INTRODUCTION

The United States is one of the wealthiest nations in the world, but that wealth does not correlate with the extent to which all U.S. residents are able to meet their basic needs. Many Americans find that they need to take on a “side hustle” to earn enough to pay for their basic living expenses. On the other end, the wealth of the top one percent of income earners continues trending upward. The healthcare delivery system is just one example which highlights the disparities worsened by the widening wealth gap. A significant portion of American residents receive their healthcare through employer sponsors. Thus, it follows that access to care is largely dependent on whether that individual or a family member has an employer that can and will sponsor that care. Even under the shadow of one of the most significant overhauls of healthcare in recent memory, the Patient Protection and Affordable Care Act (“Affordable Care Act,” “ACA,” or “the Act”), many remain uncovered. The United States, a member of the United Nations, is a signatory to several different covenants providing guidelines for the provision of adequate conditions for the flourishing of human rights and wellness. However, whether the United States’ obligations under these covenants can be satisfied while relying on a system so deeply commodified and dependent upon one’s access to employment is ripe for debate.

This article explores the history and rationales for the current structure of the U.S. healthcare system and analyzes the various weaknesses existing in the current scheme. Part I will outline the historical realities underlying the progression of the U.S. healthcare system’s development. Part II will explain the key provisions of one of the most consequential changes to the U.S. system: the Affordable Care Act. Part III will examine the shortcomings of those key provisions and the consequences of those weaknesses in the context of the United States’ international law obligations. Part IV proposes the single-payer solution to the issue of access to care, guided by international legal interpretations of human rights and the example set by Canada as a signatory to several of the same international covenants the United States has either ratified or acknowledged. This section also addresses reasonable counterarguments to the single-payer proposal. Lastly, this article concludes by proposing an overhaul and reframing of the key considerations for U.S. lawmakers as they work toward strengthening health-related law and policy.