What does universal health coverage really mean? This is the definition of universal health coverage from the World Health Organization (WHO).
Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
This definition of UHC embodies three related objectives:
- Equity in access to health services – everyone who needs services should get them, not only those who can pay for them;
- The quality of health services should be good enough to improve the health of those receiving services; and
- People should be protected against financial risk, ensuring that the cost of using services does not put people at risk of financial harm.
In 1948 WHO’s constitution declared health care a universal human right. The organization works with countries on health care financing to make universal health coverage a reality. The key concept here is the belief that health care is a right, not a privilege. As a physician, this seems like a no-brainer to me. Yet that view is controversial here in the United States. Many people espouse the view that health care should be available to all, yet believe that it’s too expensive. The other political issue that hinders universal health care in the US is the philosophy that government involvement in health care is too intrusive into individual privacy and that states should make decisions about healthcare.
Let’s take the first point first. When we say that something is too expensive, what we really mean is that it isn’t a priority. If a member of your family develops a life-threatening illness, health care suddenly becomes first priority, and you rearrange your finances to make sure that your family member gets the necessary care. We don’t leave funding of the military to states, because it is a priority. We decide, by electing our congress people, what our priorities are.
The Harvard Review published a great article in May of 2015 discussing this issue. The article points out that many poor countries have been able to initiate affordable health care for all citizens at a reasonable cost. Thailand and Rwanda are good examples. Their infant mortality rate has decreased and life expectancy increased. The key, according to the article, is that countries have to be committed to the principle that everyone deserves access to health care, and they must have their act together, meaning that everyone is on the same page, to make it happen. I don’t think we are on the same page about anything at the moment.
Now let’s look at the second issue – the privacy, big Government Issue. How does offering everyone access to health care invade privacy? If you choose not to go to the doctor, that is still your choice. As far as government involvement in healthcare, we already have it – Medicare. I don’t think most seniors would want to give that up. It’s not completely free, but it is affordable for most seniors. While the program is not perfect, and not all physicians take Medicare, acceptance by the medical community has improved. Government programs do not have to be fraught with complicated regulations if managed by the right people.
Another prevailing view is that low-income people get health care because doctors won’t turn people away. Before the ACA, some doctors did see low-income patients on a sliding scale. But many people still couldn’t afford the fees. There were some clinics for low-income people, but they still have to be funded somehow, usually by the state or federal government. Many low-income people used the emergency room (and still do) for primary care. But who pays for that? We do. It increases the cost of health care because hospitals have to compensate for it. They key to long-term good health is not acute care – just taking care of the problem at hand. It’s preventive care. That requires visiting a primary care practitioner often enough to head off potential problems.
Universal health coverage can take different forms in different countries. I’ll discuss some of them in the future. No system is perfect. But they all came into being because governments were committed to the idea that health care is a right, not a privilege. If you believe that, you have to conclude that all people deserve access.
Check out the Harvard Public Health Review article “Universal Healthcare: An Affordable Dream,” vol. 4, Global Health, May 2015 (harvardpublichealthreview.org).