Saturday, January 26, 2019

Universal health coverage under siege from both the right and the left, in the U.S. and Mexico

Here's a commentary in The Lancet, comparing attacks on the Affordable Care Act in the U.S. and on Seguro Popular in Mexico.

A dark day for universal health coverage, by Julio Frenk, Octavio Gómez-Dantés, and Felicia Marie Knaul

"Dec 14, 2018, was a dark day for universal health coverage (UHC). To begin with, a federal judge in Texas, USA, ruled that the Affordable Care Act (ACA) is unconstitutional.1 That same day, the new President of Mexico, Andrés Manuel López Obrador, announced his intention to abolish the country's largest public insurance programme, known as Seguro Popular (People's Health Insurance).2 The ACA and Seguro Popular have extended health coverage to millions of previously uninsured families, most of them among the poorest in their respective countries. Signed into law in 2010, the ACA roughly halved the number of uninsured, from 46·5 million then to 26·7 million in 2016, towards the end of the Obama administration.3,  4 Following legislative approval, Seguro Popular began full-scale implementation in Mexico in 2004. Public expenditure increased to finance coverage for non-salaried workers and their families, approximately half of Mexico's total population, who were excluded from employment-based social insurance. By 2018, 53 million beneficiaries had access to 290 essential and 65 high-cost interventions.
"The challenge to the ACA has been headed by the right wing of the US Republican Party, whereas the attack to Seguro Popular comes mostly from the far left factions of the President's Morena party. This is an example of the way in which opposing political extremes can converge in their attack against centrist positions.
"Seguro Popular is one of the most thoroughly evaluated programmes in the world. A 2006 Lancet Series set out the evidence base for the design of this innovative initiative.7,  8 A comprehensive review9 published 8 years into implementation identified a large body of peer-reviewed articles, including one of the few randomised assessments of a large-scale social intervention.10 The evidence strongly points to major benefits of Seguro Popular in terms of financial protection and effective coverage,11 without labour market distortion.12 In a recent cover article on UHC, The Economist featured Seguro Popular among the most successful efforts in low-income and middle-income countries, noting how “studies suggest that Seguro Popular has drastically reduced the number of Mexicans facing catastrophic health costs and reduced infant mortality”

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