Talk:Universal health care/Archive 4

Discussion re UHC map and SHP map
I removed poorly sourced, NPOV-violating, contentious, disputed maps and the confusing, contentious, disputed usage of the term "social health protection." The repeated readdition of contentious, disputed NPOV-violating material without consensus by Obiwankenobi (talk | contribs) is unacceptable. Contentious, disputed material stays OUT of Wikipedia until an editor obtains consensus for its inclusion. Apatens (talk) 21:44, 26 July 2013 (UTC)
 * Hi Apatens. You seem rather angry here. Did you notice that I had provided 4 separate sources that equated the terms? Please tell me what was wrong with those sources. Thanks. I note that SHP has been in the lede since mid-2012 without dispute, so it was removal of SHP that requires consensus.--Obi-Wan Kenobi (talk) 21:47, 26 July 2013 (UTC)
 * As for the map, I answered your questions on the disputed figures several months ago; you didn't respond, then you come back several months later with the same arguments. If the ILO map is so bad, can you find any sources which say so? Otherwise, just saying the ILO data is flawed is itself OR. Better yet, do you have more recent information from the ILO that might fix the inaccuracies that you found?--Obi-Wan Kenobi (talk) 21:49, 26 July 2013 (UTC)
 * As evidence that the ILO data is not considered flawed by most researchers, see this search which shows many other papers referencing the ILO one. Again, I admit there may be typos/flaws that you have identified, such as Israel, so if we find better figures we could just update the map accordingly.--Obi-Wan Kenobi (talk) 22:01, 26 July 2013 (UTC)

Your understanding of how Wikipedia works is ass-backwards. Contentious, disputed WP:NPOV-violating material stays OUT of Wikipedia articles until there is consensus for its inclusion. You have to prove to other editors that material is accurate and unbiased and obtain consensus for: • Why should this Wikipedia article include a map that makes an WP:EXCEPTIONAL claim that 90% health insurance coverage = universal health insurance coverage, instead of the common use and everyday understanding that 100% health insurance coverage = universal health insurance coverage? • Why should this Wikipedia article use a non-standard definition of universal health insurance based on a definition used in one obscure conference paper? • Furthermore, why should this Wikipedia article contain a WP:OR map that has been altered from the source map in that one obscure conference paper which misrepresents that conference paper? • Why should this Wikipedia article include a map that makes an WP:EXCEPTIONAL claim based on erroneous International Labour Organization statistics that U.S. health insurance coverage = 100%? • 2011 U.S. health insurance coverage = 84.2%, 84.3%, or 84.9% according to the Kaiser Family Foundation, US Census Bureau, and OECD, respectively. • Is "social health protection" a synonym for "universal health coverage" or "health coverage" or some different, unquantifiable concept? • Why is the following unintelligible caption used for a map of health insurance coverage percentages based on the error-laden "Table A2.2. Formal coverage in social health protection" on pages 83–90 of the 2008 ILO paper " Social health protection: An ILO strategy towards universal access to health care. Social security policy briefings, Paper 1 "? Note: The Social health protection figures from ILO used in this graph are one of three inputs to the indicator used in the map in the lead for determining which countries have Universal Health Coverage; as such, some countries may be shown with high levels of coverage here that nonetheless don't meet the legislative or service delivery thresholds for Universal Health Coverage. Your answer several months ago was that the ILO was infallible and that unless I proved to your satisfaction that they were not, your maps MUST stay in your article, and that the discussion should be moved to a Wikimedia Commons talk page that no one would read. Your Google Scholar search proves absolutely nothing. It does not say that other reliable sources back up wacky WP:EXCEPTIONAL claims that "90% = universal" or that the U.S. has 100% health insurance coverage. The onus is on the editor repeatedly reintroducing–without consensus–poorly sourced, NPOV-violating, contentious, disputed material making WP:EXCEPTIONAL claims, to provide multiple, independent high quality sources for their WP:EXCEPTIONAL claims. It is not MY responsibility to find sources discussing, analyzing, and contradicting the details of how a map in an obscure 2010 conference paper was constructed, or how erroneous data was concocted in a table of an obscure 2008 ILO paper, and carried over into a map and a table buried in a lengthy 2010 ILO publication. Non-standard definitions and erroneous data abound in little-read "scholarly" publications and are usually passed over and ignored by their miniscule audience of readers. Non-standard definitions and erroneous data in little-read publications only become an issue when the editor who WP:OWNs the "Universal health care" article insists that the maps they created MUST remain no matter how asinine and ridiculous their WP:EXCEPTIONAL claims, because WP:BRD. Contentious, disputed material should not be repeatedly reintroduced into this article without talk page consensus. Apatens (talk) 01:20, 27 July 2013 (UTC)
 * 1) inclusion of a map that says 90% health insurance coverage =  universal  health insurance coverage
 * 2) inclusion of a map that depicts the United States as having 100% health insurance coverage
 * 3) the meaning of the term "social health protection," whether the term should be used in this article, and if so, how
 * I hardly think the ILO is an obscure organization, and the google scholar search demonstrates that that particular paper is heavily cited in the literature. I also provided four sources backing up the claim that SHP is sometimes called UHC and vice versa. There is no claim made that they are synonyms - the claim is 'sometimes called', which one of the sources says directly in as many words. This is an article about a topic, and in literature about this topic this term is sometimes used. id be happy to clarify in the lede or elsewhere that some definitions of UHC contrast with some definitions of SHP but we arent doing a service to the reader by leaving out all mention of this term, so why dont we tone down the rhetoric and find a better way to word it. Fnally, you really seem irritated at the ILO number of 100% For the US. However as has been pointed out to you multiple times, this is not a health insurance coverage figure, it is a social health protection figure, which is clearly defined in the ILO paper - they aren't the same thing. If you want to add different material elaborating on actual full health insurance coverage in the US and distinguishing it from SHP then please do so. Finally, the paper I found is one of the few that sets a threshold for achievement thereof, and it too has been cited in the literature. I'm sure better papers will come along with different thresholds and I encourage you to find better sources that say 'this is what UhC is, this is how we determine Whether a country has it, and these are the countries that do or do not.' If you find such a paper I will happily help you update the graph accordingly, but for now there's nothing OR or NPOV about that paper. The graph that sat here for many years, including periods where you were editing this page I think, was based on nothing at all - the one there is based on a peer reviewed source cited by other papers. You'ce built a whole article based on a single OECD data set, o adding data based on one source is hardly foreign to you. As for the accuracy of the ILO data, I've already conceded there may be typos that you've identified, so lets get the real numbers and update the graph.-Obi-Wan Kenobi (talk) 03:21, 27 July 2013 (UTC)
 * also the reason I moved discussion off this page is b/c that same graph is used in several different wikis, and you had posted the same thing in 4 or 5 places, making discussion impossible. As such centralizing it there made sense to me. If you'd rather centralize here ok, by please AGF I did that to make a more reasoned discussion and provided pointers --Obi-Wan Kenobi (talk) 03:24, 27 July 2013 (UTC)
 * let's take a specific example: Thailand. Thailand is broadly described in the literature as having universal health coverage. However, if you look at papers published about their system, they will point to gaps in coverage and areas for improvement. In European countries as well, even those with so-called UHC, it every health condition is covered, not all procedures are payed for, and not all residents of the country are included (for example, resident aliens, immigrants, etc). I don't think there's anywhere on the planet that truly has 100% coverage for everyone within its borders for any health condition and that can demonstrate that access to said services happens for 100% of the population, especially when coverage is defined as access to care and protection at an affordable cost, which is why thresholds are needed if you're going to make a statement that carries some meaning. If we take your extreme definition, then we end with the absurd result that no countries have 'universal' health coverage. I encourage you to read that paper and understand their methodology, they struggled with this and they themselves did an extensive literature search to arrive at their threshhold definition. Finally, it's been a few years, so rather than continue debating this, lets try to find a better source? For example, according to the source you used in your article (OECD), Austria has 99.9% health insurance coverage. Are you claiming thus that Austria doesn't have universal health coverage? Or is your threshhold 99%? 95%? It's a game of definitions. If you think the OECD data paints a better picture, then lets add it to the article.  If you'd like to add the other thresholds (around observed births for example) to the map, lets add that. If you want to expand the section on SHP with sources critical of the ILO methodology, let's add that. If you don't like the wording in the SHP map, lets improve it - I agree it's not great, so make it better - the point is to explain to the reader what they're looking at. This is a complex subject, but chloropleth maps of UHC have been used in many sources (sadly sometimes the maps come from here...) so they provide a useful overview for the reader as long as we explain how old the data is, what the meaning is, and where the reader can get more info.--Obi-Wan Kenobi (talk) 04:30, 27 July 2013 (UTC)

If you prefer a difference source, we could cite this paper, which has some of the same authors, but was published in 2012 in a peer reviewed journal: http://people.ds.cam.ac.uk/ds450/details/P630%20Universal%20health%20coverage.pdf. This is also a useful background http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/02/index.html%3FcontentType%3D%26itemId%3D/content/chapter/health_glance-2011-53-en%26containerItemId%3D/index.html - note how they say 'nearly universal coverage' which means they accept that not all costs are covered, even in countries which they agree have UHC (like Austria) --Obi-Wan Kenobi (talk) 04:49, 27 July 2013 (UTC)
 * another interesting paper here http://press.thelancet.com/mexicoupdate.pdf which describes Mexico's journey to UHC. As of 2011, 98% of Mexico's population was covered by insurance, and they declared in this paper Mexico had reached universal health coverage. Another way to do the map would be to find individual sources that made a UHC claim,, and if a few sources could be found for any given country, it would be added to the map. However, there are several problems with this approach - the main one being apples and oranges - if all countries aren't judged by the same metric, the map won't carry much meaning. I think it would be interesting to add a section that details different definitions of UHC from the scholarly literature, and perhaps outline how it is used differently in different contexts - for example in the US vs in Europe vs in Latin America. As a broad topic page a discussion of the differences in how the term is used would be useful for the reader, and the Stuckley paper explicitly mentions this diversity of meanings. --Obi-Wan Kenobi (talk) 06:05, 27 July 2013 (UTC)

The United States doesn't have Universal health care
The second source you listed here states,  "Four OECD countries do not have universal health coverage,"  then goes on to list Chile, Mexico, Turkey, and the United States.

This source entitled, Universal Health Coverage: A Quest for All Countries But under Threat in Some, shows that the United States doesn't have Universal health care (see page 4).

See this source which states, "The United States is unlike every other country because it maintains so many separate systems for separate classes of people."

See this source which states, "This is not just an academic question; to understand how to move effectively toward universal health care in the United States, it is essential to understand how we got to where we are."

See this source which states, "Combined public and private spending on health care in the U.S. came to $8,233 per person in 2010, more than twice as much as relatively rich European countries such as France, Sweden and Britain that provide universal health care."

Obi-Wan Kenobi, please keep your response concise. When you flood the talk page (as you have a tendency to do), you make constructive debate overly tedious. Please just quote sources without theorizing. -- Somedifferentstuff (talk) 18:35, 28 July 2013 (UTC)


 * I personally agree with you, and many more sources could be found. I really think you need to read, carefully, what the ILO figure is claiming - it is a study of social health protection under law - it is not a measure of insurance coverage, and I don't think any claim is being made in the article that the US has UHC.--Obi-Wan Kenobi (talk) 00:11, 29 July 2013 (UTC)


 * Wrong. Obewankenobi is confused and does not understand the sources they are using.
 * Both maps are based on health insurance coverage statistics concocted by the ILO
 * (with erroneous data saying the United States has 100% health insurance coverage):
 * ILO (2007).  Social health protection: An ILO strategy towards universal access to health care. A consultation. Discussion paper 19 . Global Campaign on Social Security and Coverage for All.
 * pp. 65–71: Table 1b. Formal coverage in social health protection   [cited by: Stuckler, et al. (2010). " The political economy of universal health coverage, p. 15: healthcare insurance (including social health insurance, state coverage, private health insurance, and employer-based insurance based on the ILO data) must be greater than 90%]
 * ILO (2008).  Social health protection: An ILO strategy towards universal access to health care. Social security policy briefings, Paper 1 . Global Campaign on Social Security and Coverage for All.
 * pp. 83–90: Table A2.2. Formal coverage in social health protection [cited by: ILO (2010).  World Social Security Report 2010/11 , p. 41: Figures 3.7 and 3.8 describe legal coverage by contributory health insurance mechanisms. As figure 3.7 shows, formal legal coverage by these mechanisms remains low in many countries... pp. 275–278: Table 29. Multiple dimensions of health coverage, by levels of vulnerability: Estimate of health formal coverage (% of population)] "Formal coverage in social health protection  Formal coverage        Total (%) = State (%)2  + SHI (social health insurance) (%) + PHI (private health insurance) (%) + Other (%) + Company based/trade union (%) + MHI (mutual health insurance) (%)    Country: United States        Formal coverage, Total (%):  100             Formal coverage, State (%):  32.4 88            Formal coverage, PHI (private health insurance) (%):  71.9 9     66.4 89 2 All data regarding OECD countries from OECD (2006). OECD Health Data 2006, Paris: OECD-IRDES, and for Latin America from Mesa-Lago (2005). Las reformas de salud en América Latina y el Caribe: su impacto en los principios de la seguridad social. CEPAL/GTZ, Santiago: United Nations, and Mesa-Lago (2007). ' The extension of healthcare coverage and protection in relation to the labour market: Problems and policies in Latin America. ' International Social Security Review 60 (1): 3–31, except other sources are indicated. 9 OECD (2006). OECD Health Data 2006, Paris: OECD-IRDES; except for Germany and the Netherlands, PHI is supplementary (1st number) or complementary (2nd number) to either tax-financed or SHI-borne social protection in health. 88 In 2003, 41.2 million US citizens were enrolled in Medicare and 54 million in Medicaid (US Census Bureau (2007). The 2007 Statistical Abstract, Health & Nutrition: Medicare, Medicaid, National Data Book. Washington, D.C.: U.S. Census Bureau ( http://www.census.gov/compendia/statab/health_nutrition/medicare_medicaid/ )) 89 Hoffman et al. (2005). Health insurance coverage in America. 2004 Data Update, p. 10, Washington, D.C.: Kaiser Family Foundation ( http://www.kff.org/uninsured/upload/Health-Coverage-in-America-2004-Data-Update-Report.pdf )" I have highlighted the ILO's erroneous data in  red  for your convenience. The "Formal coverage in social health protection" tables in the 2007 and 2008 versions of ILO's Social health protection: An ILO strategy towards universal access to health care paper differ only in that the 2007 version says South Korea has total health insurance coverage of 94.0%, whereas the 2008 version (correctly) says South Korea has total health insurance coverage of 100%. The health insurance coverage data shown for 110 countries on the map in "Figure 3.7 Health protection. Proportion of the population covered by law, latest available year (percentages)" on p. 41 of the ILO's World Social Security Report 2010/11 is the total health insurance coverage data shown for the same 110 countries in "Table A2.2 Formal coverage in social health protection" on pp. 83–90 of the 2008 version of the ILO's Social health protection: An ILO strategy towards universal access to health care paper. Apatens (talk) 07:53, 29 July 2013 (UTC)
 * I suggest you write and publish and article with these findings; alternAtely you can contact the ILO and ask them to explain how they arrived at this figure, why you dispute it, and perhaps you can get them to issue a correction when they send out a new data set. Have you found any sources anywhere which dispute the ILO numbers in writing? Even a blog post or a tweet? Anything? I'm not saying you're wrong, just saying it would surprise me if you were the first one to find this discrepancy. Another possibility is their methodology for arriving at those numbers is more complex than that described in the footnotes, so you may have incomplete information.--Obi-Wan Kenobi (talk) 12:58, 29 July 2013 (UTC)
 * for example, you dispute the Medicaid figure of 54m, but recent figure show over 60m http://kff.org/medicaid/state-indicator/total-medicaid-enrollment-fy2009/ --Obi-Wan Kenobi (talk) 13:34, 29 July 2013 (UTC)
 * If you feel it is needed, we could post the figures from the 2010 census here (http://www.census.gov/prod/2012pubs/p70-133.pdf), and state that they had different findings than the ILO numbers w.r.t insurance coverage.--Obi-Wan Kenobi (talk) 18:20, 30 July 2013 (UTC)


 * There are several estimates of U.S. health insurance coverage using different surveys. The most widely publicized estimate is in the U.S. Census Bureau's annual Income, Poverty and Health Insurance Coverage report based on its Current Population Survey (CPS)—it estimated that 84.3% of the U.S. population had health insurance coverage in 2011. The Kaiser Family Foundation (KFF) statistics are based on the CPS—they estimated that 84.2% of the U.S. population had health insurance coverage in 2011. The U.S. CDC publishes quarterly health insurance coverage estimates from the National Health Interview Survey (NHIS)—it estimated that 84.9% of the U.S. population had health insurance coverage in 2011. The annual OECD Health Data health insurance coverage statistics for the U.S. are based on the NHIS—it estimated that 84.9% of the U.S. population had health insurance coverage in 2011. The U.S. Census Bureau periodically publishes Survey of Income and Program Participation (SIPP) reports—it estimated that 83.4% of the U.S. population had health insurance coverage in 2011. The U.S. Agency for Healthcare Research and Quality annually publishes Medical Expenditure Panel Survey (MEPS) reports—it estimated that 81.5% of the U.S. population had health insurance coverage in the first half of 2011. The CPS uninsured for full year estimates are higher than uninsured for full year estimates from other surveys and are thought by the U.S. Census Bureau and other analysts to be more in line with uninsured at a point-in-time estimates from other surveys. The estimates of U.S. health insurance coverage using different surveys differ somewhat, but are broadly similar and "the bottom line is that there are tens of millions of uninsured people in this country." When a map plucked out of an obscure 2010 International Labour Organization report based on erroneous data from a table in an obscure 2008 International Labour Organization paper that says:     100 % of the U.S. population has health insurance coverage is repeatedly re-added—without consensus—to this article, it is the responsibility of the editor adding the  ridiculous  WP:EXCEPTIONAL claim that has the burden of finding multiple, independent, high-quality sources proving it is correct. It is not  the responsibility of the editors removing  obvious  misinformation—that even a moron would recognize as wrong—to "find sources anywhere which dispute the ILO numbers in writing, even a blog post or a tweet, anything.""How mindlessly adding assorted invalid statistics produces nonsense : ILO 2003 U.S state health insurance coverage:  32.4 %   (41.2 million Medicare enrollees + 54 million Medicaid enrollees) / 293 million U.S. population • It is invalid to add 'point-in-time' administrative data to 'ever during the year' administrative data:    41.2 million Medicare enrollees at a point-in-time in 2003 (includes 35.0 million aged + 6.2 million non-aged disabled)    53.7 million Medicaid enrollees ever during the year 2003 (includes   4.7 million aged + 8.3 million blind/disabled; does not include 5.8 million SCHIP)        Obewankenobi's KFF FY2010 65,989,147 Medicaid enrollees is an ever during the year number and also double counts aged and disabled Medicare and Medicaid enrollees. • It is invalid to add and double-count aged and disabled Medicare and Medicaid enrollees using administrative data    (this is why survey data is used instead of mixing and matching survey data and administrative data to determine the percentage of insured/uninsured) :    41.2 million Medicare enrollees at a point-in-time in 2003 (includes 35.0 million aged + 6.2 million non-aged disabled)    42.0 million Medicaid enrollees at a point-in-time in 2003 (includes   4.1 million aged + 7.5 million blind/disabled; does not include 3.1 million SCHIP) • It is invalid to pull statistics out of thin air (that are not in the cited OECD Health Data 2006 source) :    OECD (NHIS) 2003 U.S. primary private health insurance coverage 60.2% + government/social health insurance coverage 25.2%        = total public and primary private health insurance coverage = 85.4%        Primary private health insurance (PHI): private health insurance that represents the only available access to health coverage because            (i) there is no government/social coverage or individuals are not eligible to coverage under government/social programs (principal);            (ii) individuals are entitled to government/social coverage but have chosen to opt out of such coverage (substitute).     note :    OECD (NHIS) 2003 U.S. primary private health insurance coverage 60.2%  ≠  ILO 2003 U.S. private health insurance coverage  71.9 %    OECD (NHIS) 2003 U.S. government/social health insurance coverage 25.2%  ≠  ILO 2003 U.S. state health insurance coverage  32.4 %    OECD (NHIS) 2003 U.S. total public and primary private health insurance coverage 85.4 %  ≠  ILO 2003 U.S. total health insurance coverage  100  % • It is invalid to add 'point-in-time' NHIS survey statistics (and/or administrative statistics) for all of the population to 'entire year' CPS survey statistics for part of the population (< age 65):    OECD (NHIS) 2004 U.S. primary private health insurance coverage at a point in time for all of the population 60.1%     ≠  KFF (CPS) 2004 U.S. private health insurance coverage for the entire year for the part of the population < age 65:  66.4 %"Apatens (talk) 02:30, 31 July 2013 (UTC)


 * As a fly-by comment on this dispute: one can't credibly deny countries the categorization of UHC on the basis that care is not 100% - few concepts translate so frictionlessly to real life. Having, statistically, the population with effectively high ease of access to health services approaching 100% is and always has been (within public policy studies) sufficient to call a country UHC. No country has 100% (things like crime, fraud, evasion, opt-outs - by which I mean real choice, not forced opt-outs due to poverty) always, even in countries with the most universal systems (always a few percentage). One can debate whether ease of access has been achieved (and the closer to 100% the better) but UHC is certainly realized in most countries. As far as the US in particular, I would only count ease of access among citizens (which, once the PPACA is implemented, will be up to 94%) towards UHC; I would say the only legitimate counters to including the US among the list of countries which do have UHC (such as NZ/Australia/most European countries/Japan/Canada, etc., etc.) is 1) that the PPACA has yet to take full effect (resolved after 2014); and 2) the coverage gap in states that for poor people in states without the Medicaid expansion. Sb101 (talk|contribs) 03:20, 21 August 2013 (UTC)
 * No. Within public policy studies, universal health insurance coverage means exactly what the words say: universal (100%) health insurance coverage of all of the citizens and other legal permanent residents of a country. In countries with universal health insurance coverage, full health insurance coverage is not generally extended to foreign tourists (except for those from countries with reciprocal arrangements) or undocumented migrants (though some countries provide limited coverage). This Wikipedia article's History section—and its cited references—note the year a country achieved 100% universal healthcare coverage, not the year a country achieved 90% non-universal healthcare coverage. No. Universal health care systems do not have "always a few percentage" without universal health care coverage. As shown in List of countries by health insurance coverage, in 2011, twenty (Australia, Canada, Czech Republic, Denmark, Finland, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, New Zealand, Norway, Portugal, Slovenia, South Korea, Sweden, Switzerland, United Kingdom) of thirty-four OECD countries had 100.0% health insurance coverage based on statutory universal government or social health insurance.[OECD Health Data 2013. Definitions, sources, and methods: Government/social health insurance] In some western European countries (Austria, Belgium, France, Germany, Luxembourg, Netherlands), Bismarckian social health insurance systems were gradually extended towards universal coverage and are often referred to as having (achieved in varying conflicting years) universal health insurance coverage, or sometimes referred to as having (achieved in varying conflicting years) near-universal health insurance coverage. The OECD statistics show Austria, France, Germany, and Netherlands have 99.9% health insurance coverage (based on survey data). The OECD statistics show Spain also has 99.9% health insurance coverage (based on survey data since a few high-income, self-employed professionals can opt out of the main social health insurance system). The OECD statistics show Belgium has 98.8% health insurance coverage (based a count of health insurance card holders), and show Luxembourg has 97.2% health insurance coverage (based on a government estimate). The OECD statistics show some former Soviet-bloc countries have maintained 100.0% universal health insurance coverage (Czech Republic, Hungary, Slovenia), while others have moved away from universal health insurance coverage (Poland 96.6%, Slovakia 95.2%, Estonia 92.9%).  The most recent Congressional Budget Office estimates are that U.S. nonelderly health insurance coverage under the PPACA will be 84% in 2014, 89% in 2019, and 89% in 2023.[ CBO (May 14, 2013). Effects on health insurance and the federal budget for the insurance coverage provisions in the Affordable Care Act—May 2013 Baseline ][ CBO (July 30, 2013). Analysis of the administration’s announced delay of certain requirements under the Affordable Care Act ] The legitimate counter to including the U.S. among the list of countries which do have UHC (such as NZ/Australia/most European countries/Japan/Canada, etc., etc.) is that: 1) the U.S. does not (and will not under current legislation) have UHC. Apatens (talk) 21:50, 23 August 2013 (UTC)


 * I think you've (partially) misread my comment. As I tried to make clear (with references to e.g. fraud) I identified a distinction between statutory coverage and practical coverage. My point was that we don't say that a country doesn't have UHC on the basis of the latter. This works both ways. A country which has everyone covered by law wouldn't be denied the status due to (minimal) fraud; similarly, countries such as Austria, France, Germany, and Netherlands have UHC because the population that isn't technically covered is practically covered (i.e. from memory, opt-outs among the wealthy that doesn't indicate any barrier to care; although I reserve the right to be proven incorrect on the point about the ease of access of the technically uninsured population in these countries).
 * Nor was I saying the US should be included in the list (i.e. current law doesn't achieve UHC), but was outlining what to watch before they could get on the list. This seems to boil down to closing the Medicaid coverage gap + potentially a detail about family health insurance due to an IRS ruling; but, (similar to the point on France/Germany, etc.) those who opt-out and pay the penalty (voluntarily uninsured) wouldn't count towards the uncovered presuming the aforementioned barriers to access are resolved (i.e. opt-outs are technically not covered but covered in practice since the reason they don't have insurance is by choice and they could reverse said choice).
 * In other words, what matters is not the technical coverage percentage, but whether the law ensures that anyone who so chooses has access to a minimum standard of health benefits (i.e. UHC iff 'non-coverage' comes from choice as opposed to legal/cost barriers to access). And the US certainly does not have that yet. Sb101 (talk|contribs) 08:19, 27 August 2013 (UTC)

Mexico Universal Health Care System
The Harvard University link below discusses the 10 years, from 2002 to 2012, that the United States of Mexico used to achieve Universal Health Care coverage and the enrollment of 52.6 million citizens that were previously uninsured.


 * Mexico achieves Universal Health Care. Read it here http://www.hsph.harvard.edu/news/features/mexico-universal-health/

--108.214.145.96 (talk) 16:26, 23 October 2013 (UTC)

International Covenant on Economic, Social and Cultural Rights, etc.
I removed the WP:OR additions: "History Germany has the world's oldest universal health care system, with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889. Most current universal health care systems were implemented in the period following the Second World War as a process of deliberate healthcare reform, intended to make health care available to all, in the spirit of Article 25 of the Universal Declaration of Human Rights of 1948, signed by every country doing so. The US did not ratify the social and economic rights sections, including Article 25's right to health." which were then expanded by: "History Most current universal health care systems were implemented in the period following the Second World War as a process of health care reform, intended to make health care available to all in the spirit of Article 25 of the Universal Declaration of Human Rights of 1948. Following the Declaration,international standards concerning social health protection continued to develop. The International Labour Organization’s Social Security (Minimum Standards) Convention 102 (1952) Article 7 established a minimum for the provision of social health protection which would include curative and preventative care, Article 34 of this same convention goes on to define this medical care as including general practitioner care, dental care, nursing home care, hospitalization, convalescent care, and medical and surgical supplies. Article 12 of the The International Covenant on Economic, Social, and Cultural Rights (1966) recognized the right of to the “highest attainable” states of mental and physical health. Most recently, the ILO issued Social Protection Floors Recommendation, 2012 (No. 202). This recommendation advocates for the establishment of National Social Protection Floors (SPFs), including, among other social security guarantees, provision of essential health care and basic income security (R202). Throughout this period various countries have established formal legislation promoting universal access to health care." The removed text was WP:SYNTHESIS because the cited sources did not say that any UN resolution, UN covenant, or ILO recommendation inspired or led to the countries mentioned in the "History" section implementing their universal healthcare systems. Apatens (talk) 03:07, 29 November 2013 (UTC)
 * 22:41, 3 October 2009 Mbhiii (talk | contribs)
 * 04:12, 6 October 2009 Mbhiii (talk | contribs) ( → ‎History ):
 * 10:25, 26 November 2013 Emily G. Miller (talk | contribs) (Addition of background information):

I removed the following addition to the "History" section: There is no evidence that a 2012 non-binding recommendation of the International Labour Organization was/is/will be significant to the history of universal health care. There is no evidence that a 1952 convention of the International Labour Organization ratified by only 49 countries (not ratified by 136 countries—including Australia, Canada, Finland, Hungary, New Zealand, Singapore, South Korea, United States), only 35 of which (not including Iceland, Ireland, Israel, Italy, Japan, Switzerland) accepted Part II of the convention calling for medical care coverage of 50% of their residents, was/is/will be significant in the history of universal health care. Apatens (talk) 14:18, 3 December 2013 (UTC)
 * 09:25, 2 December 2013 Emily G. Miller (talk | contribs):"History In 2012, recognizing the importance in universality of health care, the International Labour Organization issued the Social Protection Floors Recommendation (R202). The recommendation advocates for provision of 'access to a nationally defined set of goods and services, constituting essential health care, including maternity care, that meets the criteria of availability, accessibility, acceptability and quality.' The criteria of availability, accessibility, acceptability, and quality reflect the multidimensional nature of providing universal health care. The Recommendation expands upon ILO Convention C102, Social Security (Minimum Standards) adopted in 1952. C102 outlined minimum medical benefits as general practitioner care, specialist care at hospitals, essential pharmaceutical supplies, hospitalisation, and pre-natal care."
 * Can you correct the issues instead of deleting the entire addition? EllenCT (talk) 01:37, 4 March 2014 (UTC)

No. Apatens (talk) 14:17, 6 March 2014 (UTC)
 * Why not? EllenCT (talk) 02:17, 7 March 2014 (UTC)

For the reasons given above. To repeat: There is no evidence in reliable sources that the: were/are/will be significant to the history of universal health care and thus merit inclusion in this encyclopedia article. In addition, to juxtapose them with—and therefore imply that they led to—the adoption of universal health care systems in various countries, is not supported by reliable sources and would be WP:SYNTHESIS. Apatens (talk) 14:42, 7 March 2014 (UTC)
 * 1952 "International Labour Organization Convention C102, Social Security (Minimum) Standards, Part II" (advocating 50%— not universal—health care coverage, and accepted by only 35 countries)
 * 2012 non-binding "International Labour Organization Social Protection Floors Recommendation (R202)"

Universal Health Care in Peru
Peru is missing from the Map, the andean nation has universal healthcare, here you can find information about and also links to all the government websites with detailed information:

http://aus-peru.blogspot.com/ — Preceding unsigned comment added by 98.169.144.88 (talk) 16:44, 1 January 2015 (UTC)

Poland has centralized healthcare model
I am very certain that Poland has centralized healthcare. I work in clinical research and am aware of the relationship between physician/patient and physician/insurance in Poland. The map should be updated. — Preceding unsigned comment added by 75.150.162.13 (talk) 20:56, 28 January 2015 (UTC)

Universal Health Care in USA?
This might be a minor point, but the criteria the map at the top of the page uses to define UHC is a mandate for UHC, 90% health coverage, and 90% skilled birth attendance. It also says within the article that an individual mandate to buy private health insurance is a valid strategy that can produce a universal health care system. According to a new Forbes article, the United States now covers 90.8% of the public. Whether the article is correct or not is debatable, but once the United States does cover 90% of its people doesn't this make its system a universal one by the article's definition? Once this happens, will we add the United States to the list? If not, I think the article needs to clarify why the United States's system isn't sufficient, such as the mandate not being a guarantee of universal coverage. Many other countries on the list have over 90% coverage but less than, say, 98%, so what's the specific difference of the United States?

24.148.66.175 (talk) 14:25, 13 August 2015 (UTC) Derek


 * This Wikipedia article does not define "universal health care" as health insurance coverage of 90% of a population. That was part of a nonstandard definition used in a map in a symposium paper five years ago. Apatens (talk) 15:33, 13 August 2015 (UTC)

Map
That map is wildly inaccurate and outdated. Countries pictured as not having UHC (like Mexico and Brazil) have it, and I think we should also have a separate color for countries working on implementing it, such as China and Indonesia.-- RM ( Be my friend ) 01:10, 24 August 2015 (UTC) Similarly, Poland has UHC, the right to which is guaranteed in Polish Constitution.

China
China has universal healthcare coverage, which has more coverage of the population as well as a cost percentage more subsidized then Australia, yet it is not green on the obsolete map above

http://www.sciencedirect.com/science/article/pii/S0168851015001864 — Preceding unsigned comment added by 60.242.81.170 (talk) 00:52, 12 February 2016 (UTC)

Please be neutral about US Healthcare reform
I removed some statements from United States block because it was not neutral and did not cite the sources using reference links to original documents (rather general like "Under PPAC it is estimated..." Estimated by whom?). Statements like ones listed below are highly controversial and not neutral:

"it is hard to include the US on a list of countries having universal health care based on the PPAC" "this system encourages use of the emergency facilities for primary care and not just for emergency purposes" "PPAC answered none of these questions" "since the head of the CBO inappropriately visited the White House to be lobbied by the President in July 2009, many Americans have little faith in the CBO estimates"

Also someones personal blog is not a reliable source of information, unless person is an expert in the field. In this case put note this in the text like "According to XXX,..."

Dear editors, please remember, this is not a newspaper article, but an encyclopedia article. Please put back information that you think is needed, but do not violate wiki rules. —Preceding unsigned comment added by Innab (talk • contribs) 23:27, 30 March 2010

Editing the History section:

1. A 2012 study is mentioned in the last sentence of the section but barely explains anything about it. The paraphrasing is pretty similar to the original article. The study's name or authors are not at all stated. This sentence should either be deleted since it doesn't play a big role in adding to the section, or the study needs to be cited and further explained to the reader. Additions can be made such as; A groundbreaking result of 2/3 of the population of both the Philippines and Rwanda are now enrolled in health insurance.

Compulsory Insurance section:

2. Stated in the 3rd paragraph, "at one time" is used to explain the community rating system of The republic of Ireland. An actual date should be mentioned to strengthen the point.

Compulsory Insurance section

3. Also stated in that section is a narrative on "sickness funds" where the words "no advantage" is used. This terminology makes the statement sound somewhat opinionated and no real evidence on the explanation is given. I believe the writer was trying to explain further on what the sentence previous was trying to say, however the explanation became wordy and unneeded. The whole further explanation can really be deleted or if anything, redone.

Link/cite 28 is broken and does not go to an actual webpage.

Amcgraw24 (talk) 05:39, 5 November 2016 (UTC)AshleyMcGrawUCSD

Lembas bread & green cheese
The following sentence is aerospace-grade desiccated sustenance:

Thus, in the development of universal health systems, it is appropriate to recognize "healthy public policy" (Health in All Policies) as the overarching policy framework, with public health, primary health care, and community services as the cross-cutting framework for all health and health-related services operating across the spectrum from primary prevention to long term care and end-stage conditions.

It's capped off by a sentence containing a worrisome phrase:

Although that perspective is both logical and well grounded in the social ecological model, the reality is different in most settings, and there is room for improvement everywhere.

I don't think a steady diet of aerospace-grade Belgian Lembas bread is appropriate during the article's lead, when you've just stepped out your front door into the leafy Shire. &mdash; MaxEnt 20:43, 18 January 2017 (UTC)

Proposed text on Mexico
I've deleted the following text from the "Americas" section:

"????? Mexico has Universal Health care for the children who were born since January 5th, 2007...please do not delete this information, just edit it. read the info here http://www.esmas.com/noticierostelevisa/mexico/593939.html"

The tone is non-encyclopedic, and since the source isn't in English, it's impossible for a non-Spanish speaker to verify. If this information is correct (and I have no reason to believe that it is not), we need someone who can verify it and (ideally) find an English-language source, and then we need to rework the text to make it more encyclopedic. Depending on how much information is available, it may be appropriate to create a new subsection for Mexico. —Preceding unsigned comment added by EastTN (talk • contribs) 17:04, August 8, 2008


 * Mexico's Universal Health Care


 * http://www.presidencia.gob.mx/en/press/?contenido=40872


 * Accompanied by state governor Leonel Godoy Rangel and Health Secretary José Ángel Córdova Villalobos, President Calderón declared that regardless of the country's accumulated lag in health and the number of years that have elapsed without dealing with the problem, this Administration is determined to deal with it.
 * Proof of this, he declared, is that in 2009, Federal Government will assign $133 billion pesos to this sector, in other words, 20% more than in 2008. He added that over the past two years, the amount of resources assigned to the Health Secretary have doubled, while the amount allocated for Popular Insurance has risen from $16 to $48 billion pesos.
 * “I am convinced that Mexico will only be a more equitable, fairer country when every Mexican has guaranteed, quality medical care," he stated.

https://www.hsph.harvard.edu/news/features/mexico-universal-health/ — Preceding unsigned comment added by 130.245.192.19 (talk) 17:01, 22 March 2017 (UTC)


 * The President announced that the Hospital he opened in this municipality involved over $50 million pesos in investment from his administration and will benefit the northeast and east region of Michoacán.
 * He added that this General Hospital, which he suggested should be called the Bicentennial Hospital, will have six specialties: Pediatrics, gyneco-obstetrics, internal medicine, surgery, anesthesiology and dentistry, in addition to traumatology, since it is located in the middle of the Mexico-Guadalajara highway.
 * “If we go on like this, to celebrate the Bicentennial, by 2011, Mexico will be one of the few countries in the world to have achieved universal health coverage," he explained.


 * Mexico is going to accomplish public universal health care by 2011: —Preceding unsigned comment added by 70.179.104.87 (talk • contribs) 21:56, December 17, 2008

Please amend your map, Mexico achieved universal health care several years ago
Some reliable sources:

Seguro Popular: Health Coverage For All in Mexico - World Bank

Mexico achieves universal health coverage, enrolls 52.6 million people in less than a decade - Harvard School of Public Health

An overview report detailing the growth and finance of Seguro Popular during its first years:

The democratization of health in Mexico: financial innovations for universal coverage - World Health Organization

Economist2020 (talk) 19:25, 8 April 2017 (UTC)

The map source
The map source is List of countries with universa health care from mid-2018 which has since been edited multiple times, INCLUDING removing the practical table. On the talk page there is instructions on how to generate a new map. Mirarkitty (talk) 15:09, 8 February 2019 (UTC)

the map is not accurate as Singapore does not have universal heath care.

Wrong information
The map you’ve joined is wrong, particularly regarding Indonesia. In the past it is indicated that Indonesia has no free or universal healthcare, which is wrong. Indeed Indonesia has a public single payer healthcare system named BPJS. As of November 2018, almost 80% of the population was enrolled in BPJS. Healthcare in public hospital are free of charge. Id62 (talk) 13:45, 19 November 2018 (UTC)

The map also has French Guiana different than the rest of France. 72.168.160.47 (talk) 18:06, 28 January 2019 (UTC)


 * I have removed the map because of all the inaccuracies pointed out above. Natureium (talk) 18:16, 13 February 2019 (UTC)

Free Universal Health Care
The map distinguishes between "Free and Universal Health Care", and just "Universal Health Care", with only one country offering the latter, while the former is abundant. The text of the article doesn't distinguish between the two. Also, in several European countries, the funding model is by mandatory insurance coverage (which isn't free), yet those countries are marked as having "Free and Universal Health Care". So, what kind of Free is meant here? 82.161.255.208 (talk) 15:43, 17 December 2018 (UTC)
 * IMO, there is or should be in this article a place for that subset of UHC - free UHC. But also, IMO, the question "what kind of 'Free' is meant here?" is a good question. MaynardClark (talk) 18:20, 13 February 2019 (UTC)
 * The WHO's UHC Cube (universal health care cube ) illustrates how (a) nothing is free and (b) budget concerns drive expert deliberations leading to decisions about sustainable and feasible benefits packages.

Need for graphics
Since this article was initiated, graphics have been added and removed. One very helpful graphic is the WHO's UHC cube - the universal healthcare cube, which shows how the variables in the possible benefits packages are related dynamically with one another. MaynardClark (talk) 18:20, 13 February 2019 (UTC)
 * Yes, since the article was created 15 years ago, many changes have been made. It's the Wikipedia way. The existing graphics are in need of updates, and I removed one that was incorrect. Natureium (talk) 18:25, 13 February 2019 (UTC)
 * Let us consider at least referencing the UHC Cube (universal health care cube ).

Lead sections tone/format issues
Wikipedia articles typically start with something alone the lines of "Article title is..." followed by a definition of the article title in the opening sentence then a summery of the articles main points. The article currently starts with a statement of what it is not, which is not how Wikipedia article should atart. To fix this, we need to find a sourced definition of what it is and add that as the opening sentence in the lead. If there are differing or multiples definitions then we can explain how the term has multiple meanings. As I currently understand the term it most commonly means the following: A system of Healthcare where the government guarantees everyone has access to at least basic healthcare, no matter how poor. This is accomplished by one of the following: 1) Paying the total cost of the healthcare of the poorest citizen and in some countries also subsidizing the cost of the healthcare of some or all middle class citizens. or 2) Paying for basic healthcare for all citizens regardless of income (note: some single-payer countries allow for wealthier citizens to buy alternate or supplementary private insurance or pay out of pocket for all healthcare privately).

Now I seem to recall some people free-market/anti-government funded healthcare advocates defining "universal healthcare" as only guaranteeing theoretical access, provide one can pay. So if this definition can be sourced to a reliable source then it too can be added. I will try see what sort of sources I can find definitions the term and then maybe I will try and fix it myself, if someone else does not beat me too it. --Notcharliechaplin (talk) 04:24, 20 May 2019 (UTC)


 * An IP editor (who has since been blocked) edited the entire first paragraph of the article out. I've undone the damages. Let me know if the article is more satisfactory now. Googol30 (talk) 14:07, 3 June 2019 (UTC)

What does Universal But Not Free mean?
The map's categories do not correspond to the content of the article. - Frankie1969 (talk) 23:11, 25 March 2020 (UTC)
 * Great question. I suggest we remove that map unless somebody clarifies what that actually means. Nerd271 (talk) 16:02, 26 March 2020 (UTC)
 * I've removed it. Unless someone clarifies why many countries with substantial costs borne by individuals are labeled as "free and universal", or gives a reputable external source that shows that classification, I don't see an argument for keeping it. As it stands only the only sources is Wikipedia's list of countries with universal healthcare, but it doesn't explain how the information is taken from that page. Aliiqve (talk) 16:43, 5 April 2020 (UTC)
 * Good move! I will also add that by WP:RSPSOURCES, Wikipedia should not be used as a source (even for Wikipedia articles). Nerd271 (talk) 17:13, 5 April 2020 (UTC)

Table of starting years of countries with universal healthcare
I suggest adding a table to the article. The following table may provide some ideas. I am not the author of the list below. And I don't have the time right now to develop this further. I haven't checked out the references, and don't understand what some of the starting dates represent.

I did some minor link correction of Timeline of universal healthcare by Sebastian. Bottom of the timeline page says: "Content is available under Creative Commons Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0) unless otherwise noted."

Brief explanation of healthcare system type:


 * Single Payer: Insurance is provided for all residents (or citizens) by the government, which pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.
 * Two-Tier: Catastrophic or minimum insurance coverage is provided or mandated by the government for all residents (or citizens) while allowing the purchase of additional voluntary insurance or fee-for service care when desired.
 * Insurance Mandate: All citizens are mandated by the government to purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.

--Timeshifter (talk) 07:03, 28 July 2021 (UTC)

If you aren’t the author, who is? We can only post things that the author has agreed to contribute. Mr Serjeant Buzfuz (talk) 14:25, 28 July 2021 (UTC)


 * 2nd paragraph of my original post above has this:


 * {| class=wikitable

Timeline of universal healthcare by Sebastian. Bottom of the timeline page says: "Content is available under Creative Commons Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0) unless otherwise noted."
 * }
 * --Timeshifter (talk) 00:52, 29 July 2021 (UTC)

What was named after Bismarck?
The "History" section currently reads:
 * The first move towards a national health insurance system was launched in Germany in 1883, with the Sickness Insurance Law. Industrial employers were mandated to provide injury and illness insurance for their low-wage workers, and the system was funded and administered by employees and employers through "sick funds", which were drawn from deductions in workers' wages and from employers' contributions. Named after Prussian Chancellor Otto von Bismarck, this social health insurance model was the first form of universal care in modern times.

I've added "clarification needed" after the reference to Bismarck. What was named after him? The statute is referred to as the "Sickness Insurance Law", without mentioning Bismarck. Is that a mistake? Is the name of the statute given in this paragraph inaccurate and it should include a reference to Bismarck? Or, does the German health programme have a formal name that includes a reference to Bismarck? Mr Serjeant Buzfuz (talk) 15:15, 18 November 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Gurshawnstuteja.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 12:05, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Michellet82801. Peer reviewers: Michellet82801.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 12:05, 17 January 2022 (UTC)