Deliver Us From Injustice: Reforming the U.S. Healthcare System


For the last fifty years, the United States healthcare system has done an extremely poor job of delivering healthcare in a just and fair manner. The United States holds the dubious distinction of being the only industrialized nation in the world lacking provisions to ensure universal coverage. We attempt to provide some of the reasons this dysfunctional system has persisted and show that healthcare should not be a commodity. We begin with a brief historical overview of healthcare delivery in the United States since WWII. This is followed by a critical analysis of the for-profit model including reasons to support the view that healthcare should not be a free market commodity. We also demonstrate how special interest groups have been able to win support for their practices based on propaganda rather than fact. A brief analysis of the Affordable Care Act is offered along with critical comments regarding its ineffectiveness. We conclude with a brief overview of international approaches that have resulted in universal coverage and suggest the United States ought to adopt an approach similar to those outlined so that it no longer stands as the only industrialized nation to ignore the glaring problems that exist.

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  1. 1.

    Ezekiel Emanuel makes the point this way: “Prior to the passage of the ACA, [Affordable Care Act], Americans’ access to healthcare was inadequate. Nearly 50 million Americans were uninsured, and millions more were underinsured, with austere, unreliable policies that failed to protect them from grave financial loss or bankruptcy if they developed a serious illness” (Emanuel 2017, 20).

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    It was expensive for most Americans at this time as well. “The principal reason why people do not receive the care they need is that they cannot afford to pay for it on an individual basis at the time they need it. This is true not only for needy persons. It is also true for a large proportion of normally self-supporting persons” (Markel 2014).

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    This notion is further reinforced by the Emergency Medical Treatment and Labor Act (EMTALA) which requires that all patients entering an emergency room be treated and stabilized regardless of their ability to pay (CMS.Gov 2017). Ironically, hospitals are provided no financial assistance for complying with the law, and yet must act as for-profit industries. This highlights both the lack of appropriateness for using a market-based system to deliver healthcare and the moral requirement that patients should be treated without regard for their ability to pay.

  4. 4.

    It should be emphasized here that loss of employment could be due to layoffs and not employee conduct. In other words, we cannot always blame the unemployed people for losing their jobs. Furthermore, the types of COBRA coverages offered to employees who were laid off often creates financial hardship (Andrews 2013).

  5. 5.

    In the same speech and in line with our thinking, Bevan makes the following observation: “ … the best way to finance the scheme (the NHS), the fairest and most equitable way, would be to obtain the finance from the Exchequer funds by general taxation, and those who had the most would pay the most. It is a very good principle. What more pleasure can a millionaire have than to know that his taxes will help the sick?” (Bevan 1958, ¶26).


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We would like to thank Peter Jennings, Librarians/Associate Professor, Cuyahoga Community College, for his assistance in researching this topic. We would also like to thank two anonymous reviewers for their thoughtful and helpful comments on an earlier draft of this manuscript.

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Correspondence to Samuel H. LiPuma.

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LiPuma, S.H., Robichaud, A.L. Deliver Us From Injustice: Reforming the U.S. Healthcare System. Bioethical Inquiry 17, 257–270 (2020).

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  • Healthcare justice
  • Healthcare and social policy
  • Access to healthcare