High costs of health care in the USA

 One of the biggest problems the United States healthcare system struggles with is high cost. This issue contributes to reduced access to care which lead to negative consequences such as increased health debt and poorer patient outcomes. 

Rising healthcare costs creates a burden on patients by making necessary care unaffordable. This leads to delayed treatment, skipped appointments, medical debt, and patients not getting necessary prescriptions due to the cost. If patients are not able to afford healthcare this can lead to worsened chronic conditions and overall poorer health outcomes. Unaffordable healthcare can also force patients to accumulate debt through credit cards, personal loans, or high deductible plans to pay for medical care.

Woo, a young man, who used to live in a run-down apartment in Milwaukee stepped on a nail and refused to get medical help because he couldn’t afford it, according to Matthew Desmond (2024, p. 15). After a few weeks, Woo eventually had to visit the hospital. His foot and leg had a severe infection causing him to get his leg amputated (Desmond, 2024, p. 30). This story is an example of how people may put off treatment due to the cost of care, which can result in chronic conditions and overall poorer health outcomes. 

I believe that in order to improve people’s financial stability, healthcare cost should be reduced. By doing this, people will be able to reduce medical debt and allow individuals and families to afford other necessities. This will also improve public health outcomes by encouraging preventive care and early interventions, resulting in better health for the population.

Reference

Desmond, M. (2024). Poverty, by America. Penguin Random House LLC.

Americans spend about $5 trillion on healthcare.  Or, maybe that figure is up to $5.5 or $6 trillion by now.  That's about 18% of our Gross Domestic Product. 
Presumably, a national health care plan, whether covered by a single payer or whether using multiple different payers (see the German or Swiss systems for examples) would cover something slightly under 100% of costs: possibly 95% of healthcare costs.  And, presumably, there would be increased efficiencies in health care, and that would reduce costs even more, so the cost of a national health care program that covered everyone would presumably be about $5 trillion if we are currently spending nearly $6 trillion on healthcare. With 340 million Americans, that works out to about $14,700 in payments that would be needed for each person in the United States.  So, for a family of four, if the costs of all health care was spread evenly, that family would need to pay $58,800 in taxes to cover their share of health care costs.  That is the average amount each four-person household would need to contribute to a public program that covers nearly all health care for everyone. 

But of course, a health care scheme like this would not distribute costs evenly.  We already cover about 43% of health care spending through Medicare, Medicaid, and the Veteran's Administration. We would only need to raise about another 47% of total healthcare spending if we wanted a universal health care system.  So, taxes would have to gather another $2.9 trillion from the population. 

The 57% of us who receive health insurance through our employers would get a huge windfall (or our employers would), because employers would no longer have to pay for private insurance for their employees, allowing them to pass on what they now pay to cover health care benefits on to their employees as income.  The increased income from health insurance policies our employers are purchasing on our behalf would, for most of us, closely match the required increase in taxes to get federal revenue up by $2.9 trillion. The average health care benefit per employee is about $8,000, and about $19,000 for family plans.  So, with a universal public health care scheme, incomes for the 57% of us now enjoying plans paid for by our employers would increase to mostly offset the increases we would need to pay in taxes. Currently, wealthy Americans (those in the top quintile) pay about 24% to 27% of their earnings in federal and withholding (Social Security and Medicare) taxes.  If those went up to 33% to 40%, this would go far toward raising the $2.9 trillion.  Middle class households are paying about 19% to 24% of their incomes in federal and withholding taxes.  For them, if those tax rates went up to 28% to 33%, this would be enough to cover the universal health care program.  The increases in income from employers passing on as salary the money that had been used to purchase their healthcare would probably cover most or all of the cost of their increased taxes, so that their after-tax consumption levels would be essentially unchanged.  

Disparities in the U.S. Education System

 “My name is _________________” and as a college student I am writing to bring your attention to the problem of how Federal Student Aid exhibits inequities. Financial aid is an attempt to address a contemporary social problem of college affordability. Governments can directly subsidize education by allocating grants, funding, and tax breaks to universities, or governments can give students help with paying for their education through financial aid, and let money be allocated to schools where students choose to attend.  But our system fails to address the rising cost of higher education. 

Most of the rapid increase in the higher education price index (HEPI) came between 1980 and 2010, three decades when the HEPI generally went up faster than the consumer prince index (CPI).  From 2010 and 2019 the higher education price index averaged 2.2% in annual increases, which was close to the CPI.  In the most recent five years, the HEPI was significantly lower than the CPI in 2022 and 2023, and only very slightly higher than the CPI in 2020, 2021, and 2024.  Federal aid has decreased over the past decade, with total federal grant aid decreasing by 7% (in inflation-adjusted outlays) and Pell grants specifically decreasing 5% (inflation adjusted) between 2014 and 2024 (Trends in College Pricing). State funding for public universities has also declined (in inflation-adjusted terms) since 2000, and public universities have covered the loss of state funding with increased tuition, especially in the years between 2001 and 2016. 

The increase in relative costs of university and the decrease in federal and state funding for colleges and for grants to students has caused a student debt crisis. This crisis is experienced more painfully by families with fewer assets, as they are forced to borrow and use debt to cover the cost of education, whereas families with more wealth may use some of their wealth to pay for college or may secure better rates on loans for college. Since wealth, like income, is a factor that influences how much education a student can affords, inequalities in wealth exacerbate inequalities in college debt. Disparities in income are well-known: Black households had median incomes that were 60.5% the incomes of non-Hispanic white families, while Hispanic households had incomes at 77% of non-Hispanic white households (Census Income Report).  But the wealth gap is much more: The Census Bureau reported that in 2024 Black householders have a median wealth of $24,520, which is only 10% of the median wealth of White households ($250,400).  Thus, to the extent that funding for financial aid and universities cause access to higher education to be highly influenced by issues of who can afford the expense, the inequities related to wealth and race will shape access, and inadequate funding for financial aid will perpetuate income and wealth disparities rooted in historical discrimination and oppression long after the blatant discrimination and oppression are removed.

 The key sections I will be covering deals with the contemporary social problem of Federal Student Aid and how historical foundation’s structure inequity, cultural norms, policy and institutional mechanisms.

The GI Bill (1944) after World War II, was made to benefit World War II veterans with their transition back to civilian life, including tuition assistance for education. However, African American veterans had limited access to higher education because the racial inequality in the GI Bill has created wealth gaps that impact FAFSA eligibility applicants today (Hunter, 2015). The GI Bill's preferences for White applicants gave advantages in lifetime earning and wealth accumulation to White veterans, and limited the ability of many Black veterans to build generational wealth through education and homeownership. This results in fewer assets to pass down, leading to lower incomes and wealth for many  Black families today.  The FAFSA determines eligibility by a formula that includes information about family assets, but those calculations to not consider the value of non-liquid assets such as a student's primary residence (the home owned by a student's parents) ore retirement accounts.  Yet, the main asset that White families tend to have, and Black families are less likely to have, is ownership of a primary residence. In 2021, 70% of White householders had equity in their own home, but only 39% of Black householders had home ownership assets (Census Bureau report on Wealth). 

Another policy that sounds fair but ended up being unfair in practice, for example, is the Every Student Succeeds Act (ESSA). It sounded fair because it was known for demonstrating equality, but it ended up doing the opposite in practice by shifting power and decision-making away from the national government to individual state governments (Black, 2017). States have historically failed to direct educational assets to improve the educations for poor and racial or ethnic minority students, and the federal government's role in promoting efforts to equalize educational investment and outcomes across class and racial groups was terminated in the ESSA.

Today White Americans receive more financial aid then African Americans and Hispanics due to their having more financial privileges and higher education resources (e.g., private schools). For example, Dr. Shermer (2022) raises the issue that the Federal Student Aid application does not ask about retirement savings or home equity. Caucasians are more likely to have retirement savings and home equity than African Americans and Hispanics; by not asking those two questions, financial aid is providing more aid to Caucasians than African Americans and Hispanic students. Making it more likely for African Americans and Hispanic students to either borrow money for college and or not attend college at all. Schools and the justice system add to Federal Student Aid inequality also by only accepting students with strong academic records. Dr. Shermer (2022) mentioned states have certain levels of aid policies that show racial inequality by accepting students with strong academic records. Accepting students with strong academic records is a disadvantage for African Americans and Hispanics who may have a weaker high school grade point averages because they’re less inclined academically.

Student debt is another way African Americans and Hispanics experience economic inequality. They frequently take out student loans to pursue higher education for better job opportunities. Dr. Shermer (2022) noted that by the time students graduate from college, they cannot yet escape the racial wealth gap because they struggle with loan repayment which hinders their ability to build financial stability. This leads to long-term consequences that prevent economic mobility.

For example, I have an African American family member who has personally encountered this problem. As an adolescent, I saw my brother struggle to find an HVAC job after graduating from college. He was denied by multiple HVAC companies because he did not have two years of experience. His argument was “I have the degree; how do you expect me to get experience if you will not hire me?” After my brother was denied the job, he uprooted his life, and moved to Orlando, Florida where heating and cooling businesses thrive. However, he experienced the same hardships as he did in Illinois. He accumulated more than $20,000 dollars in debt due to our parent’s income reflected on his financial aid. Now he has moved back to Springfield, IL and works as a bus driver for Sangamon Mass Transit District. 

My brother continues discussing how out of all fifteen classmates (3 African American and 12 Caucasian) nine Caucasian students received internships and jobs, while the three African American students did not receive internships or jobs. My brother later found out that the same job he for which he was denied was offered to one of his Caucasian classmates with no experience, and his White classmate was hired a few weeks later. From my viewpoint, the job was hiring based on race rather than qualifications, which is considered illegal racial discrimination. Not only did my brother experience discrimination, he is also experiencing student debt, which is keeping him within his wage gap. Dr. Shermer (2022) mentioned Economic inequality is still around because African Americans and Hispanics are still relying on student loans and experiencing debt after graduating from college, which keeps them in their racial wealth gap. 

Changing policies within the United States could help make a difference. I believe Every Student Succeeds Act (ESSA) needs to change. ESSA has weakened equity standards by failing to address societal issues that contribute to educational inequality, such as racism, poverty, and school funding, according to Derek W. Black (2017). This makes it difficult for African Americans and Hispanics to access and succeed in college. The policy should stat that disadvantaged students receive the necessary resource regardless of their district’s local tax base (implement weighted student funding).

Sincerely,

References

Black, D. W. (2017). Abandoning the federal role in education: The every student succeeds act. California Law Review, 105(5), 1309-1374. https://www.jstor.org/stable/26577710 

Hunter, L. J. (2015). The untold story of the GI Bill: The experiences of African American veterans with attaining educational benefits through the Servicemen's Readjustment Act of 1944. (Publication No. 3706461) [Doctoral dissertation, University of Massachusetts Boston]. ProQuest Dissertations & Theses Global. https://uis.idm.oclc.org/login?url=https://www.proquest.com/pqdtglobal1/dissertations-theses/untold-story-gi-bill-experiences-african-american/docview/1695261565/sem-2?accountid=14554 

Shermer, E. (2022, March 28). “Indentured students”: Higher education and the student loan crisis [video]. Kaltura. https://uis.mediaspace.kaltura.com/media/ECCE+Speaker+Series+-+Indentured+Students%3A+Higher+Education+and+the+Student+Loan+Crisis/1_biewu0gj  

This was supposed to be a paper explaining a policy or program in a fairly neutral way.  I guess the problem you were examining was inequalities in college funding for making higher education affordable to people, and you were pointing out that one of the policies that attempts to make college education more affordable (student loans) is perpetuating easier access to college for households with equity in a home that they own, and since White families are almost twice as likely to be home-owners, this gives White students an unfair advantage.  You are also saying that past programs to encourage education (the G.I. Bill) also unfairly distributed benefits in a way that privileged White students. 

An interesting point is the problem with college admission standards being tied to high school academic performance or scores on standardized tests. Systematic differences in K-12 educational outcomes that disadvantage Blacks and Hispanics will be repeated at University level, because universities want to admit students who have a demonstrated likelihood of succeeding (retention and graduation rates are used to determine the quality of a university).  Admitting students who are unlikely to return for a second or third semester, or who are unlikely to ever graduate, will become a long-term problem for a university, although such admissions strategies may unethically boost admission and fee revenues in the short-term.

Is there any argument to increase financial aid or change the way it is awarded?  Is there any innovative argument to abolish federal financial aid?  Policies could fund universities directly, and allow universities to lower the costs they charge to students.  That is, governments could fund higher education so that a year of school with housing and meals that costs $30,000 to provide might be priced at $2,000 or $3,000, and little or no financial aid would be required.  On the other hand, government funding for higher education could be eliminated so that universities charged the full $30,000 for tuition and fees, and instead of funding the universities, each person could apply for $26,000 in federal student financial loans for any five years of their lives at any point between the age of 17 and 77. Is one approach to higher education subsidy better than the other? 

Promoting Affordable Childcare for Everyone Act

 Support Bill [H.R. 2900] University of Illinois-Springfield

Dear Representative Miller,

We are currently battling a child care desert epidemic. Recent studies, orchestrated by Center for American Progress, show “51 percent of people in the United States live in a child care desert” (CAP). There is a scarcity of child care options available to people, which discourages people from having families. Some families cannot afford to have only one parent working, even with federal assistance. At times two would need to work and if there is no child care nearby, what happens to their children? I realize some of your concerns align with a declining birth rate in America. If people felt like they had a strong foundation to support children while still living a decent life and providing their children with an adequate environment, they would be less likely to resort to medical procedures to end pregnancy. People cannot afford to have families with the expenses of childcare. Stated by the Pew Research Center, “In a given county, the median cost per child for paid care in 2018 was anywhere from 8.0% to 19.3% of the median household income in that county, depending on the age of the child, the type of child care program and the size of the county” (Leppert). I am sure that the median has changed after seven years, regardless child care costs are high and it does not include other expenses you may spend on a child.

For example, many parents who are ready to have children are just starting in their careers, or finishing their education.  They may fall in the bottom 30% of household incomes, which would leave them with an after-taxes-and-benefits income of less than $3,500 per month. After paying for their rent or mortgage, they might be left with less than $2,200 for all other expenses, and daycare for children ranges between $600 and $2,400 per month.  Given these economic realities, it should not be surprising that birth rates are declining and some young people still choose to end pregnancies for economic reasons.

With all being said, I would like you to support H.R. 2900 (Promoting Affordable Childcare for Everyone Act). If you are not convinced that this would be the best solution at this time, please write back or schedule a meeting to further discuss. If this is something that you also find passion in, please share it with your political allies. When the time comes, I ask that you consider supporting The Child Care for Every Community Act. It is a bill that provides universal child care for all children in America. For the majority, it would cap childcare costs at 7% of a parent’s income, but make it free for those with lower income. The act died a couple years ago and is planned to be reintroduced at some point. If you would like to get in touch with those leading the PACE Act, Representative Claudia Tenney and Brad Schneider are taking charge.

I appreciate you taking the time to read my letter. Child care is something I am passionate about, since I work at one and realize how important it is to the families. The relationships and bonds children make with their teacher demonstrate how all children should be cared for in that way. I look forward to hearing your thoughts and ideas for the bill.

Thank you,

______________________

C: ________________

E: avatsandoval@gmail.com

Sources https://www.ffyf.org/resources/2025/09/118th-congress-bipartisan-child-care-legislation-addressi ng-supply-cost-accessibility-and-quality/

https://prekcaucus-castro.house.gov/about

https://tenney.house.gov/media/press-releases/congresswoman-tenney-reintroduces-promoting-af fordable-childcare-everyone-act#:~:text=Government%20Shutdown%20Resources-,Congresswo man%20Tenney%20Reintroduces%20the%20Promoting%20Affordable%20Childcare%20for%2 0Everyone%20Act,keep%20up%20with%20today's%20economy. https://childcaredeserts.org/2018/

https://www.pewresearch.org/short-reads/2024/10/25/5-facts-about-child-care-costs-in-the-us/

This is a fine letter.  You explain a problem and offer a solution.  It occurred to me that you are writing this letter to a very conservative Republican, and I wanted her to understand the sort of economic circumstances people have at the 30th percentile (almost the same as the mean income of people in the second quintile).  What does child care cost these days?  What do people at that income level earn these days?  I wanted to show her that at the level of having a household income at the 30th percentile, child care costs without subsidies or assistance would cost between 28% and 105% of monthly income after taxes, benefits (e.g., EITC and SNAP), and housing. Leaving very little for transportation, food, and other necessities of life. 

It's good that you pointed out that the cost of childcare would be covered by families with higher incomes, but everyone would have a cap, and the subsidies or vouchers to help lower-income households afford childcare would be means-tested.  This would be an important point to make with anyone who complains about excessive government spending (not just ultra-conservatives like Representative Miller—I also would question making childcare free to everyone if that meant subsidizing childcare expenses for families in the top 40% of the income distribution). 

You also ask for a meeting with Representative Miller.  Your tone is polite and respectful.  And you make a specific "ask" from her concerning specific legislation.  These are all good aspects of the letter. 

Advocacy Letter to help social work become more affordable

Dear Lindsey LaPointe,

My name is _____ ________ and as an aspiring social worker I am writing to ask for your support for the urgent need to transition all social work internships from unpaid to paid positions. This change is not only essential for upholding the social justice principles at the heart of our profession, but it is also a vital step toward strengthening the future social services workforce. I will be addressing three key points such as student debt, financial inequity, high cost of living and how they affect interns, and why it is good to have paid internships. Please oppose the continued practice of public universities in Illinois charging social work students tuition for their field placements and assigning students to internships and field placements where they work without any pay or compensation because it creates financial inequities and leave unpaid interns without essential labor protections.

Using the “principal beneficiary test,” police internships are assessed under the Fair Labor Standards Act (FLSA) to see if interns qualify as employees who need to be paid. Although “for-profit” businesses must pay their employees under the FLSA, interns may not be considered as employees and are therefore not compelled to receive payment for their work. The FLSA principal beneficiary test applies to social work interns, because their placements are unpaid because they occur in non-profits and government agencies, which are generally exempt form FLSA wage requirements. I am advocating for the Fair Labor Standards Act to be changed so that it will classify interns as employees and be entitled to minimum wage.  

As a State Representative, I know you can't change the federal Fair Labor Standards Act, but Illinois should have a state-level law that does what I propose, and if agencies and universities cannot afford to let social work students do their field placements without paying tuition, nor can they pay stipends to those students, then I would like the state to provide funding to universities and agencies that help social work students gain expertise in field placements to reduce these costs for Illinois social work students.

Unpaid internships create financial hardships for interns in the real-world by requiring them to work for free while still needing to cover basic living expenses, and sometimes even pay for college credit. For example, I attend the University of Illinois Springfield (UIS) as an undergraduate student majoring in social work. In addition to the internship credits (for which I must pay tuition), I’m taking out extra loans to pay for living expenses in a new city. Since I have an internship from Monday through Friday from 8:00 am to 4:30 pm and class from 6:00 pm to 9:30 pm, I am unable to work part-time. This has created significant financial hardship for a position with no income. I continue to struggle with financial support for housing, food, transportation, and other expenses.

I have also spoken with peers who graduated with a Bachelor of Social Work (BSW) and Master of Social Work (MSW) who are still in debt for more than $70,0000, which is made worse by hundreds of hours of unpaid labor. According to the news article by Metz & Bonila, “MSW students graduate with an average of $68,0000- $76,000 in student loans, burdening social workers and their families for decades after graduation.” Metz & Bonila also disscused how social work education in the U.S. is experiencing a decline in student enrollment across all degree levels and believe that paying social work students for their mandatory internships could help reverse these issues. 

Research has also shown that social work interns in the U.S. are not the only ones who face difficulties with unpaid internships. In the article, “This Unpaid Placement Makes You Poor,” Morley et al. (2023) argues how field education costs are also a burden for international social work interns. According to a study done in 2023 by Morley et al. Australian social work intern’s face financial difficulties during unpaid placements. The Morley et al. (2023) gathered data from 372 interns about their financial situation, income, and how they managed to support themselves during placements. According to the findings, 66% of interns are worried about their financial situation, 17% of interns go without food and other basic necessities, 50% of interns have a weekly spending deficit, and 25% of interns must work at least 20 hours a week to make ends meet (Morley et al., 2023). This demonstrates how the current placement structure is not financially sustainable for many students, potentially affecting their well-being and ability to complete their studies. 

In order to implement a change where social work internships are paid, we need to find a way to secure funding for these positions. We could start by getting various stakeholders, including academic institutions, government officials at both state and federal levels, and organizations that benefit from social work interns, to agree to contribute financially. Sources of funding could include public grants, funding from universities, or policy changes that mandate or incentivize paid internships. In the U.S. and Australia, Metz & Bonila, discussed how they are forming groups like “End Placement Poverty” and “Payment for Placements (P4P)” movements to demand that universities, government agencies, and internship sites start paying social work interns for their labor.

While internships serve as educational opportunities, paid interns would not only help alleviate financial issues but also improve the quality and future of the social work field by valuing student labor, attract a wider, more diverse pool of talent to the social work field, and address the long-term workforce shortage in social services because interns are more motivated and invested in their work, leading to better outcomes for clients and agencies. Thank you for your time.

Sincerely,

Jasmine Gaines

References

Metz, E., & Bonila, P. O. (n.d.). Can paid internships save social work? Global Social Service Workforce Alliance. https://socialserviceworkforce.org/blog/can-paid-internships-save-social-work/

Morley, C., Hodge, L., Clarke, J., McIntyre, H., Mays, J., Briese, J., & Kosleck, T. (2023). This unpaid placement makes you poor: Australian social work students’ experiences of the financial burden of field education. Social Work Education, 43(4), 1039–1057. https://doi.org/10.1080/02615479.2022.216150

US Department of Labor Wage and Hour Division. (2010). Fact sheet# 71: Internship programs under the fair labor standards act. https://www.dol.gov/agencies/whd/fact-sheets/71-flsa-internships

This is an example of issue advocacy, where you bring a problem to the attention of someone in government and suggest why the problem must be solved and make some general recommendations of how the problem might be solved.  The problem of unpaid internships and tuition expenses for students who must do field placements or practicums in non-profit or government sectors (including social workers, school teachers, and most nursing students, but also some political science and exercise science students) could be addressed at the federal level or at the state level.  You have decided to write your letter to a person in the Illinois General Assembly, so it's appropriate for you to emphasize the importance of state-level interventions to solve the problem.  Also, you wrote to a member of the state General Assembly who is herself a social worker, and that makes sense.  Maybe you could have written this letter to all three of the social workers in the General Assembly. 

I think you make a good point when you highlight declining numbers of students earning social work degrees just as the demand for qualified social workers is increasing. You also make a good moral argument about the unfairness of the situation. Although Representative LaPointe is a liberal (a progressive), so arguments based on care and justice ethics are likely to work best, if you included Haas (a Republican), you would probably have emphasized more the effort of social work students to become financially independent as self-reliant professionals, and said something more about the tens of thousands of dollars in student debt that newer social workers may cary as they enter the field, and how those debts might drive them from the social work field into fields using similar skills and paying significantly higher salaries (management in corporations, human resource officers, sales, etc.).