Report: Universal healthcare in any country requires mandate


WASHINGTON, April 24 (UPI) -- The United States is the wealthiest and most powerful nation in the world but when it comes to healthcare coverage, it is only on par with developing nations like Ghana and Brazil, a Council on Foreign Relations report states.

The CFR conducted a roundtable discussion Tuesday on the findings of its newly released report -- "The New Global Health Agenda: Universal Health Coverage" -- which deals with the economic advantages of universal healthcare.


Universal healthcare coverage, the panel participants agreed, is the goal for all societies but each comes with its own set of political, social and infrastructural challenges to providing and guaranteeing access to affordable healthcare.

"It is a question of whether it is both feasible and desirable to try and build health coverage without resting it heavily on risk pooling," said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations.


"That means some sort of mandate that both the well and the sick are in the same pool, sharing the same burden. It is probably the only way to financially make it affordable for a community, a society, a country, a whole people."

Daniel Altman, the director of thought leadership at Dalberg Global Development Advisors, a global development consulting firm, stressed that the most efficient way to cover citizens is through a universal system that protects a population from birth to death.

Keeping everything under one roof, he said, allows providers to keep costs down and negotiate prices with drug and medical supply companies.

"This is the genius of insurance, as any economist will tell you, that you're able to pool risk with a large group so that at no time do you have to make some extraordinary outlay in order to cover your costs," Altman said.

Good health, Altman added, is the most important factor for a country to be able to get its development off the ground, even more than education. More than 20 percent of the U.S. budget goes toward healthcare costs.

"If you can get reasonable health status for people in a poor country, there's a much better chance that they'll be able to turn it into a rich country," Altman said.


Alex Preker, a health expert the head of Health Industry and Investment Policy Analysis at the World Bank Group, told an anecdote of a woman in Ghana who tried to take her sick child to a local health clinic.

Ghana built its healthcare system from the ground up after the British colonial period ended and it couldn't support the British-style system. Ghana didn't, however, include an insurance mandate.

The woman took her child to a clinic and because she didn't have health insurance so coverage, the clinic denied care to her child. It was a public relations disaster for Ghana's healthcare workers because, as Preker noted, how could you deny care to a sick child?

However, government officials had decided that without a legal mandate, people wouldn't be motivated to buy coverage if they could just go to the emergency room.

The United States could find itself in a similar situation if the U.S. Supreme Court rules against the individual mandate in U.S. President Barack Obama's healthcare law.

Even with universal access to healthcare as laid out in the Affordable Care Act, without the individual mandate, people would be able to forego an insurance plan and receive care primarily through hospital emergency departments.


The report looks at examples of universal healthcare systems around the world, all of which are successful because they were built from the ground up. The problem in the United States, Garrett pointed out, is that the healthcare system evolved in small, disparate sections that now have little to do with one another and are each beholden to countless interest groups.

"The best we can hope for is to make these fragmentary pieces work together a little bit better, be a bit better regulated." Garrett said. "And that's what the health reform act tried to do."

Even if the Supreme Court rules against the law, the experts agreed that a universal coverage system in the United States is inevitable.

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