Obamacare Brings U.S. Closer To Policies It Has Advocated Overseas

The Supreme Court’s decision yesterday to uphold the Affordable Care Act (ACA) marked a defining moment in the decades long battle to bring affordable healthcare to the U.S. But while healthcare continues to be a divisive issue domestically, the U.S. has funded and advocated for some of the best universal health systems around the world.

The U.S. is ranked 37th in the World Health Organization’s rankings of health systems. But the impact of U.S. health policy extends beyond U.S. borders. Laurie Garrett, a Senior Fellow for Global Health at the Council on Foreign Relations, wrote that the U.S. is now in line domestically with policies it has been promoting internationally:

Dating back to the Marshall Plan in post-WWII Europe, Gen. Douglas MacArthur’s 1945–49 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 (FY2012), 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 fourteen-year program to build universal health coverage.

Indeed, Japan and Marshall Plan countries in Europe make up the majority, thirteen out of twenty, of the top national health systems in the World Health Organization’s (WHO) 2000 report [PDF]. Those countries are highlighted in the following chart:

And a 2010 Commonwealth Fund comparison of population health [PDF] in seven countries — Australia, Canada, Germany, the Netherlands, New Zealand, and the UK — found the U.S. underperforming “relative to other countries on most dimensions of performance.” Half of those countries outperforming the U.S. — Germany, the Netherlands, and the UK — were recipients of Marshall Plan assistance.


The ACA will provide access to health insurance for 30 million uninsured Americans and prevent insurers from discriminating against people with pre-existing conditions. “[P]erhaps 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,” writes Garrett.