Last year, at a high-level meeting, the United Nations issued a political declaration on universal health coverage, reaffirming that “health is a human right.” The UN had previously passed a resolution in 2012, urging countries to accelerate the progress towards universal health coverage and declaring Dec. 12 as “Universal Health Coverage Day.” 

Universal Health Coverage has become a major policy priority in many countries, and a significant and growing focus of attention in our nation with some presidential candidates espousing a Medicare for All strategy. UHC has also become a recent topic of discussion in our island, and Gov. Lou Leon Guerrero included UHC as a goal in her recent State of the Island Address. UHC has become a global movement embraced by leading healthcare authorities, and organizations such as The World Bank and the World Health Organization have designated UHC as a core global objective.

Historically, the discussion on UHC in our nation dates back to 1912 when President Teddy Roosevelt supported a national health insurance plan that was promoted by the American Association for Labor Legislation. 

Germany was the first country in the world to start the implementation of UHC in 1883 — about 15 years prior to the Spanish acquisition of our island. The ACA expanded coverage and the initial goal was to achieve UHC, but evidently the law itself has evolved through time and now faces another challenge at the Supreme Court.

 According to WHO, UHC means that all people in a society are able to obtain the health service that they need, of high-quality, without fear that the cost of paying for these services at the time of use will push them into severe financial hardship. Based on WHO statistics, 18 countries around the world have achieved true UHC according to the definition. The United States is the only country out of 33 developed nations without UHC.

Some countries have achieved UHC through mixed funding models using tax revenues as the primary source of financing, while other countries have supplemented funding with additional payments or the option of private insurance for services not covered by the tax funded public system. The countries that have made the most progress in providing UHC have implemented mandatory contributions through taxation, and/or compulsory earmarked contributions for health insurance.

For instance, Japan has universal coverage but does not use a single-payer system. Coverage is mainly provided via thousands of competing health insurance plans in the Statutory Health Insurance System. The Swiss have one of the largest private healthcare sectors in the world, providing choice and competition.  Canada’s universal and publicly tax-funded system, known as Medicare, provides relatively equitable access to physician and hospital services through 13 provincial and territorial tax-funded public insurance plans. However, around 65% to 75% of Canadians have some form of supplementary health insurance to pay for services that UHC does not provide.

The key objectives in UHC include affordability, availability of essential services, sufficient system capacity of trained health workers, policies to address social determinants of health such as education, living conditions and household income, and more importantly, sustainability. UHC however, does not mean free coverage for all possible health services and conditions as countries or jurisdictions need to implement a sustainable and viable system that does not task or burden its citizens with unaffordable tax or fee increases.

It is clear that UCH will continue gaining relevance around the world and will especially gain further traction after nations of the world deal with the current global epidemic of the coronavirus.  This epidemic has exposed gaps in the health systems of many nations, and has shocked the global health system.

Our island should embrace UHC as a goal for our citizens, but the devil will be in the details and specifics of any plan that is developed.  The political policies which have to account for both federal and Guam laws, must also include a fair financing mechanism to achieve balance and sustainability. The steps taken to reach the goal cannot be abrupt   or disruptive, and must include both private and public discourse and involvement.  As stated earlier in this article, the discussion on UHC has been around the world even prior to the Spanish Armada reaching our island, and it will take some time for our island to develop and implement a viable and financially sustainable system. mbj

— Frank Campillo is a health plan administrator at Cavlo’s Select Care Health Plans. He can be reached at [email protected].