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This chapter demonstrates how the coalition of insurance companies, managed-care firms, and small businesses destroyed a proposal for home care for disabled people in the 1980s, and notes that the same coalition also attacked President Clinton's plan for universal health care in the 1990s. It begins by discussing long-term care for the weak elderly, then looks at another revival of the national health insurance and introduces the Consolidated Omnibus Reconciliation Act of 1985, which tried to fill the gaps within the private health insurance system. The chapter then studies health policy making after the Health Security failed.

This chapter provides an alternative moral framework for analyzing health financing. In the health capability paradigm, continuous universal health insurance is essential for human flourishing. Its central ethical aims are to ensure individual health, develop health functioning and agency, and enhance security. Universal health insurance requires resource redistribution, regulation and public goods creation. In contrast to mainstream economic theory, behavioral economics and prospect theory, the health capability paradigm's view of health insurance focuses on individuals' exposure to risk and their ability to manage it adequately, rather than their preferences regarding it. Under this paradigm, universal health insurance is morally justified because it ensures human flourishing and protects against vulnerability and insecurity. Unlike existing theories in medical ethics, a distinction is made between the promotion of equal access to health care and equal access to the gains in well‐being that accrue from risk pooling and health insurance. The chapter concludes with empirical evidence on the equity of health financing models and examines the public sector's role in creating equitable and efficient health systems, providing public goods and buffering market failures.

This chapter examines archetypes of health care systems, from various European national health systems to the centrally planned model of the former Soviet Union and the market-driven US model. The chapter then analyzes two key health care policy approaches: primary health care and universal health coverage. It provides illustrations of recent and ongoing health system reforms across all world regions (covering China, Thailand, the Middle East, Brazil, Mexico, South Africa, South Korea, and India) that address—to varying degrees—questions of regulation, financing, resource allocation, the nature of service provision, and principles of universality, access, affordability, quality, and equity within the politics of their context. In addition, it provides an overview of the building blocks of health care systems including facilities, different types of health care personnel, problems around health workforce migration, technology, and the powerful role of the pharmaceutical industry.

Some people object to social minimum programs, including certain health care programs, because they believe the programs impose excessive taxes and other personal costs on those who fund them. This chapter argues that the most plausible philosophical reconstruction of this objection would rely on a personal cost principle which says that, in general, the proper level of the social minimum is at least partly a function of whether the benefits provided by the social minimum programs outweigh the costs, when judged on a scale that assigns disproportionate weight to those who bear the costs. It is argued that the personal cost principle can find a place within several plausible theories of justice, and that, in addition, the benefits of a well-designed universal health insurance system outweigh its costs.

In the twenty-first century, globalization of trade, travel, and culture is likely to impose complex effect on health protection: increased trade is likely to improve material access and services but also bring harm to health and the environment; travel and human migration enrich human experience but also exacerbate health threats such as the rapid dissemination of communicable diseases; and globalized food production and ineffective regulation of food production have led to adverse human health outcomes. This chapter discusses ideas that bridge traditional public health disciplines and concepts to enable multidisciplinary actors to examine, plan, act, and implement together to protect human health and well-being. This chapter also explains how health protection might be linked to some important global policies such as Sustainable Development Goals and the New Urban Agenda. Specifically, ‘One Health’, ‘planetary health’, and ‘sustainable development’ allow the conceptualization of the relationship between human, other living organisms, and eco-system.

Priority-setting is fundamental to the fair and efficient pursuit of universal health coverage (UHC). This chapter addresses the key choices in selecting services for UHC and the alternative criteria, tools, and processes to guide these choices. The authors first describe the choices decision-makers have to make on the path to UHC and the recommendations by the WHO Consultative Group on Equity and Universal Health Coverage for how these choices can be made. Using Thailand as a case study, the authors examine how the Thai government has set priorities in its pursuit of UHC. Against this background, the authors discuss alternative criteria, tools, and processes for guiding service selection and the design of benefit packages for UHC. When doing this, the authors consider past experiences in Thailand and other countries and examine how recent developments and the insights from the preceding chapters in this volume can provide directions for the future.

Some people express concern that social minimum programs might be ineffective, inefficient, counterproductive, or unnecessary. This chapter focuses on three specific worries about efficacy that are often expressed in real-world debates about universal health insurance: the worries that universal health insurance systems would not improve aggregate national health, that they would reduce medical innovation, and that they would produce waiting lists. The first is best addressed using purely factual information, but concerns about innovation and wait lists require philosophical analysis. The chapter argues that concerns about innovation and wait lists are philosophically misguided.

This chapter considers two different ways of organizing revenue collection in statutory healthcare schemes: social health insurance and taxation. The two models are commonly referred to as ‘Bismarck vs Beveridge’ after the men associated with the origin of these systems: the first German chancellor Otto von Bismarck (1815–1898), and the British economist Lord William Beveridge (1879–1963). The differences between these two compulsory prepayment schemes are discussed and compared with private health insurance. Based on a simple diagram introduced by the World Health Organization, three dimensions of coverage are illustrated. Some policy dilemmas are highlighted when attempting to achieve universal health coverage. Finally, various combinations of public and private prepayment schemes are discussed.

Strengthening health systems in poorer countries has long been a focal point in development aid debates. Visionary models of comprehensive primary health care caught the global imagination in the late 1970s but were quickly eclipsed with the rise of neoliberal globalization in the 1980s, truncated into ‘selective’ silos appealing to donor nations. ‘Investing in health’ for economic growth eclipsed more humanitarian principles for health assistance. Corporate philanthropies began to set health agendas resonant with those of a century earlier, while private health care financing and delivery models that grew under neoliberalism’s first wave (structural adjustment) have yet to yield to the evidence of the efficiencies of public health care models. The current push to achieve Universal Health Coverage captures the ongoing tension between the interests of private capital and the need for public goods.

This chapter documents recent legal and political developments regarding the constitutional right to health in Brazil, where a broad social acceptance of this right continues to propel movement towards an equitable universal health system. It begins with a history of Brazil and an overview of the nation’s health. It then discusses human rights and accountability in Brazil; the availability, accessibility, acceptability, and quality of healthcare; limitations on rights under domestic laws to protect public health; the history of failures with respect to the human right to health; and future national directions towards the right to health.

This chapter explores the seminal topic of Universal Health Coverage (UHC), an objective within the Sustainable Development goals. It reviews the theory and definitions that shape the current conversation on UHC. The movement from selective primary health care to UHC demonstrates a global commitment to the progressive realization of the right to health. However, access to UHC is limited by barriers to care, inadequate provision of care, and poor-quality services. To deliver UHC, it is critical to align inputs in the health system with the burden of disease. Quality of care must also be improved. Steady, sufficient financing is needed to achieve the laudable goal of UHC.This chapter highlights some important steps taken by countries to expand access to quality health care. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

Wealth inequality is much sharper in America than all other industrialized countries. The income of the richest 1% Americans has soared while the income of ordinary people either decreased or stagnated in recent decades. However, America used to be a rather middle-class society. It was not before the 1980s that the G.O.P.’s far-right branch grew more influential in challenging the oppression of “big government.” New Deal era policies were gradually abandoned and wealth inequality soared. Ronald Reagan claimed that “fascism was really the basis for the New Deal,” and his heirs followed suit in denouncing the federal government’s “tyranny.” Overall, the center of the U.S. political debate on economic issues is drastically more to the right than in Europe, Canada, Australia, and New Zealand. The Democratic Party is far less devoted to the interests of the poor, the working-class, and the middle-class than other left-wing parties in the West. The G.O.P. tends to cater only to the richest of the rich, unlike virtually no other major conservative party in the modern Western world.

In the last few decades, several initiatives have been undertaken by Government of India to increase access to essential health services. A framework for UHC was also developed by a High Level Expert Group (HLEG). The recently developed National Health Policy of India also espouses equity, universality, and affordability among its key principles and commits higher financial resources with emphasis on Primary Health Care. For UHC to be viable, it has to be embedded in a broad based framework of health assurance, based on a conceptual model that extends from financial protection, across a well-functioning health system, to the social determinants of health.

Many assume that the health sector is the central government agency for health. Yet very often, health sectors are actually “illness care” sectors that give little concern to the production or maintenance of health. This chapter argues that this state of affairs needs to change so that health sectors do become stewards of the health of the population they are established to serve. Achieving such a health sector will require strong and determined leadership that is able to ensure that curative functions are effective, while also ensuring that disease prevention and health promotion flourish. This is vital to governing for health. This chapter examines the importance of primary health care, disease prevention, and health promotion. The chapter plays particular attention to community strategies, including community ownership of health services, and public health functions, including health impact assessments and Health in All Policies.

One cannot discuss the ethics of health policy without understanding how health systems work, so this chapter provides background on the American health system before and after the Affordable Care Act. It also describes two universal health insurance systems the U.S. could adopt. In Canada’s single-payer system, the government serves as the basic insurer for the entire population. In the regulated-market systems of Switzerland and the Netherlands, citizens must purchase health insurance through private companies, and the government’s main jobs are providing subsidies to less wealthy individuals and ensuring that insurance companies deal fairly with citizens. The chapter concludes by examining the core ideas behind consumer-driven health care, a set of specific policies that conservatives often add to their health care proposals.

Most Americans see the need for a national health policy that guarantees reasonable access to health insurance for all citizens, but some worry that a universal health insurance system would be inefficient, create excessive fiscal risk, or demand too much of them, either by increasing their taxes or by rendering their own health insurance unaffordable. After describing these three objections and the role they play in health care debates, the introduction outlines the contents of each chapter. It concludes with some remarks about how data will be handled in the book’s later chapters.

This chapter explores how various social determinants affect people’s health status. Drawing on UK health outcomes data segmented by class, it considers claims that the benefits of universal health care are marginal. It argues that universal health care not only confers benefits to particular individuals, but also improves population health by providing health security. Health security, or the lack of it, is a crucial multidimensional indirect effect of a society’s health care system on the population’s well-being. The chapter first considers the definition of health and how health is related to health systems. It then examines the link between social factors and health inequalities in the UK before commenting on the debate over health care reform in the United States.