Trump’s concerns about big insurance could be alleviated with universa… – Vicksburg Post

Analysis of U.S. Healthcare Policy in Relation to Sustainable Development Goals

The pursuit of universal health coverage (UHC) is a central tenet of Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. This report examines the current discourse on healthcare policy in the United States, particularly focusing on proposals and political dynamics that impact the nation’s alignment with SDG 3, as well as SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities).

Current State of U.S. Healthcare and Alignment with SDG 3

The United States remains an outlier among developed nations for not having a system of universal health coverage. This gap presents a significant challenge to achieving SDG 3.8, which calls for UHC, including financial risk protection and access to quality essential healthcare services for all.

• The Affordable Care Act (ACA): The ACA represents a step towards UHC by expanding coverage through subsidized private insurance marketplaces. Recent political efforts have focused on extending these federal subsidies, which are critical for making insurance affordable for millions and thus advancing the goals of SDG 3 and SDG 10.
• Political Polarization: A historical political divide has hindered comprehensive healthcare reform. Universal healthcare initiatives have often been characterized as “socialism,” creating a barrier to policies that could accelerate progress towards SDG 3.

Evaluation of a Proposed Policy Shift

A recent proposal suggests a fundamental change to the ACA subsidy structure, which has significant implications for financial risk protection, a key component of SDG 3.8.

Financial Implications and SDG Impact

The proposal involves redirecting federal subsidies from insurance companies directly to individuals. An analysis of this approach reveals potential shortcomings in achieving SDG objectives.

1. Subsidy Insufficiency: According to the Congressional Budget Office, federal ACA subsidies to insurance companies totaled approximately $92 billion in 2023. In contrast, Americans’ out-of-pocket healthcare costs reached $500 billion.
2. Financial Risk Exposure: Distributing the $92 billion directly to individuals would likely be insufficient to cover the costs of serious illness or accidents. This would undermine the principle of financial risk protection central to SDG 3 and could increase poverty due to medical debt, directly conflicting with SDG 1.
3. Erosion of Risk Pooling: The insurance model functions by pooling risk across a large population. A shift away from this model without a comprehensive public alternative could leave individuals with major medical needs financially vulnerable, thereby increasing health and economic inequalities, a setback for SDG 10.

Universal Health Coverage as a Solution for SDG Attainment

The challenges associated with subsidizing private insurance have led to renewed consideration of universal health coverage as a more direct pathway to achieving SDG 3.

• Public Option Models: Systems such as “Medicaid and Medicare for all” or a public option are presented as logical alternatives that align more closely with the principles of UHC.
• Implementation Flexibility: A UHC framework could be designed in various ways, potentially allowing individuals who prefer private insurance to retain it, provided it is not federally subsidized, while establishing a public system to guarantee coverage for all.

Conclusion: Political Branding and the Future of UHC

The primary obstacle to implementing a UHC system that would align the U.S. with global health and development goals appears to be political. The debate has shifted to include the branding of healthcare reform, with proposals to rename potential legislation “Trumpcare.” While seemingly superficial, overcoming political branding issues may be a pragmatic step toward achieving the substantive policy goal of universal health coverage, thereby making significant progress on Sustainable Development Goals 1, 3, and 10.

SDGs Addressed in the Article

The following Sustainable Development Goals (SDGs) are connected to the issues highlighted in the article:

• SDG 3: Good Health and Well-being: The entire article revolves around ensuring access to healthcare for all citizens. It discusses various models like “universal health care,” the “Affordable Care Act,” and different funding mechanisms (subsidies), all of which are central to achieving good health and well-being for a population.
• SDG 1: No Poverty: The article highlights the significant financial burden of healthcare on individuals. It mentions that out-of-pocket costs totaled “$500 billion for Americans” in one year and describes the “impossible-for-most task of paying those tens of thousands of dollars in health care costs” for a serious illness. This directly connects to how high medical expenses can push people into poverty or prevent them from escaping it.
• SDG 10: Reduced Inequalities: The debate over universal health care versus a system of private insurance with subsidies is fundamentally about reducing inequalities in access to essential services. The goal of “ensuring everyone has medical coverage at little or no out-of-pocket cost” is a strategy to ensure that health outcomes are not determined by an individual’s income or wealth, thereby reducing a major source of inequality.

Specific SDG Targets Identified

Based on the article’s content, the following specific SDG targets can be identified:

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   This target is the central theme of the article. The text explicitly discusses the concept of “universal health care” which it defines as “ensuring everyone has medical coverage.” It also addresses the financial risk protection component by contrasting the current system’s high out-of-pocket costs with the goal of providing care at “little or no out-of-pocket cost.”

2. Target 1.3: Implement nationally appropriate social protection systems and measures for all…and by 2030 achieve substantial coverage of the poor and the vulnerable.

   The Affordable Care Act (ACA), with its “enhanced subsidies for private insurance,” is presented as a national social protection system designed to make healthcare more accessible. The article’s discussion of extending these subsidies and the political debate around them directly relates to the implementation and strengthening of such systems to protect the population, particularly the vulnerable, from high healthcare costs.

3. Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.

   The article analyzes different fiscal and social protection policies for healthcare. It discusses the current policy of providing “$92 billion in federal ACA subsidies” to insurance companies and contrasts it with an alternative proposal to give “the money for health care directly to the American people.” This debate over how to structure and fund healthcare is a core example of using policy to address inequality in access to essential services.

Indicators for Measuring Progress

The article mentions or implies several indicators that can be used to measure progress towards the identified targets:

1. Indicator 3.8.1: Coverage of essential health services.

   This indicator is implied throughout the discussion of “universal health care” and ensuring “everyone has medical coverage.” The article references a potential scenario where “thousands of Mississippians could go uninsured if premiums rise,” directly pointing to the importance of measuring the proportion of the population with health coverage.

2. Indicator 3.8.2: Proportion of population with large household expenditures on health as a share of total household expenditure or income.

   The article provides concrete data related to this indicator. It states that “out-of-pocket costs – those not paid by the insurance companies – totaled $500 billion for Americans” in 2023. It further emphasizes the risk of catastrophic health expenditure by mentioning the “impossible-for-most task of paying those tens of thousands of dollars in health care costs” for a serious illness, which is precisely what this indicator aims to measure.

3. Indicator 1.3.1: Proportion of population covered by social protection floors/systems.

   The discussion centers on the ACA’s marketplace exchange, a social protection system for health. The fight to “extend enhanced subsidies” is a direct effort to maintain or increase the number of people covered by this system. The amount of federal spending on these subsidies, cited as “$92 billion in federal ACA subsidies in 2023,” is a measure of the scale of this social protection effort.

Summary of Findings

Source: vicksburgpost.com