Universal Health Coverage in the face of Donald Trump’s tweet on Obama Care.

Friday, 16 March 2018

Kawaldip Sehmi, IAPO's CEO, explores the attempts made in the USA  over the years towards Universal Health Coverage and more specifically what the present situation means in the face of the current president Donald Trump's tweet. All this is a foreshadowing of one of the sessions at the 8th Global Patients Congress.

Last week during our Global Congress Planning Committee site visit to review the accommodation and conference venue in Miami Dadeland, I took a walk into the local Pinecrest community to see how the locals live, work and play.

It is a very calming forested area that our patient advocates will like. During the walk, I met a resident fishing on a secluded canal near the Coral Pine Park and started talking with him. Fishermen have tall tales to tell no wonder, Ernest Hemmingway, America’s greatest short story writer, was a fisherman and a Miami resident.

Miami is full of canals. It sits on the edge of a great moving body of fresh water, the Everglades. For some residents having a boat to commute is just as important as having a car. To this fisherman, this secluded canal amongst the many powerboat commuter runs near our Congress hotel was a refuge where he could sit on a Sunday and contemplate on the slow business of catching the legendary Big Mouth fish in these waters.

My new friend was very reflective. He told me that while Miami was a dynamic city, with its multicultural and multi-ethnic communities where it was all ‘happening’, it was not representative of the United States of America (USA).  In many parts of the USA, social change happens very slowly. In fact, you don’t even notice this snail’s pace change as it happens in small slow increments taking decades. My friend continued that the USA is very risk-averse. America does not want to live in ‘interesting times' (purportedly a Mandarin curse in China).

The wise fisherman, however, noted that every quarter of a century the USA is sometimes ‘blessed’ with a messianic President who tries to bring about a paradigm shifting rapid social change that is tied to his term of office; this is typically always during his second four year term when if he is re-elected by a large majority makes him bolder! 

Here, by the bank of the canal on Sunday, this senior citizen was cushioned from Greater Miami where it was all going on as the first hordes of Spring Break USA university students flocked into the city for a ‘great time’.  

As he was a retired man and most people in the USA dream of retiring to Florida as the weather and tax incentives are great for senior citizens, I asked him about healthcare systems.  With senior citizens living longer and with polychronic diseases and a need for polypharmacy, what happens here?  He said that the ‘conservative’ approach to change is best illustrated by USA‘s resistance to alternative healthcare financing. The USA political leadership and policymakers are extremely phobic to universal health coverage.

The World Health Organization defines universal health coverage as ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services. Universal health coverage is now a major target in the Sustainable Development Goals 2030 (Target 3.8).

We know that Franklin D. Roosevelt (FDR), the thirty-second president (1933-1945) and a polio patient, first dreamt of creating a universal health care system guaranteeing healthcare to all USA citizens. He was a product of his time and his health condition, very much like the United Kingdom’s Prime Minister Clement Attlee. These men were horrified by the plight of their people during the Great Depression and the Second World War. The returning war heroes were being met with very poor healthcare services. They wanted change.

FDR’s health suffered, and he had run out of steam in realising his significant economic reform programme the New Deal; a 1930’s package of federal programs, public work projects, financial reforms and regulations enacted by him to tackle the Great Depression. FDR died without finishing the universal health coverage programme and his legacy, despite subsequently being picked up by the Democrat Presidents Harry Truman (1945-53) and Lyndon B. Johnson (1963-69), stalled.  

Meanwhile, across the pond the USA ally United Kingdom and its Prime Minister Clement Attlee and his charismatic Health Minister Aneurin (Nye) Bevan achieved the impossible and established their universal health coverage the National Health Service in July 1948; it is based on three core principles of meeting the needs of everyone, free at the point of delivery and based on clinical need, not ability to pay. Interestingly, the NHS is 70 years old during this Congress year.

History repeats itself. While the healthcare debate happily rattled along the healthcare policy country road in the USA for the next 60 years, a change in the White House reignited the FDR dream again during the second term of office of 44th President Barack Obama (2009-2017). He was the quintessential messianic president who wanted to surpass FDR’s New Deal.  He was shocked by the 2014 Commonwealth Fund International Health Policy Survey of Older Adults conducted in 11 industrial countries showing that healthcare in the USA was very expensive, reached very few people and had serious quality and safety issues.

The 2014 Commonwealth Fund International Health Policy Survey of Older Adults revealed that the United States had spent $ 3 trillion on healthcare, about one-sixth of the economy, in 2014 and this was more per capita than any other country in the world. In return for this high price tag, the USA is the only high-income country without universal health coverage, with over 12 percent of the population without health insurance coupled with a health system with a very bad patient safety record.

This shocked President Obama and he enacted the Patient Protection and Affordable Care Act (2010) to restart the FDR UHC dream.

At our Global Patients Congress in the USA we will open with a special session on universal health coverage. We will hear about how Taiwan set-up its new national Health Insurance and how it is learning to engage patients, and from the NHS the grandparent of all UHCs with a long history of patient engagement. But the key story we all want to hear is on the fate of the first green shoots of a USA UHC the Patient Protection and Affordable Care Act (2010). We are looking for an appropriate speaker!

We have all heard in the global media of President Donald Trump and the Grand Old Party’s strategy of death by thousand cuts for this legislation. Lately, we all saw a tweet by the President who said:

The Democrats are pushing for Universal HealthCare while thousands of people are marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!  12:11 PM - Feb 5, 2018

Many advocates supporting the Sustainable Development Goals 2030 and the setting up of universal health coverage in all 193 UN Member States want to hear about Democrat Senator Bernie Sanders’ campaign ‘not to leave anyone behind’ as he pushes universal health coverage in the USA. He has picked up FDR’s old dream and wants to turn it into a reality.

It will make a great opening session and light up our Congress. Be there to hear and understand it all. We don’t want to leave anyone behind.