It’s difficult to know where to begin when discussing the state of healthcare in the United States. So many knowledgeable parties have weighed in and expressed opinions that aren’t favorable by any stretch of the imagination. How does one find optimism in the face of a system made up of such blatant corruption and greed?
Medical costs & income inequality
A recent analysis published by the New England Journal of Medicine created an international scorecard depicting income inequality and healthcare in the U.S. It compares healthcare experiences for people with below-average income. Compared with 7% in Canada, 11% in France and Germany, and 1% in the United Kingdom, 39% of respondents in the U.S. had a medical problem but did not visit a doctor because of cost in the past year.
Did you catch that? Nearly 40% of the more than 43 million Americans who live below the poverty line avoid going to the doctor because of the cost of medical treatment. That’s a lot of people, almost 17 million people, to be exact. The bills are high, regardless of insurance coverage, due to rising premiums and cost sharing. It’s really quite shocking that health insurance seems to do very little to mitigate the cost of healthcare in the U.S., and that one of the only journals willing to do a thorough analysis of the issue is published in the U.K. According to Samuel Dickman, David Himmelstein, and Steffie Woolhandler’s report, “Inequality and the Health-Care System in the USA (the first of a series published in The Lancet),”
“The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years.”
Although the number of uninsured Americans dropped from almost 50 million to under 30 million between 2010 and 2015 under the ACA, the current administration wants to stop government subsidies to insurers and force political compromise on a healthcare bill. The bill that handily passed the House in what seems like a largely symbolic vote may not be able to pass muster in the Senate. As Russell Berman of The Atlantic points out, Republicans in the upper chamber will likely try to write and pass their own bill that will then need to be approved by both chambers yet again.
This is all coming at a time when income inequality in the U.S. is at its highest rate ever. According to The Lancet, “Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health.” It’s only because of increasing Republican pursuit of additional tax cuts for the wealthy that insurance for all is not feasible; as Senator Bernie Sanders reiterates in another recent Lancet article, Medicare-for-all is supported by a majority of Americans, in part because exorbitant healthcare bills are often responsible for impoverishing, even bankrupting, working families.
The high costs of healthcare in the U.S. is driving demand for more affordable options like doc-in-the-box clinics for people who are either uninsured or insured under plans with a high deductible, meaning they must pay for more out-of-pocket; therefore, retail clinics staffed by nurse practitioners, rather than doctors, provide a more financially feasible option—especially for lower-income patients. The Patient Protection and Affordable Care Act (PPACA) included investments to expand the roles of nurse practitioners in care delivery, including $65 million designated to developing nurse practitioner managed outpatient clinics, from 2012-2015. Many people avoid going to the doctor until it’s absolutely necessary, due to the high cost of treatment.
However, many people also avoid recommended preventative care such as the flu vaccine due to unfounded fears that vaccines are harmful or don’t actually help prevent the onset of influenza. Part of the misinformation may be due to the fact that what is commonly known as ‘stomach flu’ isn’t actually related to the influenza virus that the flu vaccine actually helps guard against. Rather, the stomach flu (a.k.a. gastroenteritis) is usually caused by different viruses—or less often, bacteria from contaminated or unhygienic food preparation—that can attack the gastrointestinal system. Although the stomach flu can’t be cured with medications, some of the symptoms like nausea can be treated with prescriptions, so older adults with compromised immune systems may seek out medical help to minimize their symptoms.
Another development in healthcare treatment is the implementation of telehealth technology, which could expand healthcare access and reduce medical costs, as well. However, a current piece of legislation called CONNECT (Creating Opportunities Now for Necessary and Effective Care Technologies)—yet to be passed—would expand the availability of services provided through telehealth under Medicare. Ideally, widespread implementation of telemedicine would make healthcare available to thousands of people who have limited access to care providers, either because they live in rural areas without adequate medical resources or because they are housebound or have other mobility issues.
Income & the environment
According to the Center for American Progress, “The condition and quality of a home are often influenced by the neighborhood in which it is located, underscoring how one’s health and life expectancy is determined more by ZIP code than genetic code.” In order to have a fair shot at good health, most people would probably agree that clean water and air make up the bare minimum of baseline requirements. However, according to Gallup Analytics, “75% of those who earn less than $30,000 annually are concerned a great deal about pollution of drinking water,” compared to 64% of middle-income and 56% of upper-income households. Perhaps this is because there is more to worry about in places like Flint, Michigan, where lead contamination created serious health risks for thousands of residents.
Jeremy Deaton argues that grassroots organizing is key to creating lasting change since many progressive donors have historically funded larger groups at the national level; however, grassroots organizations can be more economically efficient, so local advocates need to be engaged and politically mobilized. Although studies have shown unequivocal evidence that the relationship between neighborhood and household income levels and neighborhood hazard levels varies according to neighborhood and household racial composition, the current powers-that-be in Washington would just as happily forget there is any such connection, considering the likelihood that the existing Office of Environmental Justice will be eliminated.
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It seems clear that something must be done to change the overall situation of healthcare inequity—especially in light of facts, such as one noted by Christopher Wildeman and Emily Wang:
“The public-health situation is so bad for black men in the U.S. that they often get better health care in prison than they do outside it.”
The United States can’t justify its pretense of being the nation with the highest caliber of healthcare in the world if that care is only available to a select few. In all other measures—insurance access, overhead expenses, bureaucratic paperwork, prescription costs—we lag woefully behind the rest of the developed world.
We can and must do better. One thing we can do for now is to help increase awareness, in addition to mobilizing for political change. A lot is at stake—for all of us.