Universal Coverage - It's Happening in Mexico

When people say that universal coverage in America is a pipe dream or that the Affordable Care Act is simply too expensive to implement, just look south to Mexico.  That country, despite a much smaller GDP than the U.S. and terrible problems with drug violence, has achieved universal coverage, including the coverage of over 50 million people who were previously uninsured.  Fifty million.

Starting in 1996, the Mexican government decided to make access to care a priority.  They reached this decision because they wanted to improve the quality of services being received by the Mexican people, and because they believed that Mexican citizens were entitled – had a right – to healthcare.  Also, there was an overriding belief that undertaking reform would actually save money over the long run.

What happened?  By 2012, 345 specific treatments were covered under the combined programs of Seguro Popular (basic coverage packages) and FPGC (catastrophic illness/injury packages).  And did I mention that over 50 million people who were previously uninsured now had the ability to access care?

Of course, the Chicken Littles here in the U.S. would immediately talk about unsustainable costs.  But the costs savings that Mexico expected did in fact materialize.  Before health reform, 2.3 times as much public money was spent per capita on the uninsured as on those who had insurance. After the reforms were fully implemented, that discrepancy was down to 1.2.

Like the other country I studied, Germany, the Mexican system is imperfect and they continue to deal with a variety of challenges.  But Mexico has achieved far more than we have been able to in the U.S.  Are we content with that?  Are we not exceptional enough to at least equal Mexico’s accomplishments?

Next Stop: México

I now turn my attention to Mexico, where I will be spending much of July to study healthcare and immigration in that country.

Some examples of my work there will be meetings with personnel from ABC Hospital and learning about the delivery of state-of-the-art care; visiting the city of Zacatecas to speak with the Director of State Health Services and to learn more about the delivery of care in rural settings; a session with Javier Lozano, founder of Clínicas del Azúcar; and a conference with Dr. Gudelia Rangel of the Mexican Department of Health.

I have high hopes for the trip.  Mexico continues to be a very important relationship for the United States, and a valued trading partner for the State of Missouri where I live. More to the point, many of the people Casa serves are of Mexican origin and I hope this trip can be part of a collaborative effort to share best practices around the issues of health literacy, disease management, access to care, and data collection & evaluation.

Mexico represents the second half of my Eisenhower Fellowship travels, having first gone to Germany.  I'll take this opportunity to make one last comment about Germany for now.  I read with great interest a very recent report by the Pew Research Center about the similarities and differences in viewpoints between Germany and the U.S.  One thing that stood out was the question about “the most important event in the U.S.- German relationship.”  Of the 963 Germans who answered, a full 20% said the Marshall Plan, the American initiative to help Germany and all of Europe rebuild, named after Secretary of State George Marshall.

Seven decades after the end of WWII, that act of American generosity and forward-thinking still resonates and is considered by many Germans as the defining event for U.S. – German relations.  This is a reminder that we can be most successful when we look beyond ourselves, and that America is most exceptional when we frame our challenges not solely on how they play out domestically but also within the context of the community of nations.