The trouble with universal healthcare coverage

There's a big difference between universal coverage and access to care.

By Michael Tanner and Michael Cannon

from the April 11, 2007 edition

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Washington - As they tack left and right, state by state, the Democratic presidential contenders can't agree on much. But one cause they all support – along with Republicans such as former Massachusetts Gov. Mitt Romney and California Gov. Arnold Schwarzenegger – is universal health coverage.

And all of them are wrong.

What these politicians and many other Americans fail to understand is that there's a big difference between "universal coverage" and actual "access" to medical care.

Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.

In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip-replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some may well die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not access to health care."

Supporters of universal coverage fear that people without health insurance will be denied the healthcare they need. Of course, all Americans already have access to at least emergency care. Hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance.

You might think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care.

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