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Monday, March 2, 2020 Leer en Español

Declaring Health Care “Universal” Doesn’t Make It So

The countries that typically are said to have universal healthcare do not actually meet the World Health Organization's criteria.

Image Credit: Flickr-Molly Adams | CC BY 2.0 (

“Universal health coverage is defined as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation, and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship.”

– World Health Organization

WHO’s definition describes the ideal outcome for a healthcare system. In other words, it is a goal, not a means. Often, however, universal healthcare refers to a government action or policy, or a specific way of producing health care. Much of the healthcare debate equivocates between using “universal” to describe an outcome, or alternatively, a government action.

Map of countries with so-called universal healthcare

Many (if not all) countries which are typically said to have universal healthcare, do not meet WHO’s criteria. Take Canada as an example. A paper put out by the Fraser Institute estimated around 44,000 people died over a 16 year period due to wait times. Obviously, if a person dies while waiting for treatment, then they did not have access to the care they needed.

Canada is not an exception. Researchers concluded that delayed access to a hospital bed led to approximately 5,500 deaths in the UK over the course of 3 years. In a hospital in Sweden last year, only 20% of cancer patients received treatment within the recommended time period. It seems likely that even if a system is doing quite well, there will still be at least a few people who fall through the cracks. Even in the top-tier Swiss system which mandates purchasing health insurance and provides subsidies for those who can’t afford it, there still remains 0.5% of the population who have no health insurance. This does not meet WHO’s criteria for “all people” if we are to interpret it in a strict manner.

Yet curiously, these countries are well-known to have “universal healthcare”. So what’s going on? Well, the definition of universal healthcare is constantly in flux. On one hand, a country’s healthcare system is called universal if the government enacts certain policies. See Wikipedia’s definition for instance:

The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards.

Then, after it has been established these countries have universal coverage, a proponent can switch to WHO’s definition, which is based on the outcome of the system. The implicit assumption then, is that government actions aimed at a goal automatically produce that goal. But as we have seen in the aforementioned countries, intentions are quite different than outcomes.

Moreover, this equivocation causes most people to overlook the possibility of a non-government system that could achieve or come close to the noble goal spelled out in WHO’s definition. Affordable access to medical care can be made possible through a freed market that drives down prices, supplemented with charitable activity and mutual aid. Before the advent of significant government intervention in the US healthcare industry, mutual aid organizations had already made inexpensive medical care available to the poor and working class.

If universal healthcare means affordable access to all, then there is no reason to oppose it. It is in fact, an honorable goal. If, however, it refers to a specific government policy, then it is up for debate whether good outcomes are likely, and not at all a given. At the very least, the equivocation between the two definitions must end if there is to be any honest discussion.

This article is republished from the Principled Libertarian.

  • Andrew Kern is the author of The Myth of the Social Contract: Refuting Common Arguments for Government Authority, and he has written on libertarianism, anarchism, and private alternatives to state authority. He founded The Principled Libertarian website in 2017 with the goal of spreading the ideas of liberty and helping to define what it means to be free. His work has been published by, the Ludwig von Mises Institute, the Foundation for Economic Education, Being Libertarian, and others. You can follow him here.