Access to Health Care in the United States of America – Forever A Market Commodity or a Respected Human Right?

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The United States of America is one of the few high-income nations on earth that does not guarantee access to health care for its population. In 2010, 49.9 million Americans remained uninsured and without access to health care. Disparities in access to health care are also pronounced among poor people of color, specifically African-American, Native Americans and Hispanics. The US ranked third last for health care for women, after Mexico and Hungary (OECD, 2006). Limiting access to health care services is detrimental to both individuals and society. This may inhibit a person’s ability to reach their full potential and may negatively impact on their quality of life. Preventing access to appropriate health services, in fact, has resulted in thousands of preventable deaths. Dr. Andrew Wilper et al. in a 2009 report from Harvard published in the American Journal of Public Health found that 44 800 preventable deaths occurred annually due to lack of access to health care in the United States. This is close to 15 times the number of lives lost in 9/11 – every year.

This is ironic as the United States easily outspends all other high-income countries in terms of percentage of Gross Domestic Product (GDP) devoted to health care. The amount of money spent in private expenditures on health care is also the highest in the world. According to the World Health Organization (WHO), the United States spends more on health care per capita and more on health care as a percentage of GDP than any other nation on earth. Despite this, the infant mortality rate of the US is the highest of all high-income countries while the life expectancy is lower than that of low and middle-income countries such as Cuba and Chile. Again, the WHO ranked the US in 2000, as having the highest in cost, 37th in overall performance, and 72nd by overall level of health. Thirty percent of health care spending is waste, including fraud (Berwick, 2011). From the individual perspective of health care users, medical debt accounted for 62.1% of all bankruptcies in 2007 (Himmelstein et al., 2009). Most medical debtors were well-educated and from the middle-class. Three quarters of these individuals also had health insurance. The share of bankruptcies attributable to medical problems rose by 50% between 2001 and 2007. The United States pays (and may waste) more on health care in the private sector, with worse health care outcomes while still not providing adequate coverage for all Americans, many of whom are forced into bankruptcy to cover costs of medical care.

It is a minority of health care that is funded through public mechanisms in the United States. The majority of Americans are covered through private insurance companies with health care packages purchased through a variety of market-driven economic models. Some states, such as Massachusetts, are providing a universal model of health care, but again with a substantial subsidy to private insurance corporations. The concept of universal, government-run or a single-payer health care system is foreign to many Americans. However, this idea indeed is gaining momentum given the growing 31% of health care dollars that go to administrative costs and not towards health care. While health care reform is currently being debated, the discussion surrounding access to health care must be broadened to include perspectives shared by many Americans and citizens of the world. Health care, and access thereof, has long been deemed a basic human right, as enshrined in the United Nations’ Declaration of Human Rights. As Americans, we are starting to understand that.

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4 Responses to “Access to Health Care in the United States of America – Forever A Market Commodity or a Respected Human Right?”

  1. canarave Says:

    You make several excellent points, one of which is that limited access to health care services not only impacts individuals but also society. This cannot be stressed enough–individuals who have the “misfortune” of being without access are not isolated from the rest of society; as an interconnected “organism” society as a whole is impacted by those that are left behind. The DALYs and QALYs that are lost due to lack of access, the monetary strain on the system, not to mention the social ramifications of having some people with the assurance that they will be provided for and others without any way to get even preventive care all contribute to the state of emergency the US is experiencing with regards to health expenditures and poor health outcomes. While it is contrary to the individualistic and limited government paradigm that Americans are used to, universal health care as a human right is becoming more and more acceptable not only from a humanitarian perspective but also from a purely economic standpoint.

  2. nickseeliger Says:

    Excellent and well written argument. I have struggled with these facts ever since joining the medical profession. I was most impacted while a young medical student about 8 years ago as I observed surgical specialist in the doctors lounges complaining about cuts to medicare reimbursement for routine surgical procedures. I had just returned from a one month elective in primary care serving a rural / poor community near my hometown. There, in that community, the doctors didn’t complain about their pay they complained about not having enough resources locally to do their jobs well. Over the years I have been fortunate to serve in the military community and be a part of their “socialized” system. As a member of this community and specifically as the medical professional I have seen the benefits of “the same for all”. I am proud of the system that provides the same care to our youngest and poorest families as it does to our highest ranking officials. I certainly hope that America figures this one out as we have just taken great strides in the right direction.

  3. luiso76 Says:

    This is a good discussion of several of the ills of the US health system. The US probably meets the minimums set forth in the “Right to Health” from the UN, depending in how you read it. However, most would say that there is not true parity in access to healthcare. That said, universal provision of health care does not need to come through a government run or single payer system. Switzerland provides a good example of a consumer driven system. Those who tout market forces in the US do need to take note that Switzerland’s system does rely heavily on government regulation. Income based subsidies help to provide parity in access to the mandated individual insurance (similar to PPACA).

    The US is a leader in the development of innovative practices over the last decade. Conservative elements in the US also are concerned with how a move from market forces would affect health care innovation. I wholeheartedly agree that provision of health is a universal right. I also believe that firm steps must be taken so that income is not a detriment to one’s ability to access health care. However, we should also be willing to look at innovative systems which meet those requirements, but do not require a purely government administered system.

  4. dvandurme Says:

    Thanks for the thoughtful post on a very important subject. I found myself agreeing with most everything but took strong exception to your statement “it is a minority of health care that is funded through public mechanisms”. This is one of the persistent myths that stands in the way of significant health reform. People think it will involve the government “taking over” health care when for many years the expenses of Medicare, Medicaid, care for people in the armed services and other government employees has been climbing towards 50%. According to the National Health Expenditures Data, in 2010 the federal government paid for 29% of health care costs, state and local governments paid for 16%, private businesses covered 21% and households 28%. (I could not find who covered the “missing” 6%).

    The related myth is that cost-sharing will involve employers or businesses covering expenses. The reality is that they do not “pay” for health care, they simply pass along the costs in the form of lower wages and/or higher prices. We all need to understand that each and every one of us pays for health care, whether in wages, costs of consumer goods, taxes, or whatever. It comes out of our pockets. The sooner we can all see this, the sooner we can get behind meaningful reform.

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