Contrary to popular belief, the United States has had universal healthcare with automatic enrollment and a penalty for opting out for decades: Medicare. Upon the 65th birthday of any United States citizen or legal resident, the person in question is pulled into the Medicare system of health benefits, open enrollment plans, and medication payment initiatives. With this history of implementing broad, social standards for the betterment of society as a whole, it makes sense to try to extend this same system to the greater masses.
With respect to the justice of doing so, one must approach this from a public health standpoint. If the majority of people are gaining good quality, inexpensive, and accessible treatment for their general health concerns, the majority of people will then use this benefit and better the overall health of the country. This will consequently add to the work capacity of the nation, overall happiness, and quality of life of the general population.
The issue, however, arises in the United States in particular, when any policy seems to impede on social liberties normally tied to autonomy. With the implementation of a marketplace healthcare “shopping” system, the choices available for coverage seem to be limited. However, I believe that it is a positive trade-off given that the quality and cost are being adjusted to better suit the consumer. There is still an aspect of choice involved with partaking in the marketplace system and the general population maintains or gains more benefits. If that is the main issue with the use of such a system, especially one that is already accepted as a social good for the elderly, I believe it is negligible and can be set aside to better public health policy.
I am a bit confused about what you mean when you say, “when any policy seems to impede on social liberties normally tied to autonomy”. I think that the Healthcare Exchange that has been implemented with the Affordable Care Act actually provides a number of different plans, health care insurers, etc. People also have the ability to opt out of paying for health insurance on a number of different grounds. In many foreign countries, everyone pays into a pool so that all citizens can receive healthcare. Even if they don’t believe in seeing a doctor or in modern medicine, they are still paying so I actually think that the US gives more choice in the matter.
The health care system you are proposing reminds me a lot of Canada’s healthcare system in which everyone pays taxes to entitle them to free care, but that care is privately provided. Instead of the government running the healthcare system like in many European countries, the Canadian government pays private hospitals and doctors for their services. I think that this is a better solution because it still follows a market system in which people can choose their own doctors and facilities. This holds medical providers to a higher standard because it encourages them to deliver the highest quality care so that they can be competitive with other providers and have patients choose them. It would allow the US to promote the principles of beneficence by delivering care to people who need it, without eliminating the existing health marketplace system.
My only fear with a system like this that healthcare would turn into a marketing competition and only focus on results and stop caring about the patients as people. If hospitals and doctors are competing for funding from the government and “customers” in the form of patients to keep their jobs and their businesses booming, then the health and concerns of the patient only matter in the fact that you want to keep the customers happy. If everyone has to pay for health care, and all the money is coming from the government, then it takes the patients kind of out of the equation. Doctors may convince patients to undergo surgeries and procedures that are unnecessary in order to get more money from the government. Also, doctors might turn down high risk patients who need a surgery to survive because they don’t want to look bad and receive less funding if the patient doesn’t survive. I know this is a really extreme example, but once hospitals and doctors begin to focus on successes and competing with other hospitals, healthcare is no longer beneficent to the patient because their health and concerns are no longer a central part to healthcare.