Thinking global, living local: Voices in a globalized world

Contradictions in a Two-Tiered Nation

Written by on . Published in In sickness and in health on , .

Photo Credit: Neil Parekh/SEIU Healthcare

Photo Credit: Neil Parekh/SEIU Healthcare

Health care in the U.S. is treated more like a consumer good than a right for all people—regardless of age, race, class, or sex. In fact, the health care industry is booming at $2 trillion in annual expenditures with an ever-increasing rush of medical students enticed by the promise of lucrative careers in the health care field.1 Yet “someone files for bankruptcy every 30 seconds because of health concerns, 1.5 million families have lost their homes to foreclosure due to unaffordable medical costs, and the U.S spends six times more per capita on the administration of the health insurance system than Western European nations, who insure all of their citizens.” 2

These statistics look even worse for marginalized people who have historically felt the effects of race and class-based medical apartheid. According to Princeton economist, Uwe Reinhardt, a preference for a class-based system is reflected by a two-tiered system, “with bare boned facilities devoted strictly to Medicaid patients and the uninsured…and luxurious, better equipped and better staffed facilities for commercially insured patients whose insurers are willing to pay higher fees”. 3

The United States’ type of commoditized treatment of a necessary social good is justified by a rational that seeks to defer the responsibility of an egalitarian health care system to a market that is solely concerned with profit making. This type of two-tiered health care seems to be something we would find in an oppressive social caste system, not in a nation which takes great pride in it’s wealth and social democracy.

A nation that accepts equating poverty with character deficit will not find anything wrong with a classist health care model dependent on the status of one’s employment—which is especially detrimental to marginalized people such as minorities, women, or immigrants. Inherent prejudices of the unproductive individual, which can’t definitively be separated from racial prejudice, propagates an irrational acceptance of what Reinhardt states is an “inherently temporary private health insurance tied to a particular job with a particular company (and then to look helplessly for rescue by federal or state governments, when in their 50s and early 60s, they may find themselves structured out of their jobs and the health insurance that came with it and unable to afford coverage in the private insurance market for individuals)”.4

Progressive politics requires complete transparency regarding the reasons for the unnecessarily high cost of health care in the United States. These factors include: “rising cost of technology and prescription drugs…high administrative costs [31% of costs] from the country’s complex multiple payer system…shift from ‘non-profit’ to ‘for-profit’ healthcare providers”, and deliberately postponed medical intervention by individuals lacking insurance. 5

However, questions regarding high administrative costs have not only been successfully evaded but will increase with the Affordable Care Act. In her article titled, Is the House Health Care Bill Better than Nothing?, Marcia Angell, M.D. states, “What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies.” Angell instead suggests that subsidies should go towards medical students who will work in primary care and underserved areas. Overall, Angell concludes the House bill “simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry”. 6

In Health Care Reform and Social Movements in the United States, Beatrix Hoffman explains the real threat of reform based on elitism—even in it’s most elementary forms, elitism would and has crippled the potential for a national social movement democratically enacted from the bottom up. 7 Year after year, health care reforms rely on “expertise…professional lobbying rather than popular activism”. Beatrix states, “Important as they are…coalitions of professional reform groups are not the same thing as people’s movements.”

Yet, our privatized “American” values are built around corporate influence—an inherent prejudice towards the poor, obsession with productivity predicated by the industrious work ethic, and the need for luxury or “quality” services—and gives rise not only to a two-tiered health care system, but a two-tiered market system, a two-tiered moral system, a two-tiered political system and a two-tiered activist system. Any progressive politics must resist the inherent inequality and deception of a two-tiered system that is simply based on corporate-like media campaigns, waving euphemisms of health and reform in the air while concealing the extent to which the interests of insurance companies have costly come before the health of the people. Instead a progressive politics for the people would not placate corporate interests but demystify the (intentionally) incomprehensible House bill so that the idea of a single-payer system becomes synonymous with the 99%. The creation of a truly affordable and efficient health-care system can and will only be put in place by a democratically enacted grassroots movement.

Tags: , , ,