug introduced in 1996, is about as effective as

rivals Copaxone from Teva and Rebif from Merck Serono (not the U.S. Merck). But

competition hasn't kept the price down. According to industry analysts, the list price of

Avonex has increased from $16,000 a year in 2005 to $70,000 now, making it just as

expensive as new, more effective MS drugs. This is not the result you'd expect from a

free, transparent market. How does this happen? In a market with only a few drugs and

a few buyers, none of whom are paying out of their own pockets, price competition

can work in reverse. Take the case of Novartis' Gleevec, a lifesaving pill that puts a

deadly cancer called chronic myelogenous leukemia out of business. It was introduced in

2001 at a cost of $24,000 per patient per year. Then, in 2006, Bristol-Myers Squibb

introduced another drug, Sprycel, for patients who had failed on Gleevec. When Novartis

introduced its own successor to Gleevec, it was marketed (at first) to the sick patients
 treated with Sprycel. So it priced the drug to compete with Sprycel and raised the

Gleevec price. The result: Gleevec now costs more than $90,000 a year...The biggest

problem is not new expensive drugs but repricing old ones, and not just ones being

purchased by Martin Shkreli [or Valeant,] "You have no new research. You have no

innovation. You have nothing but increased drug prices," says Steve Miller, chief

medical officer at Express Scripts. According to his company's data, the average cost of a

branded drug has increased 127% between 2008 and 2014. (Herper 2)

To support this: an explosive account written by Aaron S. Kesselheim, MD, JD, MPH;

Jerry Avorn, MD; and Ammet Sarpatwari, JD, PhD entitled The High Cost of Prescription

Drugs in the United States: Origins and Prospects for Reform in the Journal of the American

Medical Association (JAMA) states,

Per capita prescription drug spending in the United States exceeds

that in all other countries, largely driven by brand-name drug prices that

have been increasing in recent years at rates far beyond the consumer price

index. In 2013, per capita spending on prescription drugs was $858 compared

with an average of $400 for 19 other industrialized nations. In the United States,

prescription medications now comprise an estimated 17% of overall personal

health care services. The most important factor that allows manufacturers to set

high drug prices is market exclusivity, protected by monopoly rights awarded

upon Food and Drug Administration approval and by patents. The availability of

generic drugs after this exclusivity period is the main means of reducing prices in

the United States, but access to them may be delayed by numerous business and
 legal strategies. The primary counterweight against excessive pricing during

market exclusivity is the negotiating power of the payer, which is currently

constrained by several factors, including the requirement that most government

drug payment plans cover nearly all products. Another key contributor to drug

spending is physician prescribing choices when comparable alternatives are

available at different costs. Although prices are often justified by the high cost of

drug development, there is no evidence of an association between research and

development costs and prices; rather, prescription drugs are priced in the United

States primarily on the basis of what the market will bearHigh drug prices are

the result of the approach the United States has taken to granting

government-protected monopolies to drug manufacturers, combined with

coverage requirements imposed on government-funded drug benefits. The

most realistic short-term strategies to address high prices include enforcing more

stringent requirements for the award and extension of exclusivity rights;

enhancing competition by ensuring timely generic drug availability; providing

greater opportunities for meaningful price negotiation by governmental payers;

generating more evidence about comparative cost-effectiveness of therapeutic

alternatives; and more effectively educating patients, prescribers, payers, and

policy makers about these choices. (JAMA 1)

To explain this in laymens terms: If the government were to command the prices of

prescription drugs under a universal healthcare system, it would spur the research, development

and eventual implementation of cheaper generic medicine into the market, creating competition

and driving prices down for prescription strength (name brand) medicines. This is basic supply
side economics. This action will then help facilitate drug utilization research that is distressfully

insufficient in the present so better cost-utility/effectiveness and drug efficacy statistics can be

ascertained for R&D (Research and Development.) This is certainly possible within the purview

of a universal healthcare system, but only if the federal government (through

Medicare/Medicaid) became the de facto authority. Staunch opponents to UHC, such as former

president Ronald Reagan, have gone on record comparing socialized medicine to communist

balderdash; or former governor Sarah Palin claiming that the affordable care act created death

panels which would ration healthcare. Such bullshit reifications are part and parcel of the

erstwhile baby boomer generation playing their highfalutin obstructionist oboes to the tune of

pull yourself by your bootstraps! whilst disgorging nonpartisan pernicious adynata from their

anathematic rostrums.

Another barrier facing the healthcare industry is medical nonadherence. Medical

nonadherence is when patients do not take their medicine as prescribed. Now, you may be

wondering how this affects health care costs and prevents us from having a universal health care

system. Does it really matter if patients dont take their medicine? Yes, yes it does. In a research

paper entitled, Adherence and health care costs, written by Aurel O. Iuga & Maura J. McGuire

and published by the National Center for Biotechnology Information (NCBI,)

In 2010 the costs of health care in the US exceeded $2.7 trillion and

accounted for 17.9% of the gross domestic product. Projections indicate health

care will account for 20% of the US gross domestic product by 2020.14 Twenty

percent to 30% of dollars spent in the US health care system have been identified

as wasteful.1,2,5 Providers and administrators have been challenged to contain costs

by reducing waste and by improving the effectiveness of care delivered. Patient

nonadherence to prescribed medications is associated with poor therapeutic

outcomes, progression of disease, and an estimated burden of billions per

year in avoidable direct health care costs The financial pressure is passed

to patients by payers through higher copayments, or via higher costs to

employers for coverage. Increased patient cost sharing beyond a threshold

negatively impacts the level of medication adherence.34 [Figure 1] does not

include other important drivers, such as the impact of reduced productivity,

absenteeism, and increased disability on employers or society. It has been

estimated that health-related productivity loss costs are 2.3 times higher than the

direct health care costs.35 Therefore, the benefits of improved medication

adherence may be even greater when considered at a societal level. However,

most of the existing studies consider only direct health care costs when estimating

the impact of nonadherence, and typically do not include productivity and

disability costs.17 Medication waste accounts for a small percentage of these

costs.36,37 Between $100 and $300 billion of avoidable health care costs have

been attributed to nonadherence in the US annually, representing 3% to 10%

of total US health care costs.7,38 While there is substantial information relating

nonadherence to poor patient outcomes, relatively few high quality studies report

the impact on costs. The cost of nonadherence is generally determined by using

administrative data to evaluate health care costs in populations of patients who are

adherent compared to costs of populations of patients who are nonadherent.

(NCBI 1)
 As aforementioned with prescription drug prices, if we had a universal single-payer

healthcare system in place that had accurate, real time data from drug utilization research,

medical nonadherence would be minimalized and we could be saving upwards of 10% of

healthcare costs that could be reinvested into administrative costs. This, in turn, would remove a

burdensome amount of debt from the system without inversely affecting medical practitioners

salaries. To undertake this daunting task will not be easy; but, with the right legislation and

practices, it is ostensibly within reach if executed successfully.

The next complication that poses a challenge to enacting universal healthcare is the

obesity and opioid epidemic plaguing our nation. To begin with obesity, we turn to another

research paper, Direct medical cost of overweight and obesity in the United States: a

quantitative systematic review, written by Adam gilden Tsai, MD, MSCE; David F. Williamson,

PhD, and Henry A. Glick, PhD published by NCBI,

When we multiplied our estimates (from high-quality studies) of

$266 and $1723 for overweight and obesity by the number of overweight

and obese persons in the U.S., the $Y2008 aggregate (national) costs of

overweight and obesity were $15.8 billion and $98.1 billion, or 113.9

billion total, equal to 4.8% of health care spending in 2008.65 When pooled

estimates from all 33 studies were used to compute aggregate costs, the

total costs of overweight and obesity were 29.9 billion and $91.0 billion,

respectively ($120.1 billion, or 5.0% of total health care spending). When

pooled results from only the 29 studies not classified as high-quality

studies were used, incremental costs were $531 (overweight) and $1615
 (obesity). Thus, total costs among these 29 studies were $38.4 billion

for overweight and $110.5 billion for obesity ($148.9 billion, or 6.2%

of health care spending.)(NCBI 2)

These figures were translated from cost estimates commenced by previous studies. Under

a universal healthcare system with tailored access to medicines that can treat exogenous obesity

as a pre-existing condition, this subpopulation would be given more adequate care. Specifically,

we would prescribe neurostimulant medicines under intense medical supervision: overweight

patients would receive Dextroamphetamine; obese patients Desoxyn (methamphetamine), for

short term treatment, accompanied with nutritional and physical education to help these patients

lose weight (and Ritalin in the case of methamphetamine neurotoxicity, should that issue arise.)

This would create a greater demand for physical & nutritional experts, pharmacists and

prescription drug manufacturers, expanding this industry to create more sustainable jobs in

healthcare for long term projections.

Turning to the opioid epidemic, well focus only on the statistics. Siting The Impact of

the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services by FAIR

Health, Inc.,

Since its inception around the beginning of the 21st century, the current

epidemic of opioid abuse, dependence and overdoses has taken many lives,

caused widespread suffering at every level of society and resulted in high

economic costs. In a study by Hansen and colleagues, nonmedical use of

prescription opioids alone was estimated to have cost the US economy $53.4

billion in 2006. A study by Birnbaum and colleagues arrived at a similar total,

 $55.7 billion, for the societal costs of prescription opioid abuse in 2007. The two

studies attributed different percentages of the economic burden to medical costs.

Hansens study attributed 79 percent of the costs to lost productivity ($42 billion),

15 percent to criminal justice costs ($8.2 billion) and only six percent to medical

costs, comprising four percent for drug abuse treatment ($2.2 billion) and

two percent for medical complications ($944 million). But, in Birnbaums

study, healthcare costs, defined more broadly, accounted for 45 percent ($25.0

billion) of the total, while workplace costs accounted for 46 percent ($25.6

billion) and criminal justice costs for only 9 percent ($5.1 billion). Whatever the

precise distribution of the economic impact of the opioid crisis, its healthcare

costs are clearly substantial and growing. (FAIR 1)

As we can observe, the monetary metrics involving the opioid epidemics cost on

healthcare ranges from as little as ~$2.3 billion dollars to as high as $25 billion dollars. If

universal healthcare had been in place before the beginning of the opioid epidemic began in

earnest from 1999, wed have had treatment options accessible to patients with opioid

dependency, having them covered under pre-existing conditions and keeping costs down. These

savings wouldve been earmarked to methadone clinics thatre currently underfunded and

understaffed. Patients with opioid dependency and substance abuse disorders wouldve not only

received the necessary physical treatment, but mental health services as well.

Finally, in our categorical installment of hindrances to UHC is healthcare fraud.

Remember our quote from earlier about the cost of healthcare? If you noticed, there was an

ellipsis next to it. Heres where it gets interesting,

 With the publicly funded Medicare program accounting for roughly

$554 billion of these costs; around $60 billion or 10% of the total cost of

Medicare expenditures in 2014 was spent on unnecessary payments (GAO,

2015a). These unwarranted costs have been attributed to incorrect billing

methods, abuse, and fraud. Medicare Part D, which provides prescription drug

benefits, has been specifically targeted for fraudulent activity. This activity has

resulted from actions of patients as well as physicians in the form of kickbacks

from pharmaceutical companies (Maruca, 2006). Regrettably, the Centers for

Medicare and Medicaid Services (CMS) have not created a dependable system for

expense authentication (Toothman, Moore and Lee, 2011). In the event a patient

has exhausted coverage limits for prescription medications, healthcare providers

have been known to write prescriptions for the patients spouse or family member

who has not met coverage maximums or altered medical diagnoses (in order to)

ensure prescription coverage under insurance plans (Maruca, 2006). (Marshall 2)

 I have a theory that the truth is never told during the

nine-to-five hours

It is all well and good for children and acid freaks to still believe in Santa Claus

Now that we have clearly established some numbers here, lets do some math. If,

hypothetically speaking, we could minimalize all the subject areas minus prescription drugs

(since that is a separate issue in and of itself) we can see that wasteful spending costs (using the

upper bound numbers) from medical nonadherence, obesity, opioid dependency treatment and

fraud totals $533.9 billion dollars. This doesnt even begin to put a dent into the $3 trillion-dollar

figure that is still growing.

We spend upwards of $554 billion dollars a year on Medicare, which Medicaid is

subsidized under. The Affordable Care Act (Obamacare) has provided a foundation for

covering pre-existing conditions and removes the cap on lifetime limits for those who are

struggling to pay for healthcare by offering tax subsidies to buy insurance through the state

governments,

The Affordable Care Act (ACA) leveraged Medicaid's role in serving the

poor to broaden the program's reach to millions of low-income uninsured adults,

and positioned the program as a fundamental component of the newly established

continuum of public and private coverage. Today, Medicaid provides

comprehensive, affordable coverage for over 70 million people and has been
the key driver in the historic and rapid decline in the number of uninsured

that has occurred since implementation of the ACA coverage expansions in

2014. The ACA established a new Medicaid coverage pathway for millions of

uninsured adults, building on the strong platform of coverage that Medicaid

already provided to children and pregnant women. The law created a continuum

of coverage by expanding Medicaid eligibility to nearly all non-elderlyadults with

income at or below 138% of the federal poverty level (FPL)--about $27,820 for

a family of three in 2016--with 100% federal financing to the states for the first

three years, gradually decreasing to 90% federal and 10% state funding by 2020.3

This new minimum increased eligibility for parents in many states and provided

new eligibility for other non-disabled adults without dependent children who were

largely excluded from Medicaid prior to the ACA. For those above Medicaid

income eligibility, the law establishes Health Insurance Marketplaces where

individuals can purchase insurance and provides federal tax credits for people

with incomes from 100% to 400% FPL ($20,160 to $80,640 for a family of three

in 2016) to make coverage more affordable. As of July 2016, 32 states (including

DC) have expanded Medicaid eligibility under the ACA. In the 19 states that have

not adopted the Medicaid expansion, 2.6 million uninsured poor adults are

without access to coverage through Medicaid or the MarketplaceSubstantial

coverage gains have been achieved through Medicaid and the Marketplace in the

three years since the roll-out of the major ACA coverage expansions began.

Medicaid enrollment has grown by 15.4 million since the period before open

enrollment began in October 2013, with gains particularly strong in states that
adopted the Medicaid expansion. An additional 11.1 million people are enrolled in

coverage through the Marketplace. Corresponding with implementation of the

ACA coverage provisions, the total number of nonelderly uninsured individuals

dropped to historic lows, from 41.1 million in 2013 to 28.5 million in 2015.

Nearly the entire decline in the number of uninsured people occurred among

adults. State decisions about expanding Medicaid coverage have significant

implications for coverage gains: among people below poverty, Medicaid

expansion states had a 15.3 percentage point drop in adult uninsured rates, versus

a 9.0 point drop in non-expansion states. In the 19 states not implementing the

Medicaid expansion, Medicaid eligibility for adults is quite limited: the median

income limit for parents in 2016 is just 44% of poverty, or an annual income of

$8,840 a year for a family of three, and in nearly all states not expanding,

childless adults remain ineligible. As a result, many adults with incomes below

poverty fall into a "coverage gap" of earning too much to qualify for Medicaid but

not enough to qualify for premium tax credits in the Marketplace. Reflecting state

decisions, the coverage gap disproportionately affects poor individuals residing in

Southern states and African Americans.[12] The expansion has led to improvements

not only in coverage of the low-income population, but also improved access to

care and financial well-being for low-income Americans. Individuals newly

insured through Medicaid are significantly more likely to be lower income than

adults who gained Marketplace or other private coverage, reflecting the ACA's

approach to utilizing Medicaid with its broader benefits and stronger financial

protections as the coverage vehicle for the lowest income population. Adults
newly insured through Medicaid are more likely than those who remain uninsured

to have a place to go when they are sick or need advice about their health, have a

regular doctor, and have used medical services or received preventive care.

Medicaid expansion has also been associated with significant increases in the

rates of diagnosis of chronic health conditions, such as diabetes and high

cholesterol[15] and reduced unmet need for mental health and substance use

disorder treatment among low-income adultsThe ACA Medicaid expansion was

designed to address the high uninsured rates among low-income adults, providing

a coverage option for people who had limited access to employer coverage and

limited income to purchase coverage on their own. Medicaid has played a pivotal

role in the historic drop in the uninsured rate with implementation of the ACA

enabling millions of previously uninsured low-income Americans to gain

coverage and access to health services with protection from catastrophic and

financially burdensome health care costs. For those who remain uninsured but are

eligible for Medicaid, targeted efforts aimed at overcoming remaining enrollment

barriers, particularly for the Hispanic population, can further boost coverage.

However, with many states opting not to implement the Medicaid expansion,

millions of uninsured adults remain outside the reach of the ACA and

continue to have limited, if any, option for affordable health coverage: they

are ineligible for publicly-financed coverage in their state, most do not have

access to employer-based coverage through a job, and all have limited income

available to purchase coverage on their own. Many of those who remain

uninsured reflect the legacy of the system linking Medicaid coverage to only
 certain categories of people. People who fall outside these categories--such as

adults without dependent children--are ineligible for coverage no matter how

poor. The ACA Medicaid expansion was designed to end categorical eligibility

for Medicaid and offer a coverage option to all poor Americans, but in states

not implementing the expansion, the welfare vestiges of categorical eligibility

remain.(Roland;Lyons)

To put this into perspective: ACA is part of the continual expansion of Medicare under

Medicaid. When president Lyndon Johnson created Medicare and Medicaid, it was his intention

that these programs be expanded, building upon president Roosevelts vision of an America

where healthcare was a right granted to not only the widows and children of veterans, but every

citizen. In this same breath, president Obama took the initiative and passed ACA to close the

Medicare gap created by the disastrous Medicare Part D, which saw less coverage for medicine

and preventive treatments, causing medical nonadherence for seniors covered under this plan

who became entrenched in debt or the Donut Hole, as it was called,

After drug spending reaches an initial threshold ($2,830 in 2010)

in a calendar year, beneficiaries enter the coverage gap, a period during

which they are responsible for 100% of drug costs. Beneficiaries remain in

the coverage gap period until out-of-pocket drug spending reaches a

catastrophic coverage spending threshold ($4,550 in 2010) at which time

cost-sharing is dramatically reduced, or until the benefit resets at the next

calendar yearBetween 2.9-3.8 million (11%-

14%) Medicare Part D beneficiaries reach the coverage gap each year
and receive no financial assistance to help pay for drugs during this

period [13, 14]. Proponents have argued that the coverage gap could help

both beneficiaries and the US health care system save money by

increasing beneficiaries' awareness of medication costs and encouraging

switching to or new selection of cost-effective therapeutic options [15].

Critics point to evidence that similar drug caps and increases in cost-

sharing have been associated with decreased drug utilization, increased

health services use, and adverse outcomes [6, 11, 16-18]. To date, researchers

have observed reduced drug utilization and adherence among beneficiaries

enrolled in Medicare Advantage plans who reach the coverage gap

spending threshold and had no financial assistance to pay for drugs [19-22].

Zhang et al. noted a 14% reduction in drug utilization among

beneficiaries with no financial assistance during the coverage gap [22].

These beneficiaries also reduced their adherence to chronic

medications 3%-8% during the coverage gap compared to the

precoverage gap period[20] and were 17% less likely than beneficiaries

who had financial assistance to be adherent to their medications

during the coverage gap period[19]. While important contributions to the

field, results from these Medicare Advantage-based studies may not be

generalizable to the 70% of all Part D beneficiaries enrolled in stand-alone

Part D plans [23]. Unlike stand-alone plans that only provide drug coverage,

Medicare Advantage plans manage health and drug insurance benefits, and

so may have different incentives in terms of coverage and benefit design.

The remaining study of beneficiaries' coverage gap behavior found that

among those who reached the coverage gap, 20% discontinued,

switched, or reduced their medication use [13]one-third of Medicare

beneficiaries reached the coverage gap spending threshold in an average of

7 (months) after enrollment. Beneficiaries who received no financial

assistance to help pay drug costs after reaching the threshold were two

times more likely to discontinue a drug but were 40% less likely to switch

a drug compared to beneficiaries who did receive financial assistance.

After accounting for a beneficiary's complete drug regimen, beneficiaries

who received no financial assistance were 18% more likely to reduce their

drug adherenceInstead of incentivizing beneficiaries to switch to lower-

priced or generic drugs, entry into the coverage gap resulted in an abrupt

discontinuation of or reduced adherence to drugs among elderly Medicare

beneficiaries. These results echo those of other studies that demonstrated

that blunt measures had adverse effects on drug utilization and adherence
[6, 16, 17]
and are also in line with findings

from Medicare Advantage Part D studies that observed increased rates of

drug discontinuation [19,20,22] and adherence[19-21] but did not observe higher

rates of drug switching to generics[22] during the coverage gap. A growing

body of literature from diverse settings describes the adverse clinical

consequences of stopping or reducing adherence to drugs in response to

drug benefit caps, gaps in coverage, and high deductibles [6, 17, 35, 36]. For

example, abrupt increases in drug cost-sharing in Quebec, Canada resulted

 in a 9% decrease in essential drug use and a 7% increase in serious

adverse events [6]. A three-drug per month reimbursement limit on elderly

Medicaid patients in New Hampshire resulted in a doubling of nursing

home admission rates compared to a comparator US state The adverse

clinical consequences of stopping or reducing adherence to essential

medications can be both severe and costly. Our results indicate that

beneficiaries faced with increased out-of-pocket cost burdens during

the Part D coverage gap are twice as likely to discontinue and more

likely to reduce adherence to their medications but not to switch

medications. At the population level, an estimated 18,000 additional

patients discontinued [greater than or equal to] one medication because of

an absence of financial assistance in the coverage gap period. Given the

potential adverse health consequences of such discontinuations, changes to

the coverage gap's structure are needed. The 2010 US Patient Protection

and Affordable Care Act's Part D provisions will eliminate the

coverage gap period incrementally by 2020, but beneficiaries may still

be at risk of decreased drug utilization and adverse clinical

consequences during that time.(Polinski et. al)

As ACA continues to expand our Medicare and Medicaid programs, many politicians

during the 2016 U.S. presidential election chimed in with their various health plans. Well focus

in on Senator Bernie Sanders plan. Sanders, a longtime self-described social democrat, served

on the committee that wrote ACA and rolled out a plan during the 2016 presidential election

entitled, Medicare-for-All. This plan for modernized universal healthcare would be billed as a
federally administered single-payer system which would remove all deductibles, co-payments

and so on. Senator Sanders has gone on the record stating,

It has been the goal of Democrats since Franklin D. Roosevelt to

create a universal health care system guaranteeing health care to all

people. Every other major industrialized nation has done so. It is time for

this country to join them and fulfill the legacy of Franklin D. Roosevelt,

Harry Truman, Lyndon B. Johnson and other great Democrats. The

Affordable Care Act was a critically important step towards the goal of

universal health care. Thanks to the ACA, more than 17 million

Americans have gained health insurance. Millions of low-income

Americans have coverage through expanded eligibility for Medicaid that

now exists in 31 states. Young adults can stay on their parents health plans

until theyre 26. All Americans can benefit from increased protections

against lifetime coverage limits and exclusion from coverage because

of pre-existing conditions But as we move forward, we must build

upon the success of the ACA to achieve the goal of universal health

care. Twenty-nine million Americans today still do not have health

insurance and millions more are underinsured and cannot afford the high

copayments and deductibles charged by private health insurance

companies that put profits before peopleOther industrialized nations are

making the morally principled and financially responsible decision to

provide universal health care to all of their peopleand they do so while

saving money by keeping people healthier. Those who say this goal is
 unachievable are selling the American people short. Americans need a

health care system that works for patients and providers. We need to focus

our federal investments on training the health care providers. We need to

ensure a strong health care workforce in all communities now and in the

future. We need to build on the strength of the 50 years of success of the

Medicare program. We need a health care system that significantly reduces

overhead, administrative costs and complexity. We need a system where

all people can get the care they need to maintain and improve their

health when they need it regardless of income, age or socioeconomic

status.(Sanders 1)

This plan of his entailed spending $1.38 trillion dollars per year and would be generated

through revenues from taxing employers and the wealthiest one percent of Americans,

A 6.2 percent income-based health care premium paid by employers; A

2.2 percent income-based premium paid by households. Progressive income tax

rates [which] under this plan the marginal income tax rate would be: 37 percent

on income between $250,000 and $500,000; 43 percent on income between

$500,000 and $2 million; 48 percent on income between $2 million and $10

million; and 52 percent on income above $10 million. Taxing capital gains and

dividends the same as income from work; Limit tax deductions for rich; the

responsible estate tax; and savings from health tax expenditures: Several tax

breaks that subsidize health care (health-related tax expenditures) would

become obsolete and disappear under a single-payer health care system, saving
 $310 billion per year. Most importantly, health care provided by employers is

compensation that is not subject to payroll taxes or income taxes under current

law. This is a significant tax break that would effectively disappear under this plan

because all Americans would receive health care through the new single-payer

program instead of employer-based health care. (Sanders 2)

With this plan, Sanders projected that we could be saving upwards of $6 trillion dollars in

the next decade,

Last year, the average working family paid $4,955 in premiums and

$1,318 in deductibles to private health insurance companies. Under this plan, a

family of four earning $50,000 would pay just $466 per year to the single-

payer program, amounting to a savings of over $5,800 for that family each

year. Businesses would save over $9,400 a year in health care costs for the

average employee: The average annual cost to the employer for a worker with

a family who makes $50,000 a year would go from $12,591 to just $3,100.

(Sanders 3)

It would seem our path towards universal healthcare doesnt appear to be as farfetched as

the naysayers would have you believe. However, as Bertrand Russell once said,

If a man is offered a fact which goes against his instincts, he will scrutinize it closely,

and unless the evidence is overwhelming, he will refuse to believe it. If, on the other hand, he is

offered something which affords a reason for acting in accordance with his instincts, he will

accept it even on the slenderest evidence.

 A restless idealism on one hand and a sense of impending doom on the other

In the present, a foreboding sense of minacious deportment exudes the wretched minds of

our congressional representatives. House republicans, since the outset of ACA and prior, have

opposed all forms of universal healthcare. House Speaker (and conniving harebrained randian

bootlicker) Paul Ryan has been the biggest vocal opponent of ACA and UHC,

This is a government takeover of our healthcare system. It is the

government basically running the entire healthcare system, turning

large insurers into de facto public utilities, depriving people of

choice, depriving people of options, raising people's prices, raising

taxes (Ryan 1)

The conflict and contradiction in this statement is that it was Ryan who also said,

We do not have a functioning market in the true sense of the word

in health care. That's a layer of transparency that's sorely needed in

America.(Ryan 2)

The vocal opponents to universal healthcare are the Paul Ryans of America, who believe

that larger government creates greater divide and that personal responsibility should fall squarely

on the shoulders of the individual. The prevailing attitude of the neoconservatives is one of

callous disregard for the poor. In e.g., Jason Chaffetz saying,

 So maybe, rather than getting that new iPhone that they just love and they

want to go spend hundreds of dollars on, maybe they should invest that in

health care. Theyve got to make those decisions themselves. (Chaffetz)

Another source of contention lies in the fact that implementing UHC would have to be

incremental and, as stated from senator Sanders proposal: everyones taxes would increase. If

the government were to become the sole authority for healthcare, competition would become

scarce and thus drive prices up further, contributing to what we in the business world call brain

drain. This is when the brightest minds, like medical practitioners, leave socialist countries that

have universal healthcare because of the incredible burden leveraged on them by the state. A lot

of this contention, however, is driven by the fact that medicine has become unreasonably

expensive in this country due to the pharmaceutical industries incessant avarice in not allowing

generic medicines into the market, which keeps prices artificially high and will most likely cause

another healthcare bubble like the one seen with Medicare Part D.

The house republicans who oppose UHC favor block granting Medicare and Medicaid to

the states, provided they can attach per capita caps. In an interview by Shefali Luthra of Kaiser

Health News with Edwin Park, VP for health policy at the center for budget and policy priorities

in Washington, D.C.,

Per capita caps have also been endorsed by Ryan. Under those, states also

get a fixed amount of money each year, but that sum is calculated based on how

many people are in the program. Since block grants arent based on individual

enrollment each year, the state wouldnt necessarily get more money to

compensate if, say, more people qualified for Medicaid because of an economic
 downturn. In theory, a per capita caps system would increase funding. But if, say,

an expensive new drug entered the market, or a costly new disease emerged, the

Medicaid budgets still wouldnt change to reflect thatThe block grant system is

a radical shift from how Medicaid has worked previously. Republicans say it

could save the government billions of dollars. But other analysts note those

savings could limit access to health care if the funding becomes squeezed. Thanks

to the 2010 health law, which led states to expand Medicaid eligibility, more

people would face the brunt of those cuts. The fiscal impact: The non-partisan

Congressional Budget Office estimates recent Republican block grant

proposals could cut Medicaid spending by as much as a third over the next

decade. The cuts would start small, growing larger over the years. Many

Republicans say that, because states will have greater flexibility, they can

innovate with their Medicaid programs. But opponents note that experimentation

alone wont make up for smaller budgets. The fixed grants could mean states cut

benefits or force beneficiaries to take on more cost-sharing, for instance. (Kaiser)

Returning to Ryans argument, the underlying context of his quote regarding universal

healthcare under the command of the government is that it would create a slippery slope to which

our American representative democracy would be transformed into a socialist state. The logic in

this absurdist mentality is reflective of a man who has never worked a real service sector job in

his entire life. A soulless husk of wasted protozoa and four billion years of evolution, Ryan offers

the ultimate contrite bullshit that if healthcare were to become a right, it would then cause other

markets to be subject to government rule, against the free market principles enshrined into our

capitalist society. Remember our Pruritus ani Martin Shkreli earlier? There are many more
Martin Shkrelis in the prescription drug market who price fix at anywhere from 50% to 500% on

the markup of medicine (Herper 3); On one hand, you have the argument that universal

healthcare will lead to a complete government takeover of other markets; in the other hand: our

current system in place that allows for predators to determine who lives or dies based on their

rapacious pursuit of the almighty dollar.

The solution, although simple, is far from easy: Muster enough support to pass a

constitutional amendment pertaining only to making healthcare universal. This is an

extremely daring proposition which many politicians would not undergo due to the amount of

time it would consume. In addendum: if a constitutional convention of this magnitude were to be

called now, it becomes an anything goes style of event. Given that the republicans have a

majority in both the house and senate they could: axe ACA, gay marriage, abortion, gun control,

education and any other social issue that maligns their hyper partisan agenda.

At any length of counterargument that is offered by the republicans and those who

oppose UHC, there is always going to be more pros than cons; and reasonable assertions as to

why we should have UHC instead of the current system in place. In revisiting the quote from

Bertrand Russell: the problem arises in the people. One man, one vote is how our founding

fathers devised our political system. They also were more about solving problems than creating

them. If the people perceive that UHC is more harmful because it has been repeated long enough

to them by opponents of UHC or ACA, then they will be more inclined to believe this illusory

truth as fact. The house republicans whore lulling the people into a superfluous reality are

secretly doing the bidding of special interests who work in the healthcare industry to keep UHC a

pipedream. These cowards have the added protection of making erroneous bullshit claims like,
 The Constitution nowhere authorizes the United States to mandate, either

directly or under threat of penalty, that all citizens and legal residents have

qualifying health care coverage (Maticonis)

Even more intensified bullshit ensued when, during the vote for the American Health

Care Act of 2017 (ACAs replacement,) Representative H. Morgan Griffith said,

This is a rough-and-tumble exercise that the Founding Fathers anticipated

No sir! That is a fascial argument if ever presented with one! This was not a rough-and-

tumble exercise of any sort and you would know this if you knew anything about the founding

fathers, which clearly you do not. In fact, the AHCA is something they would not have wanted.

The founding fathers supported government-run health care, you petulant tempestuous Malaya

mzee!

In 1798, John Adams signed one of the first healthcare bills in the country,

In July of 1798, Congress passed and President John Adams

signed An Act for the Relief of Sick and Disabled Seamen. The law

authorized the creation of a government operated marine hospital service

and mandated that privately employed sailors be required to purchase

health care insurance Upon passage of the law, ships were no longer

permitted to sail in and out of our ports if the health care tax had not been

collected by the ship owners and paid over to the government - thus the

creation of the first payroll tax in our nations history.When a sick or

injured sailor needed medical assistance, the government would confirm

 that his payments had been collected and turned over by his employer and

would then give the sailor a voucher entitling him to admission to the

hospital where he would be treated for whatever ailed him. While a few of

the healthcare facilities accepting the government voucher were privately

operated, the majority of the treatment was given out at the federal

maritime hospitals that were built and operated by the government in the

nations largest ports. As the nation grew and expanded, the system was

also expanded to cover sailors working the private vessels sailing the

Mississippi and Ohio rivers. The program eventually became the Public

Health Service, a government operated health service that exists to this

day under the supervision of the Surgeon Generalthe political right-

wing [has to] stop pretending they have the blessings of the Founding

Fathers as their excuse to oppose whatever this president has to offer.

History makes it abundantly clear that they do not. (Ungar)

To add insult to injury: Thomas Jefferson also supported the act,

According to Georgetown University history professor and noted

historian of Americas early days, Adam Rothman, Thomas Jefferson the

iconic hero of the Tea Party also supported the legislation. Sargent

reprints the following email he received from Prof. Rothan on the subject

Alexander Hamilton supported the establishment of Marine Hospitals in a

1792 Report, and it was a Federalist congress that passed the law in 1798.

But Jefferson (Hamilton's strict constructionist nemesis) also supported

 federal marine hospitals, and along with his own Treasury Secretary,

Albert Gallatin, took steps to improve them during his presidency. So I

guess you could say it had bipartisan support. (Ungar 2)

And mind you: Jefferson and Adams were the biggest rivals in D.C., like what we have

today with democrats and republicans. The only key difference was that if gentlemen had

disagreements with each other back then, they didnt get on one knee and beg for help like Paul

Ryan did with Representative Don Young, THEY SHOT EACH OTHER!

Every conceivable counterargument to universal healthcare amassed by the republicans in

the last seven years since the enactment of ACA has been one giant exercise in futility. Theres

no real lesson these people will learn: theyll remain intransigent because their principle donors

want them to be. They have lost all sense of their oath to protect the people from all enemies,

foreign and domestic, because they have become the enemy. Their loyalty is for-profit, their

currency: because they said so!

Their illusion of superiority, their quintessential delusion that they are of a higher

privilege and can superimpose their will onto the people, is challenged by the impetus of our

founding fathers constitution and the sheer volume of enrollees who continue the groundswell

begun in 2010. There will be metaphorical (and quite possibly literal) blood on their hands

should they repeal ACA and prevent this country from eventually having universal healthcare as

a right.
 Myths and legends die hard in America. We love them for the extra dimension they

provide, the illusion of near-infinite possibility to erase the narrow confines of most men's

reality

who does vote for these dishonest shitheads?"

So much for Objective Journalism

Wherever you fall on the issue of universal healthcare, it is an inevitable outcome from

years of progressivism starting in the 1930s with FDRs vision for healthcare as a right of the

people, to LBJs great society, Clintons H.S.A. and Obamas ACA. It was immortalized in our

declaration of independence that all men had the right to pursue life, liberty and the pursuit of

happiness. Even if the intention of the founding fathers seems completely anachronistic or too

vague, they meant that everyone who was a citizen of this nation had an inalienable right to

pursue their own path of self-determination, which would invariably include the right to access

healthcare for the continuation of their life. The reifications brought upon by the opponents of

UHC are the weak-willed responses of milksop turncoats who labor to retain power instead of

sharing it with the people. Sycophantic little napoleons attempting to impress their masters

falsified realities for the rest of us who are striving to live out our own American dreams without

fear of being unable to decide if we can afford medical healing. No one, especially the citizens of

freest country on earth that spend as much as we do on healthcare, should have to endure this

tragedy any longer, not when other industrialized nations with universal healthcare spend less

and have greater life expectancy and outcomes. The time is now: 29 million people remain

uninsured to this day. If you want to make a difference in these peoples lives: call your elected
officials, tell them you want ACA expanded into UHC. Universal healthcare is not that far away,

so long as we keep fighting for it together.

Hopes rise and dreams flicker

and die.

Love plans for tomorrow

and loneliness thinks of

yesterday.

Life is beautiful and living

is pain
 The sound
of music floats
down
a dark street.
Bibliography

(WHO) "Universal Health Coverage and Health Financing." World Health Organization. World
Health Organization, n.d. Web.

(Champlin;Knoedler) Universal health care and the economics of responsibility, Dell P.

Champlin and Janet T. Knoedler; Journal of Economic Issues. 42.4 (Dec. 2008): p913.
COPYRIGHT 2008 Association for Evolutionary Economics.
http://www.orgs.bucknell.edu/afee/jei/

(Gorin 1) Universal health care coverage in the United States: barriers, prospects, and
implications,Stephen Gorin, Health and Social Work. 22.3 (Aug. 1997): p223. COPYRIGHT
1997 Oxford University Press. http://www.naswpress.org/publications/journals/hsw.html

(Marshall 1 & 2) Bush, Jamie, Leslie Sandridge, Cierra Treadway, Kimberly Vance, and Alberto
Coustasse. "Medicare Fraud, Waste and Abuse." Marshall Digital Scholar. Marshall
University, 22 Mar. 2017. Web. May-June 2017.
(Herper 1, 2 & 3) Herper, Matthew. "Solving Pharma's Shkreli Problem." Forbes. Forbes
Magazine, 04 Feb. 2016. Web. 16 May 2017.
<https://www.forbes.com/sites/matthewherper/2016/01/20/solving-pharmas-shkreli-
problem/#234055236be3>.

(JAMA 1) Kesselheim, Aaron S., Jerry Avorn, and AmmetSarapatwari. "The High Cost of
Prescription Drugs in the United States." JAMA. American Medical Association, 23 Aug.
2016. Web. 16 May 2017. <http://jamanetwork.com/journals/jama/article-abstract/2545691>.

(NCBI 1) Iuga, Aurel O., and Maura J. McGuire. "Adherence and Health Care Costs." Risk
Management and Healthcare Policy. Dove Medical Press, 2014. Web. 16 May 2017.
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/>.

(NCBI 2) Tsai, Adam Gilden, David F. Williamson, and Henry A. Glick. "Direct Medical Cost
of Overweight and Obesity in the United States: A Quantitative Systematic Review."
Obesity Reviews : An Official Journal of the International Association for the Study of Obesity.
U.S. National Library of Medicine, Jan. 2011. Web. 16 May 2017.
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891924/>.

(FAIR 1) "The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed
Services." Fair Health, INC., Sept.-Oct. 2016. Web. 16 May 2017
<http://www.fairhealth.org/servlet/servlet.FileDownload?file=01532000001g4i3>.

(Rowland;Lyons) Rowland, Diane, and Barbara Lyons. "Medicaid's Role in Health Reform and
Closing the Coverage Gap." ArticleOne. Journal of Law, Medicine & Ethics, Jan. 2016. Web. 16
May 2017. <http://dx.doi.org.ezproxy.monroecc.edu/10.1177/1073110516684790>.

(Polinski et. All) Polinski, Jennifer M., William H. Shrank, Haiden A. Huskamp, Robert J.
Glynn, Joshua N. Libeerman, and Sebastian Schneeweiss. "Changes in Drug Utilization during a
Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap." Public
Library of Science. Public Library of Science, Aug. 2011. Web. 16 May 2017.
<http://dx.doi.org.ezproxy.monroecc.edu/10.1371/journal.pmed.1001075>.

(Sanders 1, 2 & 3) "Medicare for All: Leaving No One Behind." Bernie Sanders. N.p., n.d. Web.
16 May 2017. <https://berniesanders.com/issues/medicare-for-all/>.
(Ryan 1 & 2) "Paul Ryan." BrainyQuote.com. Xplore Inc, 2017. 16 May 2017.
https://www.brainyquote.com/quotes/quotes/p/paulryan414988.html

(Chaffetz)Prignano, Christina. "Chaffetz Iphone Quote." BostonGlobe.com. Boston Globe, 07

Mar. 2017. Web. 16 May 2017. <https://www.bostonglobe.com/news/politics/2017/03/07/jason-
chaffetz-says-people-should-invest-health-care-instead-buying-
iphones/AMInYg6rSoZzVu8Q0uhrxK/story.html>.

(Kaiser) Luthra, Shefali. "GOP's Medicaid Plans." Kaiser Health News. Kaiser Health News, 27
Jan. 2017. Web. 16 May 2017. http://khn.org/news/block-grants-medicaid-faq/

(Maticonis) Mataconis, Doug. "State of Florida v. United States Dept of HHS." Scribd. Scribd,
n.d. Web. 16 May 2017. <https://www.scribd.com/document/39344827/State-of-Florida-v-
United-States-Dept-of-HHS>.

(Ungar 1) Ungar, Rick. "Socialized Medicine - 1798, John Adams." Forbes. Forbes Magazine,
19 July 2012. Web. 16 May 2017.
<https://www.forbes.com/sites/rickungar/2011/01/17/congress-passes-socialized-medicine-and-
mandates-health-insurance-in-1798/2/#4d0be28a5527>.

(Ungar 2) Ungar, Rick. "Thomas Jefferson Also Supported Government Run Health
Care." Forbes. Forbes Magazine, 16 July 2012. Web. 16 May 2017.
<https://www.forbes.com/sites/rickungar/2011/01/21/thomas-jefferson-also-supported-
government-run-health-care/#7b19b14d5324>.