President Carter: Lack of Universal Healthcare Should Be a 'National Scandal'

This op-ed written by Gro Harlem Brundtland and Jimmy Carter was published by Time.

Gro Harlem Brundtland is a former Prime Minister of Norway and former Director-General of the World Health Organisation. Jimmy Carter is a former President of the United States of America. Both are members of The Elders, a group of independent leaders, founded by Nelson Mandela ten years ago, who work together for peace, justice and human rights. The Elders are campaigning with civil society partners for UHC as part of the #WalkTogether initiative, highlighting courageous moral leadership in communities around the world. Dr Brundtland is Deputy Chair of The Elders. President Carter is an Elder Emeritus.

"Life, liberty and the pursuit of happiness" are the inalienable rights at the heart of the Declaration of Independence of the United States of America. The text is as dear today to the hearts of the American people as it was when Thomas Jefferson first penned his words nearly two and a half centuries ago.

But these fundamental rights are denied to millions of Americans because they do not enjoy one of the essential foundations of a fair society: the right to health.

Universal Health Coverage (UHC) is a target defined in the UN Sustainable Development Goals, and it is achieved when everybody receives the health care they need without suffering financial hardship.

Twice in the last five years, all countries of the world have gathered in New York and committed themselves to achieve this noble goal, and it is the explicit health priority of the World Bank and the World Health Organization.

The Elders – the group of independent former leaders founded by Nelson Mandela, of which we have the honor to be members – has been campaigning for UHC at a global and national level for the past two years. We believe that it is as vital an issue for the US as it is for any other country in the world, and that with bold leadership from national and state leaders, it could and should become a reality.

Even after the Affordable Care Act slashed the number of uninsured Americans by about 20 million, another 28 million still lack any health insurance coverage. Many millions more who do have insurance still face unaffordable co-payments whenever they use health services.

In 2010, before the implementation of the Affordable Care Act, an estimated 26,000 Americans died prematurely due to their lack of health coverage.

This represents a violation of basic human rights. Millions of Americans cannot live healthy lives, or protect their children from illness or disease.

In a country as rich as the United States, blessed with talented medical professionals, world-class hospitals and research institutes, and an almost unparalleled capacity for technological innovation, the lack of universal health coverage should be a national scandal.

It is all the more scandalous given the extremely high cost of the US health care system, which takes up 17.1 percent of Gross National Product. This is 40 percent higher than the average for high-income countries, but the heavy reliance on private financing leads to severe inefficiencies and inequalities within the system. Around a third of health expenditure is spent on administrative costs rather than infrastructure or patient care.

None of this is inevitable, and a viable alternative is close at hand. For US neighbors and allies such as Canada and the United Kingdom, UHC has been a cherished element of the social contract between government and citizens for decades. UHC is also now an explicit Sustainable Development Goal of all countries, and some developing countries such as Thailand and Sri Lanka are already covering their entire populations.

Why should Americans not enjoy the same health rights as citizens of other countries around the globe? Why does the US have a lower life expectancy than Costa Rica (which has UHC), and a higher maternal mortality rate than Kazakhstan? Why should health care costs remain the biggest cause of bankruptcy in the US, thwarting the hopes and ambitions of hardworking families?

The answer is quite simple: commercial self-interest.

The US healthcare industry, pharmaceutical companies and private insurance firms have assiduously lobbied for decades at state and federal levels to protect their business interests. Their spokespeople and spin doctors distort arguments, so that concepts that are commonplace in almost every other industrialized country are portrayed as outlandish and dangerous.

Challenging this consensus takes political courage and commitment.

President Obama’s health reforms were a step in the right direction, especially in making health insurance mandatory, and not allowing insurance companies to exclude people with pre-existing conditions. Millions of American women also benefited from accessing free family planning services on their health insurance plans thanks to the Affordable Care Act.

But the tide has turned in the White House over the past twelve months, leading the health care debate into treacherous waters. President Trump seems intent on dismantling his predecessor’s reforms, through successive executive orders, including a halt on federal funding to provide health insurance coverage for nine million vulnerable children.

What gives us hope, however, is that the American people do not agree with this approach. A recent poll in The Economist shows that 60 percent of Americans want to see publicly-funded Medicare expanded to cover all citizens, and some political leaders are beginning to respond to their voters’ concerns.

States including California, Ohio, Colorado, Vermont and New York are all seeing moves to bring publicly-financed UHC at a state level. We urge them to lead the way.

The chaos and paralysis surrounding health reform on Capitol Hill must not be an excuse for vested interests to regain the initiative and block progress. Responsible leaders and citizens must come together and demand Americans enjoy the same rights to health as their fellow global citizens.

The Elders will stand in solidarity with you to make Jefferson’s dream a reality.


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