The passing of Dolly Parton was a gut punch to those like me assuming she still had many years left to spread kindness on this earth. It was incredible to see how she touched so many hearts well beyond U.S. borders. I got tears in my eyes watching Britain’s King’s Guard play “9 to 5” in her memory. Though her beaming smile may be gone, her eternal optimism remains. We were all just a bit nicer in the immediate hours and days after her death. It seems clear her ability to inspire from beyond the grave (or rather, from the heavens above) will remain timeless. Thinking about Dolly and her boundless productivity motivated me to write my own thoughts down. I’m no songwriter; my trade is health care. So, when it comes to universal health care, What Would Dolly Do?
I previously wrote on KevinMD about how doctors need to lead the much-needed charge for improving our health care system. Then I followed up on that when I wrote about specific changes and even regulations that could improve the system. I know the word regulation gives people pause. Regulation must be implemented by government. Do we really want our government further involved in health care? If you work in health care, you know the VA hospitals don’t have the best reputation; long waits and (at least perceived) subpar care are the expected norm. These are real concerns. Can we expect our government to implement cost-saving and effective regulations regarding health care? I argue yes, we can, when we remove special interests (and their money) from influencing the agenda. Also, no one else, no other entity can. Fear is exactly what keeps us from doing so. Well that and the white-knuckled grip on politicians that the for-profit insurance and drug companies have. As I’ve said before: Fear of concept is not a good argument against regulating monopolies that are bankrupting millions of Americans.
Some politicians are promoting agendas based on fear: Fear of gender identity (Keep males out of female bathrooms and women’s sports), Fear of Islam (Keep Sharia law out of Texas), and Fear of socialism in general. Fear is a great motivator and uniting principle. When politicians capitalize on people’s fear, they aren’t working on or promoting policy with practical solutions or often offering up any new ideas at all. Let’s not forget: “The only thing we have to fear is fear itself.” (FDR)
I understand the fear and stigma when the countries associated with socialism include China, Cuba, and North Korea. At the same time, the word socialism, or at least socialist, is having a comeback. Many political candidates running for government positions this season call themselves Democratic Socialists. Merriam-Webster defines government in many ways, including: “the organization, machinery, or agency through which a political unit exercises authority and performs functions.” Performs functions: That’s the government’s job. Without government and its functions, we are left with anarchy. I argue providing a minimum of health services is one of the functions from both a moral standpoint as well as an economic one. Will we have people abuse and take advantage of the system? For sure. That manipulation by a few is not reason enough for the government to fail to provide for its people. Remember, the United States is the only wealthy, industrialized nation without a universal health care system. That puts us in the company of developing nations like Mexico, Somalia, and the Democratic Republic of Congo.
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If you disagree that the government has a moral or ethical obligation to provide a minimum of health coverage, then consider the economic obligation. The United States currently spends $5.3 trillion or $15,474 per capita on health care. This was a 7.2 percent increase in 2024 and exceeded GDP growth at 5.3 percent. The federal government’s share of national health expenditures (NHE) is expected to continue to increase from 31 percent in 2024 (more than $1.6 trillion) to 33 percent in 2034. Despite such spending, 37 million Americans do not have health insurance, and an additional 41 million have inadequate coverage and/or access. Those numbers should be an embarrassment to Americans, especially when considering we are spending twice as much on health care as those who provide universal coverage while our premature death rate is among the highest. The money we are spending is more so lining the pockets of for-profit companies as opposed to actually improving the health of American citizens.
Will universal health coverage save us money? One 2020 study showed a 13 percent savings ($450 billion) in NHE under a single-payer, universal health care system. A more recent review from July 2026 states a savings of $1 trillion annually and universal coverage could save 114,000 lives annually. Using numbers from a study done by the Mercatus Center from 2018, the total NHE savings would be $318 billion. The author points out, though, that federal commitments would rise requiring an increase in federal taxation and/or debt, while others argue that such a system could be funded with less than what is already supplied by existing government allocations combined with current premiums (both employer and household). So, it seems clear that universal coverage would decrease overall NHE, but it’s not clear whether it would increase or decrease overall government spending on health care. It is estimated that the average “middle-class” family would save $4,400 annually, while the average business would save $9,000 in health care costs for the average employee.
Universal coverage allows greater access to preventative care. Even our government encourages preventative care, for it saves both money and lives. Considering that universal coverage could actually save lives, even an increase in government spending seems worth it. Saving lives makes tallying cost savings immeasurable.
As a recent Instagram meme said: “Dolly Parton’s 9 to 5 is a film about three women taking over an office and introducing free childcare, paid vacation, and flexible hours, resulting in a 20 percent increase in productivity.” And it’s true that Jane Fonda based the movie off the real organization, 9to5, that worked for women’s rights in the workplace including maternity and health benefits. So yes, expanding health care and ensuring that every American citizen has access to at least a minimum of provided health services is something Dolly’s character, Doralee Rhodes, certainly would support. What Would Dolly Do? Even if she were still alive, she would most certainly not publicly comment and avoid this public policy debate altogether. But I’d like to think in the spirit of her kind, generous heart and with her savvy business intellect, she couldn’t object to universal health coverage. Dolly might even support it. That’s what I like to think Dolly would do.
Alisa Berger is a urologist.
