Healthcare in America
Louis J Auguste
“The first wealth is Health.” This statement by Ralph Waldo Emerson, is universally endorsed. Everyone strives to protect himself or herself from illness in order to live a long life. This journey is seen more often than not as an individual endeavor, without consideration for the impact that the health of others may have on each one of us. An individual or a group of individuals may avail themselves of all the possible resources to achieve the best health status possible, regardless of the rest of their communities. At times, this individual welfare may even be at the expense of the rest of their communities, when resources are scarce. Depending on your position on the economic or social ladder, you may argue whether healthcare is a right or a privilege. Should it be limited to the few who can afford it or should everyone be entitled to it. In a way, this divergence of opinion fuels the on-going discourse about healthcare in America.
Another well-known thinker, Winston Churchill also opined, “Healthy citizens are the greatest asset any country can have.” A nation is like a complete living being, where one organ depends on the other in order to survive and where a diseased limb can threaten the viability of the entire organism. Society needs rich investors and smart scientists, but it also needs farmers and day laborers. Everyone living in this country is part of that societal structure, no matter his or her wealth, level of education, legal or illegal immigration status, race or ethnic origin. All segments of the population are interconnected and all contribute to the well-being of the community.
Instead, we have a society divided between blue states and red states, democrats and republicans, whites and non-whites, where the “haves” could not care less about the “have-nots” and intend to take every possible step to keep the status quo. Thus, we see the worst education system, the worst pollution levels, the most hazardous living conditions, the lowest levels of public services in the poor neighborhoods, creating a vicious cycles where the children born in these conditions and in these environments are ill-equipped to compete in the job market and condemned generations after generations to remain in the lowest strata of society. They are condemned also to perform poorly in all the health indices, when compared to the wealthier sectors of the community. Indeed, vital statistics have confirmed that the standard of living in these poor communities, whether they are in the Bronx or in Appalachia, the South side of Chicago or the Native American Reservations, is on par and often lower than that of many third world countries.
Socio-economic factors account for at least 80 % of the health issues of our communities. Adult and child mortalities soar when most of the municipal incinerators are located in these underprivileged neighborhoods, when there is no access to clean water, when the schools are underperforming, when one is forced to perform the riskiest jobs, often with inadequate personal protection, because that is the only job opportunity that one may have. The average life expectancy will be shorter when most of the industries have moved away from your neighborhood and even the few that are left prefer to hire outside of your community. It will be shorter when the community is overrun with drugs and violence. It will be shorter when there is no food safety; the community has no access to fresh produce and can only purchase stale food at the local bodegas.
The result of these unfavorable socio-economic factors is poor health and healthcare disparity. Those who are lucky enough not to deal with these daily nightmares, often build a wall around themselves, their families and their world. In fact, they do even more, by taking legislation that will limit access to care in the poorest communities, as we have seen in the southern states that chose not to implement the Medicaid expansion or the health care exchanges under the Affordable Care Act. One of the harshest debates during the preliminary discussion related to this important health measure focused on whether care should be provided to illegal immigrants. Yet, these economic or political refugees are parts of this society. They mow our lawns. They raise our children, they harvest our grapes and oranges, they slaughter the chickens that we eat every day, etc… They bring a lot of energy to this society, but they bring also their own illnesses. Thus, we have to consider the negative externalities of their presence. The grandmothers who overstay their visa and remain to care for their grand children may infect them when their dormant tuberculosis is reactivated. Immigrants from malaria-infested regions can transmit the disease in tropical parts of the country where the proper insect-vectors exist. We can reduce the budget of social programs, by excluding the poor and undocumented workers from the ranks of the beneficiaries, but the marginal cost associated with these externalities increases the social cost well beyond the individual cost of medical care.
Therefore, the creation of health or rather the preservation of wellness does not start in hospitals or medical clinics. It requires that the entire premises of community relations in this country be reevaluated. This is far from being a plea for communism, which has failed miserably. It may be considered somewhat unrealistic and utopian. However, a willingness to forgo excessive gains at the expense of underpaid and overworked employees, a fair tax system on the richest 1 % of the population that will support some of the social programs in this country, eventually a system that offers equal opportunities for education and employment to every member of the community, without regard to their race, color, sexual orientation or creed, will break the cycle of poverty and allow everyone to contribute to this society. Elevating the standard of living of the entire population may be the best healthcare initiative and the most effective way to combat healthcare disparity.
Louis Joseph Auguste, MD