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Ethical leadership & multilateral cooperation

America’s health system prioritises profit over care

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Speaking at WalkTogether for Health for All on 8 November in New York, Ban Ki-moon reiterates the universality of the health SDG and urges courageous political leadership to respond to the emerging American consensus for a publicly financed health system.

"With 60% of Americans now calling for a publicly financed health system, now is the time for these political leaders to act."

Ban Ki-moon at #WalkTogether for Health For All in New York in November 2017. (Credit: Andrew Seng)

Distinguished guests, ladies and gentleman.

I am honoured to be with you tonight in this historic New York City hospital—the oldest public hospital in the US—for today’s ground breaking event to call for and support America’s transition to universal health coverage.

I am here in my capacity as a member of The Elders. Launched ten years ago by Nelson Mandela, The Elders is an independent group of global leaders working together to ensure peace, justice, and human rights. I am proud to be the newest member of this group. In the run up to Mandela’s 100th birthday in 2018, The Elders, in partnership with civil society networks, has launched the "Walk Together” campaign. We see this as a continuation of Mandela’s long walk to freedom. Our ultimate aim is to spark hope in the world and celebrate dynamic communities – just like Bellevue Hospital – who are working for the essential freedoms that unite us all: peace, health, justice, and equality.

One of my proudest achievements during my ten year tenure as United Nations Secretary-General was bringing together every country in the world to commit to achieving the Sustainable Development Goals. These 17 landmark goals represent a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity. Importantly, these goals are built on the guiding foundations of human rights, equity, and the shared belief that no one should be left behind. Moreover, they are universal and apply to every nation on the planet, including upper income countries such as the United States.

Given the importance of health to human well-being and sustainable development, SDG 3, “Ensure healthy lives and promote wellbeing for all at all ages,” is specific to public health.

Please note this goal’s emphasis on universality: that ALL people should lead healthy lives.

Of course many different factors affect people’s health, including income level, education, nutrition, peace and security, and environmental factors. But as everyone here can recognize, access to good quality health services plays a crucial role in protecting and restoring people’s health. That’s why many organisations active in global health, including the World Bank, the World Health Organisation, and ourselves at The Elders, are arguing that one of the best ways to achieve our development goals in the field of public health is through Universal Health Coverage (UHC). This can only be possible when everybody receives the quality health services they need, without suffering financial hardship.

We are here today, alongside our partners from the Universal Health Coverage Coalition, to advance UHC and promote Nelson Mandela’s vision of “Freedom for Health.” These are not just mere words. Across the world, bold political leaders have taken their countries towards universal coverage. This includes Nelson Mandela, the founder of The Elders, whose first major social policy in 1994 was to provide free universal health care to all pregnant women and children under 6.

Universal health coverage is built on principles of equity and fairness, with health services allocated according to people’s needs and the health system financed according to people’s ability to pay. Unfortunately, in the US, all too often only rich people get access to expensive, life-saving treatments. This is unjust and threatens everybody’s health when working and middle class people with communicable diseases can’t afford treatments for their infections. And even routine preventative care is often prohibitively expensive. As America is demonstrating, you simply cannot reach UHC if your health system is dominated by private financing and ultimately functions to prioritize profit over care.

In fact, America is the only high income country without a UHC system to provide effective health coverage to its entire population. 28 million American’s lack health insurance and many millions more face unaffordable co-payments when accessing care. This is all the more astonishing when one considers that America spends 17% of its GDP on its health system, 40% higher than the average of other rich countries. Actually, many middle income countries now have UHC – for example Thailand which only spends 4.1% of its smaller GDP on its very successful universal health system. The bottom line is that America’s high health expenditure is not resulting in better health outcomes for its people. Indeed, life expectancy in America is lower than Costa Rica, which has UHC, and its maternal mortality rate is higher than Kazakhstan’s. It simply breaks my heart to see surviving victims of tragic mass shootings then be potentially bankrupted because they cannot afford their hospital and recovery bills. This is one of the clearest indictments of the state of America’s health system today. But there is a better way.

Global evidence shows that the only way to reach equitable UHC is through public financing - either through general taxation or progressive social health insurance. As you are experiencing here in America, switching from a privately financed system to a publicly financed system is inherently political and is often opposed by powerful interest groups in the medical profession, private hospitals, and insurance companies. These groups often spread mis-information and even stifle debate about the benefits of publicly financed health systems - that they eliminate choice or reduce quality. But these are myths and are simply untrue. This is clearly demonstrated by the many publicly financed health systems that have superior health outcomes to the US at a lower cost. If so many other countries can achieve better health care for less, there is simply no reason that the US cannot benefit from these outcomes as well.

You may feel that the current health care battles being fought out in the US mean that UHC is unachievable or a long way off. But the good news is that UHC transitions can occur remarkably quickly as illustrated by the UK in 1948, Japan in 1961, and my own country, South Korea in 1977. What is required is courageous political leadership to take on the interest groups and bring needed health benefits to the majority of the people. With 60% of Americans now calling for a publicly financed health system, now is the time for these political leaders to act.

As the newest member of The Elders and former UN Secretary-General, I hope that you will join us as we “Walk Together for Health for All.” When citizens, governments, and healthcare professionals work together to ensure health for all in every country, we will truly be one step closer to the freedom we all deserve.

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