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What is universal health coverage?

Universal health care coverage refers to systems in which all residents of a particular geographic area or country have health insurance. An early example of universal health coverage was Germany in the 1880s, when Chancellor Otto von Bismarck introduced a series of bills that guaranteed access to health care. Today, most industrialized nations, including France, Switzerland, and the United Kingdom, but not the United States, provide comprehensive health care coverage to their citizens.

Although the United States leads the industrialized countries in spending on health care, it has worse health outcomes and services are provided to a smaller proportion of the population. Now, the healthcare system is suffering further from the double burden of the coronavirus pandemic and the loss of income from elective surgery and routine medical care that was suspended during the pandemic. A response to the COVID-19 crisis, according to everyone from New York City Mayor Bill de Blasio, to the World Health Organization and Pope Francis, will provide Americans with universal health coverage.

Understand universal health coverage

There are at least three types of systems that can ensure that everyone in a jurisdiction is covered for medical and hospital care. These include the requirement or obligation to have health insurance, the provision of insurance (but not care) through a single government payer, and social medicine, where the government administers the insurance and Medicare.

Types of universal health coverage

Medical insurance is required

Some governments require all residents to purchase health insurance or face a fine or penalty. The government may subsidize a portion of the premiums, but most of the insurance is provided by private companies. For example, the German system includes both for-profit and non-profit insurance companies. The demand for health insurance has helped some countries, including Germany, the Netherlands and Switzerland, to achieve universal coverage.

In the United States, the Affordable Care Act of 2010 created similar requirements and regulations. The original "individual authorization" of the law imposed a tax penalty on people who did not purchase health insurance. The Tax Cuts and Jobs Act (TCJA) abolished the sanction as of 2019.

Some US states (California, Massachusetts, New Jersey, Rhode Island, and Vermont) and the District of Columbia impose their own penalties on those who do not purchase health insurance. Since 2006, the state of Massachusetts, for example, has required its residents to obtain health insurance or pay a fine. This helped boost insurance rates to 97.5% in the state.

Single payer insurance systems

Under a single payer system, the government pays all healthcare costs using tax revenues. This allows countries to control costs, in part, by making the government play a greater role in negotiating health care prices. Health insurance is comprehensive and is provided by a single entity. However, the medical care itself is provided by private doctors and hospitals.

Examples of this model include Canada and France. In both countries there are also private insurance companies, but these play a secondary role as providers of supplementary coverage.

National health systems

In these systems, the government provides both insurance and health care.

In the UK's National Health Service, for example, the government owns most of the hospitals and employs medical service providers. The publicly funded Swedish system provides care primarily through government service providers, although private companies play a limited role. Social systems are less common than single payer systems.

Special Considerations

In the United States, the ACA increased the number of people insured, but failed to achieve universal health coverage.

 At the end of 2018, long before the coronavirus outbreak, the proportion of American adults without health insurance was 13.7%. 86% of the rest have health insurance through a combination of state and private insurance companies.

In the world of employer-based insurance, large companies often use a combination of private insurance and self-insurance to cover a percentage of their employees' healthcare costs.