Universal health care is a strategic lever that forces the broader expansion of the social safety net – forcing the government to pay for health care costs requires improvements in other relevant arenas, like housing, education, and environment.

This focus on equity coincided with the Occupy movement’s protests against rising inequality, which catalyzed an ongoing debate in US politics about the largest concentration of wealth since the 1930s and the greatest income inequality since the late 1970s.19 Regressive health care financing is a significant contributor to economic inequality, producing an inverse correlation between household income and household health care spending.20 Conversely, a redistributive universal health care system in the United States would deliver significant financial relief to lower- and middle-income families.21 Providing health care as a public good could also pave the way for a broader paradigm shift toward universal public programs, replacing the threadbare safety net of means-tested benefits. Health care could function as a strategic lever for building a more equitable society through the universal provision of the goods and services needed to exercise economic and social rights. In turn, increased equity would further improve health outcomes.22 It follows that health reform goals should reflect the direct correlation between health and equity by measuring not only health but also equity indicators.

This broader equity vision characterizes the HCHR campaign’s approach to financing, which aims to disrupt the vicious circle of inequity and poor health fueled by unequal access to care based on income, wealth, and employment. International health systems research confirms that commercialized health systems with significant private sector involvement both impede access to care and deepen inequities.23 The market-based insurance system in the United States demonstrates that private pre-payment schemes are neither intended nor equipped to guarantee equity in access to and payment for care. Any redistributive potential of pre-payment is lost when the insurance business model incentivizes access restrictions by means of cost-sharing, narrow provider networks, and prior authorization processes, and when even a slightly more progressive premium structure for low-income policyholders, as mandated by the ACA, requires the channeling of sizable public subsidies to private insurance companies.