According to Healthline, 27.5 million people did not have health insurance in 2019, and about half of uninsured adults cited high cost of coverage as the reason for remaining uninsured. One of the main barriers to health care is the expense of the programs. High premiums, deductibles, copays and coinsurance of insurance plans are a major issue, especially given that most individuals in the U.S. have private insurance. According to the Centers for Disease Control and Prevention, most uninsured adults came from low-income backgrounds. Among adults, 27.4 percent of those who were poor, 25.1 percent of those who were near-poor and 8.3 percent of those who were not poor lacked health insurance coverage in 2018. (“Persons categorized as ‘poor’ have a ratio less than 1.0 (i.e., their family income is below the poverty threshold); ‘near poor’ persons have incomes of 100% to less than 200% of the poverty threshold; and ‘not poor’ persons have incomes that are 200% of the poverty threshold or greater.”) The result of this: Americans with higher income have better health outcomes than those with low income because they are almost always guaranteed health care coverage.
This “disproportionate risk of being uninsured, lacking access to care, and experiencing worse health outcomes” is called a health inequality, also known as a health disparity, which refers to a difference in the presence of disease, health outcomes and health care access between different populations. A health inequality can be an inevitable health difference based on age or, more notably, a higher likelihood of low-income individuals to suffer from chronic conditions like heart disease and diabetes which have an adverse effect on quality of life. These health inequalities are closely tied to income inequality which is exceptional in the U.S. It has become increasingly important for federal and local governments to prioritize initiatives aimed at reducing income-based health disparities, especially as income inequality has persisted and health care costs have increased.
In the past year, health care has been a defining issue many Democratic candidates have campaigned on. In 2019, Sen. Bernie Sanders, I-Vt., introduced the bill S.1129-Medicare for All, which would automatically enroll all U.S. residents for health insurance and cover essential medical services. Medicare for All is a single-payer health care proposal that would streamline the current multi-payer health care system and eliminate the private sector’s role in providing and paying for health care.
Currently, Medicare is a government-provided health insurance program only available to people aged 65 or older (and some younger people with disabilities). Medicare covers about half of all health care expenses and people often have to pay out-of-pocket (OOP) expenses or join another health insurance to cover the uninsured services. These OOP expenses include copays, premiums and deductibles, which go back to financing the insurance.
The new Medicare for All bill based on Sanders’s proposal is an expanded version of the current program all U.S. residents would be eligible for. It would essentially eliminate all private insurance, including employer-based coverage. The bill states that private insurance can only be “supplemental” to the program to offer coverage for services not covered under it. This would be a huge change to the current health care system, where over 68.9 percent of adults have private insurance. Furthermore, this current system costs significantly more than public health insurance.
There are a number of defining health insurance proposals made by Sen. Elizabeth Warren, D-Mass., a cosponsor of Sanders’s bill, former Vice President Joe Biden and other candidates. Biden has proposed the Biden Plan, which is a public insurance program that would reshape rather than eliminate private insurance while increasing the scope of Obamacare (Affordable Care Act).
Regardless of the type of policy, providing health care to all individuals is the first step toward eliminating health disparities in the U.S. The rhetoric, though, shouldn’t be about “insuring more than an estimated 97 percent of Americans” as Biden says. Everyone should already have access to health care, not just 97 percent of us. Health is a fundamental human right and these policies only resolve the first problem, lack of access to health care. The availability of health care to everyone should be a given. These policies only make it so that everyone has access to the same level of health care, but does not address the systemic health inequities that have become deeply rooted in our health care system.
Health inequities are specific types of disparities that are avoidable, unjust and the result of continued and persistent health differences. When health differences are “preventable and unnecessary, allowing them to persist is unjust,” writes Mariana Arcaya, Alyssa Arcaya and S.V. Subramanian from Global Health Action. The underlying difference between inequality and inequity is that the latter suggests injustices against a vulnerable population group based on race or ethnicity. Unlike age-related health differences, health inequities are clearly demonstrated in things such as higher rates of infant mortality among Black children than white children. This difference in mortality rate is seen among Black and white children in the same income group as well which suggests the underlying cause of this inequity is “rooted in social injustice.”
A powerful visual for health equity is three people standing behind a fence, each a bit shorter than the person before him. If you give them all an equally sized stand, only the tallest one will be able to see beyond the fence. The two others still won’t be able to see beyond the fence. Health equity is the idea that you give each of them the correctly sized stand that lets them all see beyond the fence. Healthy equality is not equity.
The current policy proposals presented only touch upon the underlying causes of health disparities and inequities in our health care system. Equitable health care access involves more than equal access to health care. It requires the equitable distribution of resources, finances and benefits to those who need it. Our current multi-payer system is neither equitable nor equal. We, as college students and voters, need to call upon our representatives to reassess the distribution of both resources and funding to fully understand how we can redesign and shape our current health care system to reduce persisting health disparities and inequities
Jenny Gurung can be reached at jennygrg@umich.edu.