American foreign policy had built such programs abroad since the Marshall Plan, so why not at home?
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Millions of lives are prolonged or saved throughout the world, thanks to United States-supported health programs. But Americans aren't so lucky. For many, the best way to get affordable treatment at U.S. taxpayers' expense might be to move to a poor country that is committed to building universal coverage, backed by U.S. development aid.
The Supreme Court decision on the Affordable Care Act opens the possibility that the United States may now begin to domestically implement policies that foreign aid agencies and the Department of Defense have long supported, both politically and economically, as elements of U.S. foreign policy. It may now be possible to harmonize longstanding U.S. foreign and domestic policies regarding healthcare access for poor and middle class peoples.
Dating back to the Marshall Plan in post-WWII Europe, General Douglas MacArthur's 1945-1949 occupation of Japan, and then the Korean War, it has been a matter of U.S. foreign policy to invest in the creation of universal health systems. More recently, the Marshall Plan was cited by AFRICOM in support of a Department of Defense engagement in health systems construction across Africa. This year, South Africa was the number one recipient of health aid from the United States, totaling nearly $470 million, much of which is supporting the country's 14-year program to build universal health coverage.
Meanwhile, on the home front, 2012 polling shows that 26 percent of Americans have faced grave financial difficulties due to medical costs, and 58 percent have delayed treatments due to their inability to pay out-of-pocket expenses or insurance co-pays. For those without health insurance or Medicare coverage, a startling 81 percent say they forego treatments, as do 72 percent of poor Americans earning less than $40,000 per year. By 2010, medical bills were the number one cause of bankruptcy in the United States, exceeding housing foreclosure as cause for limiting food, heat, and rent purchasing. Four million Americans declared bankruptcy that year, citing medical costs. A 2011 Department of Health and Human Services study found that the average American patient could only afford to cover 12 percent of their hospital bills, and that failure to gain full reimbursement on such bills accounted for $73 billion in losses for hospitals.
A lack of access to affordable health care also has real health impacts in the United States. In 1950, the United States ranked number five in the world for female life expectancy; by 2009, it had fallen to number forty-six. A 2010 Commonwealth Fund comparison of population health in seven wealthy nations found the United States in last place. Between 1987 and 2006 the number of American women dying from pregnancy-related causes actually increased from 6.6 per 100,000 live births to 13.3 -- a doubling. In nearly all OECD countries, almost all of which have universal coverage, the reverse trend was seen, as ever-fewer women died year by year.
Political pundits will now argue the impact of the U.S. Supreme Court decision and the likelihood that Republican opponents to the health reform law will be able to overturn it through legislation. But perhaps it will now be possible for an HIV-infected individual in Mississippi or Alabama to have access, at taxpayers' expense, to the same level of care as the U.S. government supports for comparable individuals in Johannesburg.
This article originally appeared at CFR.org, an Atlantic partner site.