It seems the more the United States advances, the farther the reality of universal health care becomes. The most developed country in the world has yet to guarantee health insurance as a right to all its citizens. Long term health implications of being either underinsured or uninsured go well beyond a single generation. So then why? The richest country in the modern world surely can find a way to provide health care to its citizens. The US regularly turns a blind eye to a massively uninsured/underinsured population that mainly affects black and brown individuals. Perhaps the reluctance to guarantee healthcare uncovers a grim reality. The current system disproportionately affecting people of color is absolutely a public health crisis. And needs to be addressed as such.
US Healthcare at a glance
Healthcare has long been a polarized affair in the US, now more so than ever. On an international level, the United States takes gold in overall healthcare spending, hospitalizations, administrative costs and prescription drugs. The problem is, along with spending twice as much on healthcare as other developed nations, the US has the lowest life expectancy and the highest rates of infant mortality. The average American spends $1,443 per person on prescription drugs compared to the $750 per person across other countries. US spending on imagine services and routine medical procedures is also considerably higher compared to others.
Healthcare costs aside, what does all this mean in terms of actual coverage. Americans either have private insurance tied to employment or must rely on public healthcare (Medicare/medicaid). However, there are obvious problems with this decentralized approach. Full time minimum wage puts one over the line for qualifying for Medicaid and under the line to afford private insurance. In other words, uninsured. Close to 44 million people in the US are uninsured, and another 38 million have inadequate health insurance. Individuals with a lower socioeconomic status who rely more on hourly/lower skilled (requiring less education) fall into this void everyday. Making too much for public insurance and not making enough for private insurance.
Health inequality is a ‘race’ issue
In the US, Black and minority groups experience poor health outcomes compared to whites. This is an unfortunate and disturbing reality in this country. Medicine’s purpose is to provide care across the board. However the decentralized system in the US is powered by social and economic factors.
Racial disparities have been made obvious during the Covid-19. In terms of infection rates, mortality rates and in the so far appalling vaccine distribution. Black and brown communities are crumbling under Covid-19. And are far lower on priority for vaccine distribution. In addition to the overall flawed delivery system, the cycle of uninsured runs concurrently for people of color. Severe income inequality (economic factors) has left Black and brown communities sidelined. Lower skilled/lower waged jobs leads to inability to afford private insurance. Unable to afford healthy food, adequate housing, insurance and private transportation (social factors), these individuals often delay essential preventative care. Neglecting early intervention and immunizations leads to the development of chronic conditions like diabetes, high bp and obesity, all preventable illnesses.
Health care services are in fact more robust in areas where the majority of people are actually insured. On the contrary, underinsured communities not only have limited access, but inadequate service as well. These social, economic and environmental factors affect POC significantly more, ultimately trapping them in a loop predisposing them to poor health outcomes based on race and ethnicity.
A ‘free market’ is a problem
Since WWII, the healthcare delivery system has stayed relatively consistent. In that it is tied to employment. Given the economic state during and post world war II, employers saw more benefit in offering health insurance to workers instead of higher wages. The obvious problem here is if you lose your job, you lose coverage. The ACA sought to address this issue, by expanding state coverage and providing subsidies for those below the poverty line. Essentially to include more low income families who make too much for medicaid and not enough for private insurance. I.e., providing coverage for 20 million Americans. Not perfect, but absolutely a step in the right direction.
However considering how fast the US adopted the robust capitalism driven infrastructure, millions still remain unaccounted. The problem is there are fundamental obstacles in achieving universal health care under financialized capitalism. Economic and political players control the market making it inequitable and driving up the costs. A ‘free market’ has allowed for a few big players to monopolize the field. Charging ridiculous amounts for coverage tied to employment as a price. Pharmaceutical companies are given free rein to charge disgusting amounts for prescription drugs because of zero government regulation. The US fails to intervene in obvious life and death situations which affect (majority) black and brown communities to avoid ‘too much government control’. Rationing health insurance made available only as a means of either employment or insufficient public aid (medicare/medicaid) to only some citizens, is not a free and equal society.
Capitalism is the priority, not health equity
If the US really wants an equal healthcare delivery system, it must first acknowledge the obvious inequities which affect the majority non-white population. The social determinants of health like low income/wages, lack of affordable care, transportation, homelessness etc. The problem is not limited availability, there are enough providers. The problem is that they are not equitable, or accessible to individuals who fall into a certain socioeconomic class, or educational level or housing status. Health service equality and health equity are not the same.
Public health’s role in reform
The goal of public health is to ensure people are healthy, however that maybe. All individuals (regardless of race and ethnicity). For an equitable country, the US must guarantee healthcare as a right, not a privilege tied to employment. And serving POC while accounting for systematically (racist) created social and economic factors that otherwise inhibit them for healthcare.
Public health is designed to be a pillar of support. The system must work cross functionally, mobilizing government, education, hospital systems, insurance providers and pharma. As far as public responsibility goes, we must fully understand the current flaws. Acknowledge the reality that POC face poor health outcomes just because systematic social and economic factors affect them more based on race/ethnicity. Call out American healthcare for what it is, grotesque capitalism in its truest form.