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Is Population Growth + Market Monopolies Driving the U.S. Toward Universal Healthcare?
- jccollins1s
- Apr 24
- 3 min read
To understand where U.S. healthcare may be headed, we first need to look at the population landscape and how healthcare is currently accessed. Here’s a breakdown of U.S. healthcare coverage based on 2023 data:
Total U.S. Population (2023): 334 Million
A Reality Check: Nearly 1 in 3 Americans Lives at or Near the Poverty Line
One of the most telling indicators of where healthcare reform must begin is in our economic makeup. Nearly 30% of the U.S. population qualifies for Medicaid. Equivalent to living at or below $15K in annual income for an individual. That’s not just a healthcare issue, it’s an economic one.
In fact, over 53% of Americans are covered by government-subsidized healthcare programs, and that doesn’t even include the uninsured population. Any conversation about “fixing” healthcare that doesn’t include this economic lens is incomplete.
Are We Shifting Toward Value-Based Care?
The shift away from fee-for-service and toward value-based care is commendable. It seeks to reward quality of care, prevention, and coordination not just volume and utilization.
It’s definitely a step in the right direction, but I’m not sure it’s the smoking gun people are hoping for to ultimately fix healthcare. To truly address the root of the issue, we need to look deeper at the populations that make up our country and the economic realities they face. Without that foundational context, even the best care models can only go so far.
Are Market Monopolies Driving Up Costs?
Healthcare access is increasingly shaped by monopolistic trends. Most cities and especially rural areas are dominated by a small number of health systems and insurance giants. The barriers to entry are high for new players, who often struggle to compete due to exclusivity deals, broker relationships, and pricing power.
This type of market concentration often leads to higher costs and fewer choices for consumers. It’s hard to imagine real transformation when pricing and access are controlled by so few.
Is Universal Healthcare a Real Possibility in the U.S.?
I used to think the U.S. was simply too large and complex for universal healthcare to be feasible. But after watching 72 other countries—including China and India—successfully implement universal systems, I’m no longer so sure.
If universal healthcare were introduced in the U.S., critical questions would have to be addressed:
Who pays for it? Most countries use higher income taxes to fund universal care, some approaching 50%+ in annual tax rates.
What happens to private insurers and their workforces? It’s likely they would shift to roles within a government-managed system or pivot to other lines of insurance.
Will providers adapt? Greater utilization may follow, and specialist wait times could increase as we’ve seen in countries like the U.K. I see a system in which providers will be overburdened and strategies to address this will need to be developed.
Would it be free? No. Universal doesn’t mean “no cost.” It means coverage for all, funded differently.
In the end, the biggest winners in a universal model would be the people and especially those currently postponing necessary care due to cost. I suspect if the U.S. does move in this direction, it will likely adopt a hybrid model: core universal care with optional private enhancements.
How TotalMed Networks Supports Providers in Today’s System
At TotalMed Networks, we help healthcare providers and systems tackle the financial and operational challenges facing today’s market. Our services include:
Revenue cycle and A/R optimization
Medicaid population steerage strategies
Provider-payer alignment initiatives
Contract negotiation support
Cost containment consulting
We’re focused on helping our partners navigate complexity with intelligent strategies that improve care delivery, enhance operational sustainability, and ensure financial resilience.
Let’s Start the Conversation
What do you think? Is the U.S. heading toward universal healthcare? What should we be doing now to prepare, whether it happens or not?
I’d love to hear your insights in the comments.
Sources: Medicaid.gov, U.S. Census Bureau, HHS.gov, Forbes, Countries with Universal Healthcare Medicaid.gov Link United States Census Bureau Link Forbes Link Link HHS.Gov Link Source Link Source Link Source Link Source Link Source Link Source Link Source Link
Legal Disclaimer
The views expressed in this article are those of the author in their personal capacity and do not necessarily reflect the views of any organization they are affiliated with. This article is intended for informational purposes only and does not constitute professional advice or a recommendation for action.
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