Implementing a UHC would require massive political capital from Biden.

Writing in the British Medical Journal, Gro Harlem Brundtland explains how Universal Health Coverage is a matter of political commitment since it consists of a political process ensuring the creation of an equitable health financing system. "Universal health coverage is not just desirable, but eminently achievable"- Gro Harlem Brundtland The new Director-General of the World Health Organization, Dr Tedros Adhamon, has made his priority clear: to work tirelessly to fulfil the promise of Universal Health Coverage (UHC). This was his message throughout his successful election campaign, which he reiterated during May’s World Health Assembly. As one of his predecessors at WHO, I applaud his vision and ambition. There is a growing political consensus that UHC is not just desirable, but eminently achievable. At The Elders, where I am the deputy chair, we see UHC as the best strategy to achieve the overall health sustainable development goal. Dr Tedros also made another very significant statement during his speech, that: “Universal Health Coverage is a matter of political commitment and we have to ensure political commitment if we are going to achieve it.” "Universal Health Coverage is a matter of political commitment." This is an extremely important message for the global health community, which often tends to overlook the politics of health reforms in preferring to focus on technical solutions. But across the world we know that in every country, extending health coverage is an inherently political process, especially when it comes to creating an equitable health financing system. This is because UHC can only be achieved by the state compelling healthy and wealthy members of society to subsidise services for the sick and the poor. In effect, UHC can only be reached through public financing where the state has a big role in raising revenues fairly, according to people’s ability to pay and allocating pooled resources according to health needs. "UHC can only be reached through public financing where the state compels healthy and wealthy members of society to subsidise services for the sick and poor." Not surprisingly, this transition to a publicly financed health system is often challenged by interest groups that tend to benefit from a fragmented privately financed system—for example private insurance companies, private hospitals, and those who are ideologically opposed to a welfare state. This opposition can be extremely well organised and powerful as we are seeing in the United States and South Africa. Overcoming this opposition and launching successful UHC reforms therefore requires a large investment of public financing and political capital by the government. In fact, given the huge political costs and benefits involved, it is usually the case that UHC reforms must be led by the head of state, as ministries of health lack the power to raise sufficient funding and tackle UHC opponents effectively.