Every developed country except the United States has designed a health care system that covers every resident. That’s why St. Mary’s Hospital in London gave my daughter immediate and competent care for her swollen ear, for free, less than a week after we arrived in Britain. These countries give everybody access to a doctor partly as a moral issue. But health officials in all the countries I visited told me that universal coverage also has pragmatic benefits that make any health care system cheaper and more effective.
This realization helps us answer the question: Which problem should America tackle first? The various shortcomings of the U.S. health care system can be summarized in three words: cost, coverage, and quality. When we set out to fix our system, where should we start? At first blush, it might seem logical to go after health care costs first; once costs are under control, we could more easily afford universal coverage. But everywhere I went on my global quest, I was told that this approach gets things backward. Universal coverage has to come first. Universal coverage is an essential tool to control costs and maintain the overall quality of a nation’s health.
Covering everybody in a unified system creates a powerful political dynamic for managing the cost of health care. Since the costs of medical care are rising around the world, every health care system has to find ways to limit expenses, either by limiting the procedures and medications it will pay for or by cutting the price it pays for the procedures that are covered. If everybody is covered, then everybody has an interest in seeing costs controlled; after all, if the system pays too much for my neighbor’s Botox treatment, it may not have enough money to treat my broken shoulder. In a democracy, universal coverage helps create the political will to accept limitations and cost-control measures within the system. In any country, any decision to ration medical care is going to be unpopular with somebody. But if everyone is included in the health care system, people are more likely to accept a necessary but unpopular decision, because it leaves more money to treat everybody else.
Universal coverage also enhances health care results, by improving the overall health of a nation. If everyone has access to a doctor, then people can get the diagnostic and preventive treatment that will keep them healthy. One of the major reasons the United States ranks low, compared to other rich nations, in standard measures of health care quality is that millions of Americans don’t get any care until they are acutely ill. Universal access to diagnostic and preventive care also reduces costs, because it is much cheaper to treat a problem early than to take heroic medical measures when the illness becomes life threatening.
It may be possible to provide fair and effective health care for everybody in a system where tens of millions of people have no insurance coverage. It may be possible, but no country has ever made it work. In the United States, our incomplete coverage is a key reason that twenty-two thousand of our fellow citizens die every year from diseases that could have been treated if they’d had health insurance. No other developed country wants to do things the way we do.