Universal health care: how to become a national hero

When you look down the list of countries with universal health coverage (UHC) – as we do with our NHS – there at the bottom is the United States with the date 2014 followed by a question mark.

This list was on the website, Truecostblog.com, and they ask that with the Supreme Court’s decision to uphold Obamacare in 2013 and with President Obama’s inauguration to a second term, will the United States join the 32 developed nations who have universal health care?

Obviously the blog is out of date because history (albeit recent) has now given us that answer and the answer is no. The US will not be joining those other nations. While the President-elect Donald Trump appears to have rowed back on threats to repeal the Affordable Care Act, currently UHC seems a long way off in the US.

Yet at a meeting organised by Action for Global Health to celebrate the third ever UHC day, one of the speakers on the panel (which I was chairing) said that he believed President Obama would one day be credited with having moved America’s poor closer to UHC than any other President.

Robert Yates, head of UHC policy forum, at the Centre on Global Health Security, Chatham House, has long argued that achieving UHC is hugely electorally popular – that it can win elections.

This will resonate in any country. We only need to look to past elections in the UK when promises to invest in the NHS (or to save the NHS, as it is more often put) have been vote winners.

But look further back to the creation of the NHS in a Britain that had barely started recovering from the Second World War and was in turmoil, especially financially.

A universal health system paid for out of taxes was hugely popular and has remained so. And the man who pushed through the legislation, Aneurin Bevan (pictured above), has been glorified ever since.

The argument is that countries, particularly those who are post-conflict or fragile, could capitalise on the human need for universal access to healthcare.

The WHO definition of UHC is “all individuals and communities receive the health services they need without suffering financial hardship”. It is also one of the Sustainable Development Goals (SDG3)

There are 400 million people who lack access to one or more essential health services and every year 100 million are pushed into poverty because of the cost to them of accessing healthcare.

Mobilising and increasing countries’ own domestic finances will be essential in order to move towards UHC. But just as the UK – post WWII – relied on US aid to help rebuild, we now in turn have the expertise to help others develop systems, processes and technology to put in place UHC.

And while DfID is currently under scrutiny for some of its spending decisions, the department is universally recognised for work it has carried out in developing countries to help them move towards better health system.

So much more than political will is, of course, needed. There are countries who need help with infrastructure, developing health financing systems, education, and especially training and retention of medical staff.

But as a first step, so the argument goes, persuade presidential candidates that they could not only win an election but turn themselves into a national hero simply by giving their citizens access to universal healthcare.

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