At its simplest, the universal health care definition is any action that a government can take to provide health care to as many of its people as possible. According to the World Health Organization (WHO), UHC means giving all people access to health services:
• That they need.
• When and as they need them.
• Without imposing financial hardship upon them.
This guide will break down UHC and examine what precisely it means for people worldwide.
UHC, as noted above, refers to a government system or program that guarantees that all people under that government have access to any and all health services they need. The system will provide such services when and as required, without causing financial hardship for the individual receiving them. UHC programs, by design, offer all essential health services. These include:
• Health promotion – Services intended to make people who are not sick healthier or to maintain their good health. Health promotion generally consists of encouraging healthy behaviors and discouraging those that can lead to severe or chronic illness.
• Preventative care – Routine health care services, including screenings, vaccinations, annual physicals, checkups and patient counseling. Other such services include well-woman visits, screening tests and well-baby visits.
• Medical treatment – The management and care of a patient to combat disease or disorder or provide treatment for injury. Treatment includes most medical treatments and drugs (prescription and over-the-counter). It also includes the use of wound-closing devices and devices designed to immobilize body parts, administer oxygen and perform surgeries.
• Rehabilitation– Care that helps a patient get back, keep or improve abilities needed for daily life. Covered abilities may be physical, mental or cognitive. The losses could have resulted from an illness or injury or as a side effect from other medical treatment.
• Palliative and hospice care – Medical services that are not intended to cure an illness or injury but rather to provide comfort or ease where there is little to no likelihood of recovery. Palliative care can be delivered to anyone living with a serious or chronic illness such as heart disease, cancer, forms of dementia and other similar conditions. Death does not need to be imminent or likely for an individual to be eligible for palliative care. On the other hand, hospice care is explicitly end-of-life care that can be delivered at home or in a hospice or assisted living facility. Hospice care focuses on providing comprehensive comfort to the patient without any effort made to cure the patient’s illness. It is generally available to those whose physicians believe that they have less than six months to live.
While the concept of UHC remains at the core of each government's view, the pillars are slightly different. For example, Mexico's Progresa program emphasizes what the country's then-president defines as the four pillars of UHC. They are the clarity of:
• Purpose.
• Design.
• Financing.
• Incentives.
Other programs adopt these four pillars:
• Universal health coverage.
• Financial risk protection.
• Access to quality and affordable essential medicines.
• Vaccines for all.
Indeed, no matter how one defines the pillars, the intent is the same: to provide affordable, quality medical and health services to all persons and do so without patients worrying about the financial details. Citizen debate on UHC in the US is likely to be an important point in the political landscape for many years to come.
The government (which means its citizens) pays for UHC, usually either through income taxes or payroll taxes. The national debt of the United States is currently at historic high levels in part because of COVID-19. This fact limits the ability of the US to think or act creatively in the UHC universe.
UHC guarantees access to all necessary medical goods and services without financial hardship. But, because UHC can be a tremendous government expense, consideration must be given to whether a government can, in fact, afford UHC in its fullest sense. As has been seen with the COVID-19 crisis, health care service to all people is time-consuming and incredibly expensive. American citizens will need to decide if they want to achieve that goal and how they want to pay for it. Every dollar spent on universal health care is a dollar that cannot be spent elsewhere.
The United States spends more on health care than any other country in the world, having spent 16.9% of the gross domestic product on healthcare in 2018. The share of US GDP spent on health care has risen steadily for the past four decades, and each time, health spending has outperformed economic growth. The good news is that much of the price increase comes from advances in medical technology. Rising prices in the health sector and increased demand have also, unfortunately, impacted the growth in health care spending.
Currently, the United States features four primary methods of paying for health care. Each of them presents its own advantages and disadvantages. However, none (separately or as a group) provide anywhere near universal coverage:
• Out-of-pocket payment – The individual patient uses their dollars and pays in cash in full for all services provided.
• Individual private insurance – The individual patient uses their dollars to purchase private health insurance in the marketplace at a market price.
• Employment-based group private insurance – Private employers purchase group health insurance plans that are provided – wholly or partially paid for by the employer – to employees as part of a comprehensive wage and benefits package. Prices are generally significantly below the market price for individual private insurance.
• Government financing – Insurance such as Medicare or Medicaid that government funds pay for.
Despite its comparatively high level of health care spending, the United States is the only one of the developed countriesthat do not have UHC. It does, however, provide health care to particular population groups through Medicare, Medicaidand Veterans Affairs programs. A significant issue in the 2020 presidential election campaign was the universal health care debate surrounding the possible implementation of Medicare for All. Medicare for All is a proposal that seeks to expand Medicare into a single public program. This program would cover all Americans, including US residents, however they arrived in the US. The services would be free at the point of service and funded by tax contributions.
The dilemma of how to provide affordable universal health care in the US has been front and center of federal politics for more than a decade. The Affordable Care Act (ACA), adopted early in the Obama administration, was designed as a first step toward UHC. It was expected to bring many more people under health care coverage at more affordable rates. Unfortunately, ACA increased the costs of health care and insurance for many. This left an overall trillion-dollar increase in annual health care spending in the US over its first eight years.
There are many arguments on both sides on the concept of UHC. And, surprisingly, they do not all divide on a left-versus-right perspective, nor do they necessarily consider an all-or-nothing proposition. Some favor one payment method over another; some prefer the British model over the Canadian model. Others fear what they see as the inevitable rationing of health care and loss of research and discovery that could result from the cost limitations imposed by the nature of UHC.
Universal health care pros and cons include the following.
There are many advantages to UHC, the most obvious one of which is, simply, that everyone has access to medical insurance, and no one goes bankrupt due to medical costs.
Another often-cited advantage is that societal medical expenditures may be lowered because the government controls the prices for medical goods and services. Even medical service providers benefit because of the increased efficiency in dealing with only one payer.
Universal health care benefits also include uniform care to everyone. This leads to a society with a healthier workforce, longer life expectancies and social equality.
On the other hand, the disadvantages of universal health care are equally prevalent. Many universal health care countries have exceptionally long wait times for care.
Moreover, care focuses on younger, healthier patients, while rare diseases, end-of-life conditions and elective procedures fall by the wayside.
Even more critical, UHC can be hugely expensive. Indeed, any government offering UHC will likely face the need for cutting other programs and rationing medical care.
There can be significant benefits to an economy that features UHC. Among these are:
• Salaries and wages can go up because employers no longer have to pay for health insurance.
• Less stress of changing jobs because there is no impact on health care.
• Increased affordability of self-employment and small business development when health insurance costs are not an obstacle.
• Net job increase as job losses in health insurance administration and billing are offset by gains in health care provider jobs.
• Governmental and private employers with more money for other uses, since they no longer have to budget for employee health insurance costs.
The coronavirus pandemic has tended to focus public attention away from UHC. It has also shown that the underlying reasons supporting it continue to be true. Some have even speculated that the pandemic, with its requirement for rapid and universal deployment of vaccines and treatment, is itself an argument for UHC.
Countries that already had strong health care systems are generally responding more successfully to the pandemic,which some view as an argument in support of UHC.
In the United States, the Democratic Party generally represents the left, which has been consistently more supportive of UHC than has the right, as represented by the Republican Party.
While the political right has long opposed UHC, the last decade has seen some changes in that long-held view. Physicians for a National Health Plan argue that UHC provides better care, lowers universal health care cost and creates better societal health results in every country where it operates.
Many other conservatives prefer to see health care provided at the state level. They would do so by offering lump-sum grants to state governments to spend on health care. At the very least, the right professes a healthy skepticism about universal health care and the government’s ability to provide affordable and efficient medical care for all.
In contrast, the political left has been a supporter of UHC. In essence, the left believes that health care is an equal right for all, which should be implemented through a social insurance system. That system should provide universal health coverage, equitable financial arrangements for it, and equality of care for all. It is this viewpoint that, as of 2020, nearly two-thirds of Americans support.
There has long been criticism of the concept of UHC. Among the primary concerns is the belief that both quality and quantity of health care will decline. Countries with UHC often see patients experience long wait times for care or even for an appointment to seek care. There are logistical challenges to developing the system and enormous economic challenges in costs, job losses in health care, and the simple fact that the United States is far more economically and geographically diverse than most countries offering a UHC program. Further, those who see government as generally inefficient and less effective than free markets argue that government-provided health care cannot help but be less desirable than the current market-based system.
The beginnings of what might be called universal health care go back at least as far as ancient Egypt, with more recent historical developments arising with the unification of the German states under Bismarck. By 1948, in the first significant modern example, the United Kingdom had implemented UHC provided through the National Health Service financed by the state.
The United States, in contrast, has struggled for decades with issues relating to UHC. Many on the right attacked the creation of Medicare and Medicaid (under President Lyndon Johnson) as socialized medicine. In contrast, many on the left considered the programs insufficient.
There have been several modifications and extensions of these programs in the decades since. Nonetheless, as mentioned above, the United States remains the only developed country that does not provide its citizens with universal health care.
There are three basic kinds of UHC plans, each with its own advantages and disadvantages:
• Socialized medicine – A system in which employees of the central government own all health care services and providers. The United Kingdom’s National Health Service uses this type of system. While it has been cost-effective over time, it also limits the range of care available. Plus, it can lead to long wait times and rationing of care.
• Single-payer system – In a single-payer system, like universal health care in Canada, the government gives everyone health insurance. However, medical services and providers are still private. This system is more costly than socialized medicine but also offers more choice and somewhat less rationing and wait times.
• Private insurance – The government regulates private insurance companies and requires that everyone buy some type of health insurance coverage. Switzerland works under this system, and the Affordable Care Act was the first step toward one in the US. These types of programs all offer the most choice but are also the most expensive.
The 2020 presidential season brought heavy debate on a fourth type of plan too. It would allow individuals to purchase their own insurance in the marketplace or to buy into existing government insurance programs like Medicare and Medicaid. Many opponents view this as simply a way-station toward a single-payer system.
UHC is a highly complicated issue, made only more complex by the rapidly changing health care situation created by pandemic disease and its related health care crisis. The coming decades will undoubtedly see the United States struggling with the companion issues of evident need challenged by overwhelming cost. As a society, we will have to engage in balancing those two facts.
Wherever you fall on the issue of universal health care, as a young person, you will be the decider in years to come.
The future of health care is your future. You can take steps to affect and implement the health care system that you want. Join in and shape your world.
Young people across America are getting educated about UHC and making changes at their colleges and universities with Up to Us. Sign the pledge to let local representatives know that you are concerned about the nation’s fiscal future and how it relates to health care, or get involved by learning about how you can make a difference in your own community.