As the contenders and seconds in the United States’ presidential duel continue slapping each others’ cheeks with allegations about who loves Medicare more, Mexico has quietly (at least in decibels heard north of the border) achieved universal health coverage for all of its citizens.
That Mexico could join Canada, Britain, or Israel, among others, in providing for all of its citizens may seem especially remarkable given the country’s frequent one-dimensional depiction as a dystopian narco-state.
And of course, coverage isn’t equivalent to care. Mexico’s health system isn’t perfect, as a policy paper appearing online in The Lancet on Thursday made clear: “As for all countries,” wrote the paper’s 18 authors, led by Felicia Marie Knaul of the Harvard Global Equity Initiative, “quality of care is a moving target for Mexico.”
Mexico achieved universal health care, in part, by taking a diametrically different tack from the U.S.: Rather than strengthening the link between employment and the provision of insurance, Mexico severed any such tie and made health care a universal (and a constitutional) right. As a result, many of the lessons learned in the nine years since the nation began its Seguro Popular program and managed to cover 52 million previously uninsured (in a population of 100 million) Mexicans are not as immediately germane in the U.S. as they are to say Colombia, Ghana, Turkey, or Thailand.
There are lots of aspects of Seguro Popular that would be manifestly unpopular in the U.S., where even Obamacare’s minor shifting of oversight and direction to government generated howls. Besides the obvious nonstarter that the federal and state governments would be on the fiscal hook for the whole program, which is built on a public insurance plan, mandatory health checkups and federal electronic health registry of all citizens would inevitably set off libertarian klaxons. Providers, by the way, are a mix of public and private entities.
But for those who worry about tax burdens of supporting health care, it’s worth noting that the average Mexican’s out-of -pocket costs are falling (those can afford it are required to pay some premium costs) while their health outcomes are improving.
But overall spending, as a percentage of the gross domestic product, has risen, from 5.1 percent in 2000 to 6.3 percent in 2010. (It was 17.9 percent in the U.S. in 2010.) Mexico’s government is spending more on health, and the federal bureaucracy that controls it has seen its budget rise by 142 percent in that same period. Nonetheless, as an editorial accompanying The Lancet paper argues, “Health reform, done properly, boosts economic development.”
Mexico is not the United States. Its population is poorer, younger and on the whole less litigious. Expectations may be more muted. There’s a dearth of specialists, and many of its remote areas are truly remote.
Nonetheless, it’s worth restating: Mexico has achieved universal health care.