Failing to Support Us When it Matters Most
By Anonymous / Spring 2020
My grandmother was diagnosed with breast cancer in her 40’s and passed away before I was born, but it propelled my mom to pursue a career as an oncology nurse. My mom has been an oncology nurse for 25 years, and over the course of her career she has treated hundreds of patients. Most days she comes home with stories of them, how sweet her new 11 year old patient is and his weird obsession with Star Wars, the patient who’s cancer has gone into remission after months of care, or the 42-year-old mom battling breast cancer who was just admitted under her care. She shares their joy, their anxiety over the sight of needles, their odd sense of humor, and even sometimes pain of their brief stay. So, most days I see her experience the typical emotions associated with a career, the stress, frustration, the bright moments, but I have learned that she hides a lot of them too. Maybe a few months later her patient has relapsed, and the cancer has returned in a worse state, or the 11-year-old lost his battle with leukemia. On those days, my mom is more quiet than usual, but she doesn’t bring those moments home to show us.
Sometimes she will break down and share ugly truth of the ruthlessness of cancer, how it has been treatable and other times where they can only prolong the inevitable. But there have been times where she has come angry and frustrated, explaining how one of her patients was no longer able to afford the co-pay for treatment or they changed insurance companies so it had to be delayed or canceled. The patient would come back to find their cancer had gotten worse and harder to treat, and in some cases, they would lose their battle with it. Different forms of cancer are very treatable with the proper health care but take that away and the mortality rate skyrockets. My mom’s stories point to a systemic issue here in the United States: our health care system. Our health care is bound to the depths of our wallets and the insurance companies we rely on. Health is a fundamental human right, and affordability should not be the deciding factor in where someone lives or dies. In order to work towards a system that can one day be both equitable and affordable, we must analyze the historical roots of the problem to understand where the issues lie.
The health care system today is largely due to the ideologies and shifts in power that took place during the 1970s. In the 1970s, when the United States was hit by economic turmoil followed by a period of “stagflation” --- a high inflation and unemployment rate and low economic growth (Gaffney). As a result, the economic instability presented an unique opportunity for corporations and businessmen to reassert their places in power, “These years saw an explosion in the number of corporate political action committees (PACs), in the number of corporations with public affairs offices in Washington, and in the quantity of corporate political donations” (Gaffney). While the idea for a new system of healthcare was still being debated, the sequence of events in the 1970s settled the debate. The combination of the rising costs in medical care because of the stagflation with the surge of corporate influence produced the dogma that universal health care was simply unaffordable, and instead shifted focus to the privatized model of healthcare. So far, health care has been privatized and corporations and other business interests have infiltrated our governing body, but the issue still remains: health care is still largely affordable and available.
Enter the concept of moral hazard. Originally coined by Mark Pauly in his paper “The Economics of Moral Hazard,” it referred to the idea that patients would use health care unnecessarily because it was free (Gaffney). As a result, the idea of moral hazard prompted the health care industry to develop “various devices of ‘cost-sharing’ (i.e. deductibles, copayments and co-insurance)” (Gaffney) to discourage people from taking advantage of the system. There was a fundamental belief that this supposed excess use of health services imposed a “welfare loss” on society (Gaffney). Out of this rose the fundamental component of our health care system today, where in order to combat this abuse of services and to better suit individuals, our health care system would revolve around the idea that “the optimal state would be one in which ‘various types of policies are purchased by various groups of people’” (Gaffney). By now, not only does health care incur high personal expenses and restrictions tied to employment, but the coverage now varies on an individual basis. The last component is the consumer-driven health care model that we see today, which began with the passage of the Medicare Modernization Act in 2003. It led to a rise in consumer-directed health insurance plans where “patients would now be spending their ‘own’ money whenever they needed health care, forcing them to act more like consumers” (Gaffney). It was believed to give consumers more control over their care, to compare costs and get lower prices on their plans. However, under this consumer-driven healthcare system, health care costs have only risen while the quality in care has gone down.
What have been the consequences of our history of privatization and individual choice? The United States has the lowest life expectancy out of the 11 OCED countries with more and more people every year avoiding medical attention simply because they cannot afford it: “For 2018, the percentage of the population that failed to obtain needed medical care due to cost at some time during the past 12 months was 4.8%” (www.cdc.gov). Our system is clearly only benefitting those who can afford it and have access to quality health insurance. To illustrate this point further we can turn to the most recent US Census which found “8.5 percent of people, or 27.5 million, did not have health insurance at any point during the year” (US Census Bureau 2019). It is not that we lack the resources to have effective medical care facilities or professionals, people just cannot afford the massive bill that comes along with them. We have the capacity and tools to help, and yet people are still dying and suffering from common and sometimes preventable health issues because they cannot bear the financial burden.
The recent COVID-19 pandemic has revealed the shortcomings of our healthcare system and the blatant inequality in access to care. As the Corona virus has shutdown most non-essential businesses, people have found themselves without work or a way to provide for themselves and their families during this crisis. Those who can afford to stay home and stay safe, the upper class and wealthy, remain unaffected and only inconvenienced. Meanwhile, those in poorer communities do not have the same luxury. In fact, this pandemic has shown to have only benefitted the wealthy even more, “’Billionaires have made nearly $500m while essential workers have not even been given guaranteed health care, a living wage or a water supply that is protected from being shut off’” as Rev William Barber of the Poor People’s Campaign points out (Pilkington 2020). Not everyone can afford to stay home or have the luxury of working from home and therefore must go out, risking their lives to support their families. This point becomes clear when we turn to a recent Guardian article that highlighted contributing factors to the growing Coronavirus pandemic in the United States: “low-income people have been dying in high proportions through a combination of lack of health insurance, hospital closures and policies pursued by southern governors that have exposed vulnerable citizens to danger” (Pilkington 2020). The cards have been stacked against poorer communities, as public healthcare services have been cut, the lack of quality and affordable healthcare have worsened the problem. Now that we have examined the historical roots of our health care system and witnessed the disproportionate affect it has on the poorer communities; we can consider the ideologies that allow them to remain.
The health care system that exists today is in response to a Neoliberal shift that took place in response to the FDR’s postwar liberal policies. Neoliberalism is the economic school of thought that embraced the idea of free market capitalism, privatization, and deregulation. It was not too long ago when the United States health care system was not driven by neoliberal philosophies and powerful corporate lobbyists. Three decades after the emergence of FDR’s New Deal liberalism, the new Neoliberal ideology took hold denouncing the idea of universal health care and other forms of social welfare. Friedrich Hayek in his 1960 paper The Constitution of Liberty embodies the essence of the Neoliberal view on healthcare which was essentially, “we all have different preferences for how much health care we want in proportion to the other ‘material advantages’ in life” (Gaffney). His argument was that people have different needs for their health care coverage and it should be up to the consumer to make their own choices regarding their wallet. Opposition to this claim was quickly put out as this was reinforced by another dominant American belief that individuals and now corporations have the freedom to act without any interference, otherwise known as negative liberty. Any opposition to consumer choice was an infringement on one’s personal freedom. These ideologies have produced a society that promotes individualism and profit above the wellbeing and health of others. This has led to the destruction of our social safety net through the cuts to numerous public services, deregulation, and privatization; the consequences of which we are seeing today.
The Coronavirus pandemic in the United States has been exasperated by the lack of ventilators and other medical supplies that are necessary for the treatment and safety of medical care professionals. According to a recent article, in Forbes, states have been in a bidding war “amongst each other and the federal government to get critical medical supplies” (Estes). Not only are hospitals short on the supplies they desperately need but the state governments are put in competition with each other for these life-saving supplies. States that do not have access to greater financial resources are left without any viable options, but this bidding war serves to drive the price skyward. In drastic times such as this, it is paramount that everyone should be working in cooperation with each other, not in competition. No single party serves to benefit from this situation, except for the private suppliers who serve to gain financially from it. Furthermore, our neoliberal ideology’s denouncement of government-funded care has crippled hospitals when we need them the most and further demonstrates its shortcomings. Many of the southern states have been hit especially hard. Particularly in Alabama where cuts to healthcare benefits has led to drastic consequences: “75% of rural hospitals operate at a financial deficit…healthcare advocates warned the pandemic could lead to a number of hospitals closing at the height of an outbreak due to the financial pressures associated with treating uninsured people” (Laughland 2020). Even before the pandemic hit, we were ill prepared due to cuts to state and federal budgets, and now hospitals will be forced to close because they cannot afford to treat patients. In times of crisis our neoliberal healthcare system has failed to solve our problems while also creating new ones, showing the need for a change in mind set.
We must reverse the ideological shift that we have undergone because our current neoliberal ideology is not sustainable. For that we must return to the democratic principles that FDR embodies during his years in office. The United States is built upon the idea of democracy and personal freedoms, the right to life, liberty, and the pursuit of happiness. FDR embraced these ideals and built upon them in his speech, “The Second Bill of Rights,” adding: “The right to adequate medical care and the opportunity to achieve and enjoy good health” (Roosevelt). Everyone has a right to live a healthy life without the worry of financial ruin or access to care. Our individualism has driven us to focus on our family’s health but has numbed us to the welfare of anyone outside our circle. It is too common for us to blame other’s personal failings for their poor health or to accuse them of taking advantage of a system that is put in place to help them. Our neoliberal ideologies have shaped us to see each other as the competition, divided us and as a result we have forgotten that we are all in the “same house.” In MLK Jr.’s “The World House” he calls for us to move towards a “person-oriented society” one in which everyone is interconnected and has compassion for one another: “Ultimately a great nation is a compassionate nation. No individual or nation can be great if it does not have a concern for the “least of these”’ (King 2010). If we can look past our immediate wants and needs, and understand the struggles others face, share the same compassion for one another, we can live in a society where our wealth determines whether we live or die. Armed with these principles we can create a healthcare system that is both equitable, and affordable.
The main obstacle that we face today is the rhetoric that people take advantage of welfare programs, thus there is a general objection to paying for and supporting a universal healthcare system. Many opponents to universal healthcare have labeled it as “socialist” and characterized it as a largely expensive, ineffective, and “anti-American” system that could never work. The first important step to overcome these obstacles would be to dismantle the false rhetoric and misinformation that is circulating regarding single payer healthcare. What we need is for people to brush aside their shortsightedness, and animosity towards each other, and work towards a system that has the potential to benefit everyone. The current pandemic has provided a unique opportunity for people to witness firsthand the current problems plaguing our health care system and demonstrate the kind of person they want to be. Yes, we have seen some guided by misinformation protest it as a hoax or hoard supplies to turn a quick profit. But there have also been people reaching out and united together to help others get the supplies they need. We need to learn to look out for one another, to treat each other with compassion and empathy, not contempt. Once we have that, then we can move forward with collective action.
The biggest obstacle we face today lies with the healthcare and pharmaceutical industries. Under our current system, they have consolidated considerable wealth and influence, something they will not easy forfeit in the name of the common good. Collectively, we must work towards establishing a universal, single payer health care system. It will be a long road ahead of us as the policymakers we have to rely on for systemic change are being paid by these very same companies. According to “OpenSecrets”, a nonpartisan, independent research group tracking money in US politics, “individual companies within the pharmaceuticals and health products sector spent $194.3 million on lobbying as of October 24, 2018” (Scutti 2019). Our elected officials who are supposed to be working for the people are working for their own self-interests, and it is vital that we continue to address the glaring conflicts of interests in our governing bodies.
Universal health care has the potential to fix the inequitable and broken healthcare system we have in the United States today. People will no longer have to worry about whether they will be able to afford their treatment or whether they face financial ruin as a result. Healthcare will no longer be based on your social class or your employment and poorer communities will have greater access to quality health care. We can see a clear example of this in Brazil which adopted a series of health care reforms that established a universal health care system. “Prior to 1988, the year the Unified Health System came into being, just 30 million Brazilians had access to health services. Today, coverage is closer to 140 million” (Yates & Humphreys). Not only did their coverage grow exponentially but their quality of care increased as well: “infant mortality…fell from 46 per 1000 live births in 1990 to 17.3 per 1000 live births in 2010” (Yates & Humphreys). So, it is quite clear that universal coverage improves quality of care and overall coverage, but there is also the concern about the cost to individuals. To see this, we can examine a recent review of Thailand’s Universal Coverage Scheme over a ten year period that revealed how the poorest individuals’ out-of-pocket healthcare expenses decreased: “Between 1996 and 2008 the incidence of catastrophic health care expenditure amongst the poorest quintile of households covered by the UCS fell from 6.8% to 2.8%” (Yates & Humphreys) . The benefits also extended to higher income households as well: “incidence of non-poor households falling below the poverty line because of health care costs fell from 2.71% in 2000 to 0.49%” (Yates & Humphreys). Universal health care has drastically improved the health and financial conditions in many other countries. With the United States’ resources and infrastructure, universal health care can fix our fragmented system.
This is a problem that affects all of us, disease and medical conditions do not discriminate based on class, race, or gender. Many may find it easy to ignore the people who are suffering, both financially and physically, because of our system, but sooner or later they may find themselves or a loved one suffering as well. We should not have to wait for that to happen. Now is the moment to call for reform and for change especially in this unique time of crisis. The coronavirus pandemic has hit the United States especially hard, our neoliberal ideology failing to support us when it matters most. It is time for a new system, one that will support everyone regardless of class, income level, or employment status.
Works Cited
Estes, Clary. “States Are Being Forced Into Bidding Wars To Get Medical Equipment To Combat Coronavirus.” Forbes, Forbes Magazine, 30 Mar. 2020.
“FastStats - Access to Health Care.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 May 2017.
Gaffney, Adam. “The Neoliberal Turn in American Health Care.” Jacobin.
King Jr., Martin Luther. “The World House”. Where Do We Go from Here: Chaos or Community? pp 177-202. Beacon, 2010.
Laughland, Oliver. “'A Perfect Storm': Poverty and Race Add to Covid-19 Toll in US Deep South.” The Guardian, Guardian News and Media, 12 Apr. 2020.
Pilkington, Ed. “As 100,000 Die, the Virus Lays Bare America's Brutal Fault Lines – Race, Gender, Poverty and Broken Politics.” The Guardian, Guardian News and Media, 28 May 2020.
Roosevelt, Franklin D. “State of the Union 1944 (The Second Bill of Rights).” WCWP 100:
Systemic Analysis for Everyday Life, edited by Niall Twohig, UC San Diego, 2020, pp. 91–99.
Scutti, Susan. “Big Pharma Spends Record Millions on Lobbying amid Pressure to Lower Drug Prices.” CNN, Cable News Network, 24 Jan. 2019.
US Census Bureau. “Health Insurance Coverage in the United States: 2018.” The United States Census Bureau, 8 Nov. 2019.
Yates, Robert, and Gary Humphreys. Arguing for Universal Health Coverage. World Health Organization.