Binaries are a central theme in American political culture. From a two party political system (which, at election time, gives rise to another binary – winners and losers) to an economy which increasingly creates haves and have-nots, this diverse country is often broken down into only two, usually unequal categories. One of the most persistent binaries in recent years – those who have health insurance and those who do not – has also served as a fault line on which the haves and have-nots divide. Working people with insurance could well be counted among the haves – they can have check-ups and they can have care in case of catastrophe, or so the theory goes.
Change has been the theme of this election cycle, to some extent on both sides. Obama has long proclaimed that we are beyond the binary, talking about purple states and post-partisanship, and McCain has trumpeted his purportedly valiant forays through the Washington logjam and across the aisle. Little, of course, has yet changed in Washington for mere talk of change, but as a new study released last week shows, our economy is moving us past an old binary, though this change is not for the better.
The Center for Studying Health System Change concluded that from 2003-2007 the number of people not getting or delaying needed medical care in the United States increased by more than half, from 36 million in 2003 to 57 million in 2007. Much of the increase occurred among those who actually do have health insurance. Rising out-of-pocket costs of all kinds – premiums, deductibles and copayments, prescription drug costs – have all contributed to an environment in which people with health insurance cannot actually use their insurance to get the health care that they need – and that they assumed they had already paid for when buying coverage.
More people than ever before have to make the impossible choice between paying their bills and getting medical care. From a cost-efficiency perspective, fewer people seeking care will only make existing problems worse. Prevention is the cheapest solution to improving health outcomes, an early fix is next best, but a late fix is most costly of all. In the long run, people forced to delay treatment will cost more to treat, exacerbating the health-cost mess.
A human rights approach tells us that the health of every human being must be protected, that health care should be denied to none, regardless of ability to pay. Yet the U.S. is unique amongst industrialized countries in its poor health outcomes, high degree of privatization, and its astronomical health care costs. The US spends far more per capita on health care than any other nation, yet fails to provide basic care for a fifth of its population – a number which is rising even among the supposedly insured. Even those who do receive care pay more for it than anyone else in the world.
Some insurers place the blame on doctors and hospitals while at the same time defending the value added by private insurance companies. But considering how much people in the US pay for health care coverage, only to be denied access to care when they need it, the sole efficiency claim insurers can make is efficient profit generation.
If we as a society insist on the current approach in which a health care binary is allowed – a binary that signals power differentials and exclusionary dynamics – in which some are made to go without care because they cannot pay, we will only see more unnecessary illnesses and deaths. Traditionally, the fact that the majority receives care has deflected attention from the fact that so many do not. In the midst of the current election campaign, health care reform advocacy has been influenced by research indicating that nearly ninety-five percent of voters are insured and so has sidelined the plight of the uninsured in favor of seeming political expediency. For the longest time, insured people were lured into thinking the system, while expensive, “worked,” because they felt they had a de facto guarantee of health care, even if not a de jure one. As new barriers to care cause this spurious guarantee to vanish, we must demand of our government a system that protects health and serves people, rather than protecting profit margins and serving insurers. Providing universal care, especially preventive care, and enabling people to see doctors before illnesses worsen is not only an efficient idea; it is also the only humane one – and it is our human right.