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Universal Health Care Under Free-Market Capitalism


The promotion of good health is one of the major governmental contributions to society’s development. During the last centuries, certain attempts were made to stabilize healthcare services and choose between universal and single-payer care types. Governments worldwide find it necessary to spend billions of dollars annually to ensure their populations access high-quality care and medical workers have enough equipment and resources. Investments in citizens are characterized by productivity, competitiveness at regional and national levels, and tax payments. Some countries prefer to encourage universal health care and make it easier for patients to receive treatment and use medical services. However, countries like the United States do not have a universal system and rely on private insurance. As a result, the healthcare industry is closely connected to such spheres as economics and politics. Capitalism is one of the common political and economic ideologies to drive prosperity under private owners’ control. This concept was thoroughly studied by Adam Smith, Karl Marx, and Max Weber. In this paper, the co-existence of free-market capitalism and universal health care will be discussed to prove this possibility and inevitable challenges related to insurance, personal freedoms, and options.

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To understand their goals and possibilities, people have to live in accordance with the principles of a specific system. Since the 19the century, the two economic systems have been frequently applied to explain the relationships between the government and society, namely capitalism and socialism. Socialism promotes a philosophy of wealth controlled by the government and based on social stability, equality, and cooperation. Capitalism focuses on private ownership when trade and industrial relationships are never controlled by the state. This system is attractive to many individuals because it becomes possible to own and manage the resources. However, some groups of people do not find it beneficial because it is hard to obtain outside help and financial support but constantly make private economic decisions about earning and spending incomes.

Since the 1800s, many theorists have developed their definitions of “capitalism,” and the ideas of Smith, Weber, and Marx remain the most common. Although Smith did not coin the chosen concept, his works referred to capitalism considerably. His argument that “no society can surely be flourishing and happy, of which the far greater part of the members are poor and miserable” proves a core idea of capitalism (Smith 2007, 52). Smith’s capitalism is “equity” in terms of which people “who feed, cloath and lodge” must “have such a share of the produce of their own labour” (Smith 2007, 52). Marx did not support Smith as he thought that individuals were not able to obtain enough benefits and meet their needs. People are obsessed with the necessity to become rich and are ready to sacrifice their minds and health (Marx 1978). Marx chose the wage aspect to determine how capitalism provoked mania. He admitted, “the worker becomes all the poor the more wealth he produces” and “becomes even cheaper commodity” (Marx 1978, 71). If Smith saw capitalism as an opportunity, Marx compared it with a commodity that people could not control.

Weber introduced another position on how to understand capitalism through the prism of inevitable Europe’s historical development. The author explicated that “the spirit of capitalism is best understood as a part of the development of rationalism as a whole” (Weber 2005, 37). On the one hand, Weber agreed with Smith and underlined the necessity to think about “that you possess” and “keep an exact account for some time both of your expenses and your incomes” (2005, 15). Capitalism is critical for people to understand their needs and use available resources consciously. On the other hand, the same way Marx did, Weber (2005) could not ignore people’s dependence on profits and defined the prolific nature of money when “money can beget money” (15). Capitalism is never simple, but its changing spirit may be integrated within today’s society, including the healthcare system.

Universal Health Care

When people think about health care, they expect to receive high-quality services and improve their health to any possible extent. Many developed countries have already implemented universal standards according to which the government offers enough opportunities to all people, regardless of their incomes or demographics. The United States is known for its regular improvements in the healthcare sphere, but its acts and interventions lack some characteristics. Therefore, to understand if capitalism may co-exist with universal health care, it is necessary to learn what makes health care universal.

Characteristics of Universal Health Care

An evident benefit of universal health care is its accessibility to all people. According to Bloom, Khoury, and Subberamn (2018), it is a reflection of certain social and economic development. The major characteristics of this type of care are derived from social benefits and include health promotion, patient-centered care, disease prevention, effective treatment, rehabilitation, and education (Bloom, Khoury, and Subberamn 2018). To stay universal means to be rooted in communities’ needs. Healthcare workers should not only treat or prevent illnesses but also consider the steps to improve the quality of life in general. However, even the most skilled employees do not usually have access to enough resources like people and equipment. Therefore, they expect the government to provide enough financial help, which makes capitalism questionable but still possible in relation to universal health care. Technological innovations, exchange of human resources, and the growth of international relationships remain contributing factors to improve health care.

Care in the United States

The United States shows a successful mix of capitalist and socialist economies, in terms of which the government may interfere for the public good, but economic freedoms are never neglected. However, being the country with one of the most developed economies in the world, the United States has a number of recurring financing problems. The Affordable Care Act (Obamacare) is one of the possible examples of capitalism, the main idea of which is to provide all citizens with health care and reduce unnecessary payments (Skinner and Chandra 2016). Over the last several years, the costs of healthcare in the country have been considerably increased due to tax penalties and the inability to qualify for subsidies. In other words, the representatives of middle and upper classes may not struggle to pay for healthcare, and people from lower classes continue suffering from their financial inabilities and lack of care.

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Today, Obamacare is considered a huge political issue that is coming up strongly during the 2020 Presidential elections. The recent strides to some form of universal care in the country came after 2008. In addition to expanding traditional avenues of access like Medicare and Medicaid, the legislation attempted to address several new issues. Attention is now paid to the structure of coverage, insurance access, and financial payments that make high-income earners spend more to subsidize the program for low-income earners (Cheng 2020). It was expected that this strategy, coupled with direct government subsidies and employer benefits like tax exemptions, increased access to healthcare insurance and provided extra opportunities for affordable healthcare. While there was no contention over the program’s efficacy, it formed the basis of modern deliberations on affordability and access to healthcare in the country.

Co-Existence of Capitalism and Universal Health Care

Taking into consideration the current situation in the United States, the elements of a capitalist economy like free markets and private ownership can be brutal, especially on the low-income cadres of the society who rely on the state’s goodwill to access essential services. Despite the intention to create one of the largest economies in the world in terms of its GDP per capita and healthcare spending, the US government lags behind in providing health care to its citizens. The United States spent about 8.5% of its GDP on health care five years ago, which is high than in the United Kingdom (7.7%), Canada (7.4%), or Australia (6.5%) (Sawyer and Cox 2018). However, recent years show that health-spending growth has been slowed in the United States compared to other countries.

Many Americans still struggle to access quality health care due to existing financial and administrative restrictions. In fact, capitalism makes the US labor market obsessed with competition, labor-intensive, and capital accumulation by corporations. Employees should demonstrate that their productivity justifies or qualifies their healthcare compensation. Businesses do not see enough opportunities in the market and have to expand their offerings and market positions, which results in unfair compensations. Obamacare may be defined as an example of capitalism in the country, but it faces a serious challenge because many employed and unemployed Americans have little to no insurance coverage.

Position of Marx on Co-Existence of Universal Healthcare and Capitalism

Financing and facilitating healthcare in the context of free markets presents various conditions that have to be fulfilled. According to Marx (1978), the capitalist political economy presupposes the promotion of “private property, the separation of labor, capital and land, and of wages, profit of capital and rent of land” (70). As a result, a redefinition of the worker’s position is possible and even inevitable. Marx (1978) criticizes capitalism because, on its basis, people could sink “to the level of a commodity” or become “the most wretched of commodities” (70). McDonald (2017) contends a similar position and believes that the healthcare market will never be a normal market, and it is time to repeal Obamacare and restructure the industry, relying on the free market. However, Marx (1978) worked and addressed the conditions inherent to the 19th century, including estranged labor, devaluation, and monopoly restoration. McDonald (2017), in his turn, underlines the current situation when young people do not strive for their health insurance because they do not believe they may need it. However, when the necessity to receive care (repeated chemotherapy or expensive surgery) challenges, people are not ready.

When working up universal healthcare in a capitalist society, it is crucial to think of who should pay for healthcare first. With all its pros and cons, the Affordable Care Act was financed by a combination of direct deductions from employees’ income based on a predetermined formula, employee payments, and government subsidies. In her study, Sell (2019) admits that managing a truly universal healthcare insurance and coverage program requires a planned shift from out-of-pocket expenditures to pooled health spending support by Obama’s system. With more government investment in these structures, the overall government expenditure goes up, and the federal government may be forced to borrow more money and facilitate this transition or disadvantage other government departments. The level of achievement is hard to estimate because of the complex nature of the American market and the existing labor and income disparities.

The promotion of a free-market system as a part of universal health care may be defined as profit- and cost-driven. Although there is a need to improve the current situation and remove financial challenges, American society is not ready in terms of its labor organization. Cheng (2017) introduces one challenge with the American labor structure, calling the system individualistic. Due to such an attitude to employees and unemployed citizens, health care remains treated as a complex bureaucratic business issue, the solution of which is predetermined by financial opportunities of organizations, not individuals.

Smith and His Arguments for Capitalism in Society

Compared to Marx, who saw capitalism as a reason for economic and political stagnation and multiple contradictions, Smith took a definite position about capitalism (although he did not use this word in his works). The goal of Smith (2007) was to prove the ineffectiveness of mercantilism and the necessity to recognize self-interest and social benefits. In his book The Wealth of Nations, Smith (2007) introduced a new approach to be implemented to an economic theory. He explained the development of a free market through the division of labor and the removal of governmental interventions. The author believed that the creation of a wealthy nation largely was possible through the context of a free market, where the citizens had the liberty to invest their time in their own productivity. Enterprises also played an important role in understanding the universal principles in a capitalist society when they should generate a higher return for a given, usually manageable, risk level.

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As a support of the free market and, thus, the ideas of capitalism, Smith advanced his concepts based on laissez-faire economic policies. His intention was to prove that the lesser the government is involved in how businesses and enterprises are run within the market, the better the business and society will be. Relying on the ideas of Smith, the perception of universal health care is possible under capitalist principles because the government does not have much control over taxation, intervention, and regulation. People become free to use their own resources and achievements to cover their healthcare needs. Still, many aspects of such a system remain unclear because it is hard to predict how capitalist society is able to support healthcare facilities and evaluate the needs and expectations of medical facilities and the staff.

To solve this problem and remove uncertainties, Smith advanced the concept of the “invisible hand.” In fact, this metaphor was not properly presented and described in Smith’s The Wealth of Nation, but firstly appeared in The Theory of Moral Sentiments as an attempt of free markets to regulate their competitions, supply, and demand, relying on self-interests. Free markets can guide the labor and capital systems and identify maximum levels of their efficiency. The argument is that the free market may be used as a tool to motivate society towards more significant enrichment in all its dimensions. In utilizing this thinking, enterprises or industries that promise the greatest returns or cost-savings will be the one deemed to have the most significant benefit to society. Smith (2007) contended that there should be reconciliation between individuals’ self-interests and the realization of the greater good of society. His book is not for entrepreneurs or business planners but for individuals who want to control and improve their lives.

The contentious debate is how the arguments offered by Smith should fit financing processes in modern healthcare to drive down costs, making them affordable to everyone in society. It is possible to formulate several opinions about the provision of universal healthcare and its relations to the benevolence of the free market. As demonstrated by Marx and other thinkers, the owners of capital and land tend to create independent production systems, and everyone else is seen only as a commodity in the actualization of their primal profit goals. Smith (2007) convinced the users that, in the pursuit of business in the markets, there would be natural leaning towards the betterment of services, with direct governmental control. Thus, it remains unclear if the entire coverage industry can be managed from a free market effectively or generate benefits to the end consumer. When the entire industry relies on the free market, consumers can choose which cover or service they need and potentially pay for what they want. Following the example of drug production, the market offers various generic medications, supporting affordable purchase with no change in the efficacy.

However, in terms of healthcare coverage, the principles of free market cannot be treated the same way. Macdonald (2017) argues that the invisible hand will likely struggle to help the healthcare market. When a patient has a life-threatening emergency condition, there is no time for comparing what the market offers and if all cost-saving aspects are considered. The focus is on saving a human life, and Macdonald (2017) defines free market models as infeasible, especially considering the significant role of healthcare insurance in the country. Using the model offered by Smith, people should treat the free market model as an opportunity to divide available resources with respect to human needs and financial assets. Healthcare costs are determined by many complex conditions and may be invariably changed. Based on Smith’s argument, the coverage landscape should be leveled, and various players allowed thriving and giving room for the public to choose what coverage may be the most necessary for them at the moment.

Weber and His Position about Capitalism in Health Care

In his economic thinking, Weber went against the mainstream thought of economic thinking and argued that rationality was the missing link when thinking about economic theory. While Smith (2007) placed profit and realization of societal good as being centric, Weber (2005) argued the pursuit of profit could not be considered as being capitalistic. While not entirely in support of socialism, Weber presents the fact that bureaucracy and government control would always be a part of services offered to society, making the modern capitalism’s orientation towards the market rational (Denham 2004). He supported the influence of bureaucracy and emphasized that such systems control the government in the market.

In this context, the idea that governments provide free universal healthcare should be brought to question because there are neither free options nor definite, affordable prices. According to Hadler (2016), the arguments surrounding universal health coverage are all linked to widening government control of patient care for the good of all. Simply, the government attempts to leverage bureaucracy and introduce policies like the Affordable Care Act, which are imperfect and geared to some form of social good. It is impossible to imagine universal health coverage without widening access to everyone. It was expected that the number of uninsured people significantly decreased in the country, but such results were hardly achieved after the implementation of the Affordable Care Act. Skinner and Chandra (2016) admit the benefits of coverage expansion, including the possibilities for more than 20 million Americans to be insured and justifiable in claiming care efficacy. However, disparities in access to healthcare remain a critical issue. It is necessary to find new resources and increase care access. Free market capitalism is characterized by evident benefits and options, but it threats cannot be ignored in modern America.


The main idea of capitalism is to extend free-market relationships and encourage the privatization of public services. As a result, people can control their commodities and define their needs. Instead of thinking about what the government may offer to its people, the population must understand what they want to get from the government. Although the promotion of capitalism is characterized by conflicting interests and social or economic challenges, its impact on American society cannot be neglected. The benefits include global value chains, private capital, and free trade of services. Universal health care has already been approved in many countries, and the United States is close to similar interventions by improving insurance conditions, respecting people’s freedoms, and offering options. Capitalism and universal health care may and even should co-exist because it is the only chance for people to realize what they should have and why they must work, develop, and grow socially and financially.


Bloom, David E., Alexander Khoury, and Ramnath Subberamn. 2018. “The Promise and Peril of Universal Health Care.” Science 361 (6404).

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Cheng, Catherine. 2020. “Can Universal Health Care and Capitalism Coexist? Yes, Here’s How.” KevinMD. Web.

Denham, David. 2004. “Marx, Durkheim and Weber on Market Society.” Frontiers of Sociology. Web.

Hadler, Nortin M. 2016. “There Is Nothing Free About the Health Care Free Market.” The Health Care Blog. Web.

Marx, Karl. 1978. “Economic and Philosophic Manuscripts of 1844.” In The Marx-Engels Reader, 2nd ed., edited by Robert C. Tucker, 66-125. New York: W. W. Norton & Company.

McDonald, Darlene. 2017. “The Invisible Hand Struggles to Help the Health Care Market.” InsuranceNewsNet. Web.

Sawyer, Bradley and Cynthia Cox. 2018. “How Does Health Spending in the U.S. Compare to Other Countries?” Health System Tracker. Web.

Sell, Susan K. 2019. “21st-Century Capitalism: Structural Challenges for Universal Health Care.” Globalization and Health. Web.

Skinner, Jonathan and Amitabh Chandra. 2016. “The Past and Future of the Affordable Care Act.” JAMA 316 (5): 497-499.

Smith, Adam. 2010. The Wealth of Nations: An Inquiry into the Nature and Causes of the Wealth of Nations. Hampshire: Harriman House Limited.

Weber, Max. 2005. The Protestant Ethics and the Spirit of Capitalism. Translated by Talcott Parsons and edited by Anthony Giddens. New York: Routledge.

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