“Even the Costa Ricans have health insurance for all their people.” That was Howard Dean’s old line, when he was talking about all the countries that had universal health care. Today, Dean could also say “Even the Mexicans” or “even the Chinese.”
As Noam Levey reports in the Los Angeles Times, expanding access to health care has become a truly global cause, with even developing countries pushing hard to make sure all of their citizens have insurance or some other way of getting affordable medical care.
China, after years of underfunding healthcare, is on track to complete a three-year, $124-billion initiative projected to cover more than 90% of the nation's residents.
Mexico, which a decade ago covered less than half its population, just completed an eight-year drive for universal coverage that has dramatically expanded Mexicans' access to life-saving treatments for diseases such as leukemia and breast cancer.
In Thailand, where the gross domestic product per person is a fifth of America's, just 1% of the population lacks health insurance. And in sub-Saharan Africa, Rwanda and Ghana—two of the world's poorest nations—are working to create networks of insurance plans to cover their citizens.
"This is truly a global movement," said Dr. Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health. "As countries advance, they are realizing that creating universal healthcare systems is a necessity for long-term economic development."
That last point is important. These countries have come to the same conclusion that every other developed nation on the plane has: Access to health care provides all kinds of benefits, economic as well as social, that more than justify the investment.
That’s not to say these countries don’t struggle with the cost of health care or that the actual delivery systems in places like Mexico or China compare favorably to those in the United States. They do not, based on everything I know. And I'm pretty sure—based on what friends in China tell me, as well as my visit there last summer—that "universal access" is still very much an illusion there. But developed countries in Europe and Asia, from France and the Netherlands to Japan and Taiwan, have demonstrated that it’s possible to provide high quality, convenient care while actually spending less than we do—and yet still make sure every person has health insurance.
Will the U.S. ever get there? The Affordable Care Act will, upon full implementation, bring health insurance to more than 90 percent of the population (and an even higher percentage of legal residents). It will also put in place a system that, if strengthened, could eventually bring insurance to everybody, while starting the hard work of reengineering the medical care system so that it becomes more efficient.
But Republicans in Congress have already tried to repeal the law and Mitt Romney has pledged to do the same thing as soon as he gets to office. The Supreme Court, meanwhile, may get there first, by striking down the measure in part or in whole. If any of them succeed, the U.S. will remain a "developing" country, not a developed one, at least when it comes to making health insurance universal.
Update: A friend from China wrote to remind me that the country is still very far away from universal access. He's right, and I've updated my item accordingly.
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