October 19, 2009 11:47AM # Should Congress Even Try to Achieve Universal Coverage? By [Michael F. Cannon](https://www.cato.org/people/michael-f-cannon) --- SHARE If the goal is to improve health, then the answer is clearly [no](https://www.cato.org/?s=anti+universal+coverage+club). Ironically, even though universal coverage is presumably about helping the sick, the Democrats’ pursuit of universal coverage demonstrates not how much, but how *little* they care about their neighbors’ health. Economists Helen Levy and David Meltzer explain, in a [book](http://www.urban.org/books/uninsured/contents.cfm) published by the Urban Institute, “There is no evidence at this time that money aimed at improving health would be better spent on expanding insurance coverage than on…other possibilities,” such as clinics, hypertension screening, nutrition campaigns, or even education. In the *[Annual Review of Public Health](http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.publhealth.28.021406.144042?journalCode=publhealth)*, they explain further: > The central question of how health insurance affects health, for whom it matters, and how much, remains largely unanswered at the level of detail needed to inform policy decisions…Understanding the magnitude of health benefits associated with insurance is not just an academic exercise…it is crucial to ensuring that the benefits of a given amount of public spending on health are maximized. If Democrats were serious about improving health, they would first gather evidence about which of those strategies produces the most health per dollar spent. (As I recommend [elsewhere](http://www.kaiserhealthnews.org/Columns/2009/June/060109cannon.aspx), the $1.1 billion Congress [allocated](http://corner.nationalreview.com/post/?q=MjI0NDQ2ZTVmMTMxMTYyOWQ5OWNkZDM5YzBiYzExOWQ=) for comparative-effectiveness research should just about do the trick.) Democrats would then fund the most cost-effective strategies, which may or may not include broader insurance coverage. But the fact that Democrats are pursuing universal coverage without any such evidence *necessarily* means that they are willing to sacrifice potentially greater health improvements to achieve…whatever else they hope universal coverage will achieve. Universal coverage is not about improving public health. It is about subordinating health to some X‑factor that [supporters](https://www.cato.org/?s=church+of+universal+coverage) value even more. Which leads to an even more intriguing question: what is that X‑factor? Financial security? (If so, would universal coverage [achieve that](http://www.usatoday.com/money/perfi/retirement/2008-06-16-bankruptcy-seniors_N.htm)? Or are there better strategies?) Political power? Dependence on government? [Industry subsidies](http://www.kaiserhealthnews.org/Columns/2009/July/071609Cannon.aspx)? The appearance of compassion? I’d like to see that question put to the group. (Cross-posted at *National Journal*’s [Health Care Experts Blog](http://healthcare.nationaljournal.com/2009/10/defining-universal-coverage.php).) ##### Related Tags [Health Care](https://www.cato.org/health-care) [![Creative Commons License](/build/cato_2020/images/creative-commons.svg)](http://creativecommons.org/licenses/by-nc-sa/4.0/) This work is licensed under a [Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License](https://creativecommons.org/licenses/by-nc-sa/4.0/).