Universal Health Coverage is Not the Same as Universal Health Care: An Evaluation of the Public Health Economics Behind the Obama-Plan – Or the Flawed Logic Behind a Flawed Goal

18 Pages Posted: 17 Jan 2011

See all articles by Barbara Pfeffer Billauer

Barbara Pfeffer Billauer

Institute of World Politics; International Program in Bioethics, U. of Porto; Foundation for Law and Science Centers, Inc.

Date Written: January 14, 2011


The political solution to the health crisis appears to be an expansion of the health coverage program, perhaps requiring universal and mandatory health insurance. Increased coverage is expected to result in affordable (and available) care, which will translate into earlier diagnoses and more effective treatment, which, in turn, is expected to lower national health costs.

To sustain itself, any feasible insurance program must realize lower health costs, as even maximizing funds by including the young and well in the premium pot will not provide enough funds to cover the health care costs an aging population. However, the goal of universal coverage i.e., maximizing funding, is not the same as improving health or providing more health providers. Consequently, universal coverage per se will not result in lower health care costs, notwithstanding its promises to do so.

The flaws of the current reasoning derive from some (unnamed, unspecified, and uncited) article of faith, - that once health insurance becomes mandatory, competitive and quality coverage will instantaneously materialize which would lower insurance costs. Driving this miraculous state of affairs would be the venerated concept of market-place competition. (What is considered quality care, of course, is not defined, but left to the market to determine.) Augmenting the planned panacea is the expectation of lowered health care costs due to costly wellness plans, prevention programs (much of which is now available for free on the internet), and early detection via increased screening programs. These responses are confused with, but different from, the costs of the insurance (which include administration and underwriting).

Based on the fallacy that the root cause of ill health is late diagnosis, universal health insurance programs advocate early screening - a low cost device - falsely believing that screening prevents disease and that early diagnosis lowers health costs. The increased costs that will certainly result from increased screening - as we begin to detect more cases - is ignored in costing the program. In this article I demonstrate the fallacy of relying on early detection to lower health care costs, demonstrating instead that these programs will increase health costs in a manner that the insurance costs cannot handle, leading to either their ultimate failure and demise of the insurance product or a serious curtailment of benefits that emasculates the entire concept. Instead, I suggest that rather that showering everyone with generic care and screening - our initial focus should be identifying precise causes and the best cures for illnesses, determining whether past data are representative of the current population and hence reflect future disease mortality and morbidity costs. A comparative assessment of the cost of provider services by country is also suggested.

Keywords: universal health care, universal health coverage, right to health, health insurance, universal health insurance, cost of public health, cost of public health screening, constitutionality of health insurance law

Suggested Citation

Billauer, Barbara P., Universal Health Coverage is Not the Same as Universal Health Care: An Evaluation of the Public Health Economics Behind the Obama-Plan – Or the Flawed Logic Behind a Flawed Goal (January 14, 2011). Available at SSRN: https://ssrn.com/abstract=1740509 or http://dx.doi.org/10.2139/ssrn.1740509

Barbara P. Billauer (Contact Author)

Institute of World Politics ( email )

1521 16th St NW,
Washington, DC
United States
+1 202-462-2101 (Phone)

International Program in Bioethics, U. of Porto ( email )

Rua Dr. Roberto Frias
4200-464 Porto

Foundation for Law and Science Centers, Inc. ( email )

1020 16th Street NW
Suite LL1
Washington, DC 20036
United States
972 54 344 6055 (Phone)

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