Trend toward more equal access to care is reversing
By Chris Tomlinson
Houston Chronicle, July 12, 2016
Money can’t buy you love, but it can buy you health, according to a new study from Harvard Medical School.
Add inequality in health care to the growing evidence that the United States is becoming a more class-based society, with a shrinking middle class, a greater economic gap between the rich and poor and growing social unrest.
“In 2012, the wealthiest fifth of Americans got 43 percent more health care ($1,743 more per person) than the poorest fifth of Americans, and 23 percent more care ($1,082 per person) than middle-income people,” the paper published in “Health Affairs” stated. “These numbers reflect a striking reversal of a long-term trend toward greater equality in health care use by all income groups.”
The shift away from more equal access to health care came in the mid-2000s, at about the same time that conservative lawmakers began trying to rein in spending on Medicaid, the health program for the poor and disabled. Spending by poor people has actually dropped 3.7 percent since then, while spending by the wealthy is up 19.7 percent.
The study found no change in health care inequality in Medicare, the health program that covers almost every American over the age of 65.
President Lyndon Johnson’s Medicare and Medicaid programs brought much more equal access to health care beginning in the 1960s. Prior to that, the wealthy used about twice as much health care than poor and middle class people.
The study’s authors attribute the growing inequality to the “widening U.S. income inequality, the 2007-2009 recession, the slow recovery for the poor and middle class, and a sharp rise in health insurance co-payments and deductibles that discourage non-wealthy Americans from seeking care.”
There is little debate that health care costs are growing too fast, and the United States needs to discourage over-utilization. Co-pays and deductibles can achieve those goals, but this study shows that people with higher incomes are not as deterred as lower-income Americans. There is also a risk that lower-income Americans who should be seeking early treatment are waiting until they are much more ill before getting help, creating a larger burden on the health care system.
The fact that Medicare doesn’t have the same problem argues for a single-payer system for all Americans, not just the elderly. As long as we use price to ration health care, rather than science-based medicine, then greater income inequality will lead to greater health care inequality.
The middle and lower classes in America are becoming increasingly frustrated with the status quo, which is leading to greater inequality of every kind in this country. High health care costs is an important part of that frustration, and one that will political leaders need to address.
Chris Tomlinson is business columnist at the Houston Chronicle.