That the inadequate healthcare system needs a significant and immediate overhaul is undeniable. Health care professionals understand the problems associated with the failing system more so than anyone and are the first to voice their concerns. Americans of all political ideologies agree too many individuals and families are uninsured or underinsured and that health care costs are higher than necessary but Republican and Democratic lawmakers disagree on the solution. Unlike other industrialized countries, economic status plays a major role in determining health status for Americans, a despicable circumstance in the minds of Europeans who enjoy cradle-to-grave medical care.
They consider it a birthright. Taking care of the nation’s sick without regard to their social position is a responsibility civilized society’s embrace, at least those outside the U.S. The Republican solution is to give tax incentives to individuals and businesses that purchase health insurance but this would not address the root of the problem. Even people with insurance are limited to the care they receive, many times dependent on bureaucrats instead of physicians to determine treatment.
Democrats favor what is termed as a ‘single payer system, otherwise referred to as universal health care, a more efficient system that covers everyone, essentially emulating a similar approach employed by Britain, Canada, Cuba, Brazil, Russia, Japan, western European countries and many other nations. Implementing universal health care will significantly reduce the burden of escalating healthcare costs to working families and eliminate the quality of care divide in this country that exists between the wealthy and the other 95 percent of the population.
A Society is Judged by How it Treats the Most Vulnerable
How Does the U.S. Rate?
Most Americans identify the health care crisis as one of the main concerns facing the nation as evidenced by the amount of rhetoric allocated to this issue in the current presidential debates, at least on the Democratic side. The majority of Americans concurs with the majority of the world’s population in that a society has the responsibility to care for its sick and injured regardless of their financial status. “Nearly seven in ten respondents go so far as indicating they would be willing to pay more in federal taxes to assure that every American citizen has health care coverage” (“Who should pay” 2004).
That more than 40 million Americans do not have health insurance is widely acknowledged but those who are insured often cannot afford the medical care they require. A universal health care system similar to what is offered the bulk of the ‘civilized’ world should not be a matter of debate, it should be a reality. It’s what the public desires and moreover, what they deserve as U.S. citizens. Many times we hear the phrase, ‘America is number one!’ but of course this applies to economic and military prowess only and certainly does not include other areas, the quality, and affordability of health care in particular. “The United States, which has the most expensive health system in the world, underperforms consistently relative to other countries and differs most notably in the fact that Americans have no universal health insurance coverage” (Presse, 2007).
The U.S. is unquestionably not number one with regards to health care delivery. The infant mortality rate in America ranks 23rd worldwide, 20th in life expectancy, and trails Botswana, coming in at 67th with regard to child immunizations and this is just a partial list. Overall, the U.S. and the very poor third-world country of Cuba are neck-and-neck in providing health care to its citizens. “The United States ranks poorly relative to other industrialized nations in health care despite having the best trained health care providers and the best medical infrastructure of any industrialized nation” (Battista, McCabe, 1999).
Those opposed to universal health care such as insurance and pharmaceutical companies have characterized this system as ‘socialized medicine.’ This moniker elicits fears of communist ideals, the ‘red menace’ creeping into American society. Universal health care, however, cannot be accurately described as socialized medicine. “It is health care payment system, health care providers would be in fee for service practice, and would not be employees of the government, which would be socialized medicine” (Battista, McCabe, 1999). If the single-payer system can be categorized as socialism then other worthwhile endeavors such as the military can be as well.
Few, if any, are opposed to socialized police, fire, and ambulance services or would want to privatize the public school system. Americans of all political leanings are willing to finance these important services yet some, those influenced by the fear-mongering of insurance and pharmaceutical lobbying efforts, would deny health care delivered by the same method. Meeting the health needs of people is as or more important than the other services currently supplied in a socialistic means. “In the United States, certain publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, and the poor and federal law ensures public access to emergency services regardless of ability to pay; however, a system of universal health care has not been implemented” (“Universal” 2005).
In a universal, or single-payer, health care system, the government accumulates tax monies from individuals and businesses to finance health care facilities that are freely open to everyone. Implementing such a system would mean an end to Health Maintenance Organizations (HMOs) and insurance companies that provide health insurance, a fact few are heartbroken about. Universal health care is not simply a humanitarian concern which alone would be reason enough to rally support for it but continuing with the present system will push many more families to the brink of financial ruin as well.
The Costs of Health Care
In September of 2006, in a report by the Kaiser Family Foundation, it was shown Americans paid an average of $11,500 for family health care benefits through their employer (Leonhardt, 2006). This is a 7.7 percent rise from the previous year. Benefit-cost have doubled since 1999 but wages and corporation revenues, which heavily subsidize insurance, have risen only fractionally. The term spiraling and healthcare costs have become conjoined in common language usage and this is creating an economic crisis for both employers and employees.
According to David Leonhardt (2006), the average person spent just under $100 a year for health care benefits or the equivalent of $500 in today’s dollars in 1950. In 2005, the average person spent close to $6,000. “In a new Christian Science Monitor/TIPP poll, 54 percent of respondents reported that their healthcare costs had increased in the past year, hurting family finances” (Sappenfield, 2002).
Costs in Perspective
Medical bills were of little concern to families in the 1950s but medical technology seems archaic by today’s standards. Half a century ago, a person’s lifespan was approximately 68 where today, it is a decade longer. Those in their 40’s today can reasonably expect to see their 80th birthday. Most, presumably, would prefer to spend more money to live longer which is what has happened. From this perspective, healthcare could be considered a good return on investment. The benefits and costs of healthcare are not unrelated yet many do not understand why they have to pay more than they did equivalent to the 1950s or even to 1999. People generally consider healthcare costs to be a commodity in the same way they think of electricity or gasoline where price has little bearing on the quality of the product.
Prescription Drug Costs
The price of prescriptions is not determined by production costs or by monies allocated to researching new drugs. Competition, the projected volume of sales as opposed to actual sales, and estimates of revenue produced by the product are among other factors that drive drug prices. Because of the competition in some drug classes such as headache relief medications or cholesterol-lowering drugs, prices are kept low. But in the case of a medication where a suitable substitute isn’t available, its manufacturer can ask practically any price they wish. For example, Abbott Laboratories raised its price on Norvir, a drug that treats AIDS to $265 in 2003 (Berenson, 2006).
The price was $54 when it was introduced in 1996. No other comparable drug exists as of yet so Abbott can set the price higher with no other justification other than wanting to increase its profits. The Food and Drug Administration takes no part in the regulation of drug prices and federal law prohibits Medicare from taking into account price when deciding on what treatments to cover. Insurance companies, government agencies, and individuals must pay the prices drug manufacturers establish.
The Price of Costly Healthcare
If health insurance costs continue the present trend of increasing 100 percent every seven years, the costs will soon be prohibitive for employers and their employees alike. Spending money on consumer goods stimulates the economy and it is viewed as patriotic in an abstract sense. Taking on a mortgage on a house is an investment but healthcare is considered simply a cost. If it rises to the point where very few can afford it, the lives of the majority will be cut short. Which is more important, to go on a spending spree at the mall, buy a bigger house or live another decade or so? It seems the country’s priorities are misplaced (Leonhardt, 2006).
At present, about 45 million Americans are without healthcare insurance and that number rises every day due to the escalating costs. Healthcare costs can be cut but the crisis seems not to be among the country’s priorities.
Financial Status Determines Quality of Care
Social location can be an accurate predictor of health status. Individuals, their families, and groups in the higher social classes live longer on average. The life expectancy of children born to higher-income families today in Western societies is five years longer than those born to working-class families (Acheson, 1998). Until recent studies directed attention toward the sociological explanation for the inequality that exists in health status, a more direct link was thought to explain the disparity, a line of reasoning that merits serious consideration.
Low-status jobs generally pay less. Lower incomes translate to restricted choices which means choosing food, housing, and health care based on budgetary constraints, not on which is the healthier choice (Marmot, 1984). This direct association, while valid, is only a surface view of the link between social class and health status. A more clearly defined view of this social phenomenon can be found only by examining the less obvious psychological and sociological aspects of the connection. The psychological component of this triad is the product of various sources many of which are sociological in nature.
Psychological concerns involve the extent to which levels of pessimism, optimism, and general feelings of self-esteem affect health. Self-esteem can be linked to health by two dissimilar social processes. First, “low self-esteem is part of a causal sequence that may lead to severe depression and related psychiatric disorders” (Brown, 1990). The second suggests a more indirect explanation that likely is the more harmful of the two. “Persons with low self-esteem lack the confidence and determination to adopt or maintain appropriate health behaviors with regard to smoking, substance abuse, diet, and exercise” (Hurst, 1997).
The Rich Stay Healthy, the Sick Stay Poor
Social location more often than not is closely related to a physical location. Living in certain areas of the country and cities is a determining factor in projecting health outcomes. Lower-income people who live in the inner cities suffer what is commonly referred to as the ‘urban health penalty.’ This phrase illustrates the reality that health status is decidedly lower among lower-class neighborhoods. This faction of society doesn’t possess the political influence or financial means to effect change in their desperate circumstance. They are likely to remain poor and living in places that exacerbate their health problems. “Inner-city-bound populations, such as the poor and working poor often have heightened health risks because of smog, toxic waste dumping, noise, traffic, crime, violence, drug abuse, and crumbling infrastructures” (Short, 2001).
The National Center for Children in Poverty released a report in 1997 that provided hard statistics that reproved the prevalent sociological theory. According to the report, nearly three million impoverished children in the U.S. are confronted by an increased chance of developing brain disorders as a result of being exposed to several ‘risk factors’ connected with living in such social circumstances. These ‘risk factors’ comprise exposure to lead-based paint and asbestos, inadequate diet, and drug abuse. According to this report, “55 percent of African-American children living in poverty have toxic levels of lead in their blood” (Short, 2001).
Those seemingly entrapped by their impoverished circumstances seldom seek preventative medical care or other health services until they require an emergency room visit. The expense of modern health care is prohibitive to most residents of the inner city who can neither afford medical insurance. “The American Medical Association warns physicians that, due to the lack of affordable health insurance, more patients will delay treatment” (Zinser, Hsieh, 2008).
Studies have consistently demonstrated that the lower the social status, the odds they will be of poorer health and die at a younger age increases proportionately. “Data stretching back centuries demonstrate that each step down the socioeconomic ladder increases the morbidity and mortality for numerous diseases. This gradient, documented in all industrialized societies, is considerable, with mortality rates due to some diseases differing by an order of magnitude between the highest and lowest echelons of socioeconomic ladders” (Adler et al. 1993). Theoretically, the reverse is true as well.
The health benefits of enjoying a higher social status are most evident in the elderly. “The social position that each older individual occupies, which exerts such strong influence on health, is the result of lifelong processes, and may itself be influenced by earlier health status” (House, et al. 1994).
Poor Children, Poor Health Care
Children raised in a higher social location are, to no one’s surprise, healthier as adults than those raised in indigent conditions. An individual’s social position at every phase of life influences health later in life. “Being born with economic advantages is likely to lead to educational success, which is linked to occupational advantage and later financial security. Social stratification early in the life course affects the trajectory an individual is likely to follow” (Blane, 1999).
The duration of an individual’s education, nature of their earliest employment, the job title they hold, and financial status during their middle years all are known to play a role in increasing stress which negatively affects health and leads to an early demise. The significance of social class during the course of a lifetime has been proven to be a future predictor of health by numerous studies conducted of many world societies over many years.
A 24 year-long study conducted by the National Longitudinal Survey of Labor Market Experience concurs with these findings. “When individuals were categorized according to the number of points in their life when they were living with a father who held a manual labor job or they themselves held a manual job, those who never engaged in manual labor had better health than those who did” (Blane, 1999).
Universal Health Care Works Elsewhere
The vastly contrasting societies of the U.S., Cuba, and Japan were compared by the study to illustrate this finding. The gross domestic product (GDP) was balanced against the average life span in each country which proved higher incomes did not necessarily equate to healthier citizens. The GDP (per person) in the U.S. is $34,000 while the lifespan averages about 77 years. Cuba’s GDP is $5200 but the life expectancy is the same.
The Japanese GDP is $25,000 and the life expectancy, the highest in the world, is better than 81 years (Bhattacharya, 2004). Social status, which is not automatically dependent upon financial status, determines the level of happiness and self-worth which translates into improved health outcomes. “Hierarchies are inevitable but how hierarchies are translated to differences in health is the crucial question. Social arrangements, education and social cohesion may be crucial factors” (Marmot, 1991).
The Japanese society puts much emphasis on social arrangements and education and is universally acknowledged as cohesive when compared to all others. This cohesiveness is possible because, in this society, there exists less of a perceived gap in the social hierarchy. It models an ‘all for one and one for all type of mentality. The conflict theory is not applicable in Japan to the same degree as in other countries. The working class doesn’t experience similar internal or external psychological pressures to rise to a higher social class nor is ashamed and frustrated by their current social location to the same degree as those in other societies.
The people of Japan put greater importance on caring for the elderly, the crime rate is lower and industrial productivity is higher than in the U.S. There is much less of a chasm between the ‘haves’ and the ‘have nots’ than in the U.S. and they enjoy a longer and healthier life.
Universal heal care will eliminate the financial burden to the elderly, poor, and middle-class families. Opponents to the plan make the argument that people are not entitled to health care. This view is in the vast minority compared to the rest of the world and the U.S. as well yet reflects the reality in the country. “The United States is the only industrialized nation that does not guarantee access to health care as a right of citizenship” (Battista, McCabe, 1999).
Opponents also claim universal health care would be prohibitively costly. The facts do not bear out this fear, however. The U.S. spends more money, per capita, than all other nations that provide universal coverage, a startling 40 percent more than any of these countries. According to studies by both the Federal Budget and General Accounting Office, the U.S. would save between $100 and $200 billion every year if universal health care was implemented. The State of Massachusetts has recently enacted a single-payer health care system and expects to save between $1 and 2$ billion in the first year.
Connecticut is soon to follow. These savings have been confirmed in studies conducted by that state. Canada went to the single-payer system in 1971. The vast majority of its citizens would not choose to revert back to the old, U.S.-style system nor would the government which has saved significant amounts of money through the economy is weak as compared to the U.S. Much of the savings is in bureaucratic expenses. “Single payer universal health care costs would be lower than the current U.S. system due to lower administrative costs. The United States spends 50 to 100 percent more on administration than single payer systems. By lowering these administrative costs the United States would have the ability to provide universal health care, without managed care, increase benefits and still save money” (Battista, McCabe, 1999).
Currently, the U.S. is the only industrialized, ‘civilized’ country that allows its citizens to be refused health care due to their inability to pay. This embarrassing circumstance would be eliminated by implementing universal health care and the government would save hundreds of billions every year. Other than insurance and pharmaceutical companies, all would benefit. Individuals would profit both financially and medically and the government on the state and federal level could divert the monies spent now on the broken health care system to social programs that would further benefit society as a whole.
Patients would not be forced to choose from a list of doctors unlike the current system and would not have to rely on a bean-counting to decide to what extent or if their condition will be covered by insurance. Americans are needlessly suffering and dying while vast amounts of money are being wasted, all for no reason other than the stubbornness of the leaders of the country to address the problem. It’s not because universal health care does not make sense economically or politically. The insurance and pharmaceutical industries are large contributors to politicians and have the funds to bombard the media with self-serving propaganda designed to scare people into continuing the current failed system. Americans should be appalled and ashamed of the system and themselves for being so blindly manipulated.
Acheson D. Independent Inquiry into Inequalities in Health. London: Stationery Office; 1998.
Adler N, Boyce T, Chesney M, Folkman S, Syme S. “Socioeconomic inequalities in health: No easy solution.” Journal of the American Medical Association. Vol. 269, (l993):3140–45.
Battista, John R., M.D. McCabe, Justine, Ph.D. “Talk Given To The Association of State Green Parties” (1999). Web.
Berenson, Alex. “A Cancer Drug’s Big Price Rise is Cause for Concern.” New York Times. (2006). Web.
Bhattacharya, Shaoni “Higher status leads to a longer life.” New Scientist. (2004). Web.
Blane, D. “The Life Course, the Social Gradients and Health.” Social Determinants of Health. M. Marmot and R. G. Wilkinson (Eds.). Oxford, U.K.: Oxford University Press, (1999): 64–80.
Brown GW, Andrews B, Bifulco A, Veiel H. “Self-esteem and depression: Measurement issues and prediction of onset.” Social Psychiatry Psychiatric Epidemiology. Vol. 25, (1990): 200-9. [PMID: 2399477].
House, J. S.; Lepkowski, J. M.; Kinney, A. M.; Mero, R. P.; Kessler, R. C.; and Herzog, A. R. “The Social Stratification of Aging and Health.” Journal of Health and Social Behavior. Vol. 35, (1994): 213–234.
Hurst DF, Boswell DL, Boogaard SE, Watson MW. “The relationship of self-esteem to the health-related behaviors of the patients of a primary care clinic.” Archives of Family Medicine. Vol. 6, (1997):67-70. [PMID: 9003174]
Leonhardt, David. “The Choice: A Longer Life or More Stuff.” New York Times. (2006). Web.
Marmot MG, Shipley MJ, Rose G. “Inequalities in death—specific explanations of a general pattern?” Lancet. Vol. 1, (1984):1003-6. [PMID: 6143919].
Presse, Agence France. “U.S. Health System Ranks Last Compared to Other Countries” (2007). Web.
Sappenfield, Mark. “More states flirt with universal healthcare” The Christian Science Monitor (2002). Web.
Short, Gail. “Perilous Places: Links Between Location and Health.” UAB Magazine. Vol. 21, N. 2, (2001).
“Universal Health Care” QuickOverview.com. (2005). Web.
“Who Should Pay for Health Care?” PBS.org (2004). Web.
Zinser, Lin, Hsieh, Paul “Moral Health Care vs. Universal Health Care” The Objective Standard (2007-2008). Web.