Even as Americans debate whether President Obama’s health-care law and its promise of guaranteed health coverage should be scrapped, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.
China, after years of underfunding health care, is on track to complete a three-year, $124 billion initiative projected to cover more than 90 percent of the nation’s residents.
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Mexico, which a decade ago covered less than half its population, completed an eight-year drive for universal coverage that has dramatically expanded Mexicans’ access to life-saving treatments for diseases such as leukemia and breast cancer.
In Thailand, where the gross domestic product per person is one-fifth that of the United States, just 1 percent of the population lacks health insurance. And in sub-Saharan Africa, Rwanda and Ghana — two of the world’s poorest nations — are working to create networks of insurance plans to cover their citizens.
“This is truly a global movement,” said Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health. “As countries advance, they are realizing that creating universal health-care systems is a necessity for long-term economic development.”
Many countries are struggling to improve the quality of their medical care. And making health care affordable remains a challenge for most countries, as it does for the United States, where about 15 percent of people lack coverage.
But the international drive to provide health care for everyone is leaving America behind.
“We are really an outlier,” said David de Ferranti, a former World Bank vice president who heads the Results for Development Institute, an international nonprofit organization based in Washington.
That stands in stark contrast to the United States’ historical leadership in education, he said. Long before most European countries, the United States ensured access to public schooling. Today, it is alone among the world’s richest nations in not providing health-care coverage to all citizens.
Though the new U.S. health law is scheduled to do that in 2014, former Massachusetts governor Mitt Romney, the presumptive Republican presidential nominee, has promised to repeal it. Romney’s alternative does not include any provision to guarantee coverage.
Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal health-care systems amid a drive to set up free-market economies. But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.
Some countries have set up public systems like those in Great Britain and Canada. But many others are relying on a mix of government and commercial insurance, as in the United States.
“People are demanding responses from their governments,” said Cristian Baeza, the World Bank’s director for health, nutrition and population. Indeed, in countries such as India, politicians have learned that one of the surest ways to secure votes is to promise better access to health care.
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