We do not choose the bodies we are born into. Our genetics, environment, and life experiences are products of chance—yet they play an overwhelming, almost determinative, role in our health outcomes. Spotty access to medical care and resources around the world contributes to the plight of millions suffering from preventable disease and chronic pain. Amidst this lottery of living, what do we say to the millions of people for whom the poverty line is a hospital visit, an immunization, or a prescription away? Half of the world’s population doesn’t even have access to basic healthcare services, and every year, about 100 million people are forced into extreme poverty due to monstrously high health expenses. Condemning people to this needless misery is a human rights violation, and nations around the world must offer healthcare to all people in order to begin healing the scars of the past.
This convoluted, menacing beast of limited healthcare access to healthcare looms over developed and developing nations alike, with a grim reaper-like scythe. As defined by the World Health Organization (WHO), universal healthcare (UHC) consists of essential health services for all: services to promote health, prevent illness, and provide quality treatment without subjecting people to financial peril. In 2015, the United Nations General Assembly created a vision board for the world: 17 global goals that would transform the lives of everyone on Earth. These Sustainable Development Goals (SDGs) are essentially a checklist that covers issues of poverty, education, social justice, and health. The third SDG promises to ensure healthy lives and to promote wellbeing for all by ending preventable deaths, epidemics, and deaths via contamination and improving women’s health, substance abuse treatment, and global health management . These goals must be attainedsecured in developed and developing countries alike in order to secure every person’s human rights.
The concept of healthcare is unanimously agreed upon to be important for a healthy society, and almost all industrialized countries do employ some form of government-aided healthcare plan. However, different systems, like single-payer or multi-payer, can greatly impact access to services—leading to disparities even within the most industrialized nations. In practice, aA single-payer system is a form of UHC and would functions a bit like public schools: taxpayer money funds a civic service available to everyone. Canada uses this system, so insurance is financed by the government while the care aspect is handled by the private sector. Thise results ins long lines and wait times, yet this is a single-payer system is a highly equitable and understandable setup. In contrast, a multi-payer system is more individualistic in that people personally take care of their health insurance amidst private and public regulations.
Multi-payer systems can manifest in a number of ways, but they always involve multiple payers to cover medical bills. A primary example is the United States’ healthcare system, which is a convoluted conglomerate of single-payer Medicare, private plans through employers, state-controlled Medicaid controlled by states, and insurance through the Affordable Care Act. Still, millions of people in America remain uninsured. Although the healthcare structure in the US is disorganized, the United States stands as an unparalleled force in the global market of novel pharmaceutical medicine (as measured by the number of patents for new molecular entities and drug spending by inventor companies). Money is funneled into research for drug development, producing molecular medicines that are highly effective but extremely expensive for domestic buyers due to FDAthe regulations of the FDA. These pharmaceutical companies must offer their products at low costs to foreign buyers or run the risk of competing for patents. . While monetary motives do spur incredible advancements in medical progress, the absence of foreign competition creates a disproportionate burden on American drug companies. As a counterexample to the US’ medicine innovation monopply, in the commercial market, many countries compete to champion both low-cost and innovation, further encouraging trade and developing the global market as a whole. That competition is absent in the global medical market. The United States is the current leading source for medical drug advancements, and refuses to sacrifice that title for the greater good and lowered costs forof its citizens. A multi-payer system inherently denies the rights of people who cannot afford care.
Dr. Peter Aronson, an award-winning professor of nephrology and physiology at Yale, told the ground-breaking history of what may have been the United States’ closest encounter with universal healthcare. Daily, our The kidneys filter incredible amounts of our blood daily in order to sufficiently excrete toxins and waste. However, those with kidney failure face a bleak prognosis if they cannot afford dialysis, a treatment in which a patient’s blood is cleaned by a machine for several hours each week. Dialysis is effective, but it is cripplingly costly. In 1972, Congress deliberated for over a month before deciding to pass an unprecedented change to Social Security that granted complete coverage to any person diagnosed with kidney disease. People with renal disease in the United States are now able to access this life-saving therapy. However, with an expression of exasperation, Aronson added that the root of the problem is ignoring preventative care until the effects accumulate into chronic issues.
The moral of the story is that universal healthcare must begin with preventative methods in order to both drastically improve quality of life and be practically beneficial. The new Dean of the Yale School of Public Health, Dr. Sten Vermund, described the field of public health as steeped in the pragmatic. And once wounds are inflicted on the body, the field of medicine comes in, specializing in damage control. Universal healthcare has always invoked the stereotypical hospital scene of sterile white coats filled with robolike doctors and long lines of rolling beds filled with wounded patients. But what if healthcare could be reinvisioned through the lens of public health to provide life-saving preventative care?
While the beneficial effects of bolstering preventative UHC are less visible than the suture dressings and surgical casts typical of hospital care, they deliver comfort, safety, and peace of mind. Prevention, manifested as immunizations, counseling, and disease screening, has been proven to improve patient outcomes. Unlike the US’ current system of innovating medicine, The public-health-based approach prioritizes not only favorable health outcomes but also the implementation of equitable systems, effectively restoring the human right to health. A combination of the ideals of prevention and accessibility for all narrow down three logistic goals for nations: care, cost, and health. North Star Alliance is a network of clinics across Africa that exemplify how developing nations can maximize these three goals . This nonprofit repurposesutilizes big, blue shipping containersby flipping them, which are flipped into portable, roadside clinics—–accessible to underserved populations, such as sex workers and truck drivers. Peer educators interact with the community in order to build credibility and trust. Once in the clinics, IT systems track biometrics and patient files while people receive services for STIs, HIV, malaria, tuberculosis, and other primary healthcare needs. The expansion of healthcare systems is not cookie-cutter; it can be individualized to regional features, population needs, and financial restraints.
Jacob Wallace is an assistant professor at the Yale School of Public Health who conducts research on health policy and the economics of managed care in public insurance programs. He described the financial side to healthcare, pointing out that the economics exist to achieve universal healthcare—the major boundary being political disunity. UHC has not been proven to save highly significant amounts of money. However, Wallace noted that universal healthcare is much more cost-effective in terms of health, quality of life, and self-reported outcomes. One study in Health Affairs that tested the monetary efficacy of 20 proven preventive services recommended by the United States Preventive Services Task Force found that $3.7 billion could have been saved. Although this number seems significant, it only accounts for 0.2% of personal healthcare spending in that year. Some opponents of universal healthcare believe that an overarching government system will limit the free market. However, the Heritage Index of Economic Freedom ranks Switzerland and Singapore much higher than the United States in terms of economic freedom, and both countries have implemented successful universal health insurance systems at significantly less cost than the US. Without sacrificing economic freedom or budget, we can live in a healthier world.
After disproving the myths of UHC and emphasizing its benefits, we can look forward to action. According to health science researchers, there are preconditions in order to effectively accomplish universal healthcare at a national level, in any country. First, a concept of enrollment must be established to guarantee registry of all disadvantaged and underserved populations—leaving no one behind. Second, policy constraints by external governmental bodies should be considered and taken into account. And third, an entity must be named or created in order to implement and integrate the new health structures. This entity will be charged with the responsibility of redesigning services, involving the population, and handling finances. The realization of universal healthcare also requires ethical consideration. It is unacceptable to offer a human right to only those who can pay—and life-saving healthcare should be treated as such. Accountability needs to be institutionalized into any healthcare framework so that progressive policies can be maintained.
At the global level, the best course of action is to invest in the world of medicine. Bolstering funding for pharmaceutical advancements in all countries will equalize drug costs by improving foreign competition. Incentives for medical training will expand the medical workforce, allowing for an accessible labor pool when clinics open, ready for staffing—especially important in developing countries. Creating a sustainable system for education, training, and accessibility of medical resources will allow industrialized and developing countries alike to have a customized healthcare system that promotes wellness and tailored innovation.
Essential services should be available to all who need them. In our neighbors, whether they are across the street or across the world, we see ourselves. The quest to achieve equitable, accessible universal healthcare begins in policy, in community, and in empathy. Through universal healthcare we can begin to change the lives of people who haven’t won the lottery—we can rig the system.