Health Care Inequality: Getting Farmed and Getting Dead Sooner

by Shelley Pineo-Jensen, Ph.D.

Bernie Sanders is the only viable candidate for president who advocates for single-payer health care, also known as “Medicare for all.” If you are eligible to vote in this country, this issue, Health Care for All, should be enough for you to register as a Democrat and vote for Bernie Sanders in the presidential primary in your state.

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LACK OF HEALTH CARE EQUALS AN EARLIER DEATH

What health care inequality distributes, ultimately, is death, by which I mean that people who get the short end of the stick regarding access to quality health care have shorter and more painful lives. This economically driven disparity is, in its effects, both racist and classist. It starts at the very beginning of life; poor women are more likely to give birth to infants with low birth weight.  A study published in the Western Journal of Medicine found that “low birth weight is the major determinant of infant mortality [and] . . . women without medical insurance coverage had babies with the lowest mean birth weights, as well as significantly fewer prenatal visits. The U.S. government Forum on Child and Family Statistics reported that the rate of low birth weight children for black mothers is about double what it is for white mothers.

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Rationed Health Care in the US is Racist

In a 2013 report, The Center for Disease Control (CDC) found that African Americans have the largest death rates from heart disease and stroke and twice the level of diabetes of whites. Periodontitis (gum disease) is the greatest among African American and Mexican Americans, as compared with whites. Infant mortality is highest among African Americans, twice the rate of whites. In 2010, a larger percentage of Hispanic and African American adults aged 18-64 years were without health insurance compared with white and Asian/Pacific Islander counterparts. Life expectancy was lower for African Americans than for whites. Lack of access to health care was cited as a factor contributing to poor health outcomes among African Americans.

Dick Cheney’s Heart and Other Health Care Perks for the Rich

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According to a report in Forbes when Dick Cheney was 71 years old he had a heart transplant which probably cost around a million dollars.

A New York Times columnist reported on “concierge medicine.” Patients with the means to pay for these services have a completely different experience of the for-profit health care industry. In an emergency, their concierge doctor will push them to the front of the line to see a top specialist. Elites with money buy exclusive medical care, around the clock and anywhere in the world, including on a yacht or private plane. The New York Times reported about “Hospitals Vie for the Affluent”:

The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble. Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, “I’ll be your butler.”

It was Greenberg 14 South, the elite wing on the new penthouse floor of New York-Presbyterian/Weill Cornell hospital. Pampering and décor to rival a grand hotel, if not a Downton Abbey, have long been the hallmark of such “amenities units,” often hidden behind closed doors at New York’s premier hospitals. But the phenomenon is escalating here and around the country, health care design specialists say, part of an international competition for wealthy patients willing to pay extra, even as the federal government cuts back hospital reimbursement in pursuit of a more universal and affordable American medical system.

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Health care settings DO contribute to better health care outcomes. A meta-analysis of 600 rigorous studies by The Center for Health Design made a number of recommendations:

The large research literature surveyed in this report points to several actions we can take immediately:

  • Provide single-bed rooms in almost all situations. Single rooms have been shown to lower hospital-induced nosocomial infections, reduce room transfers and associated medical errors, greatly lessen noise, improve patient confidentiality and privacy, facilitate social support by families, improve staff communication to patients, and increase patients’ overall satisfaction with health care.
  • New hospitals should be much quieter to reduce stress and improve sleep and other outcomes. Noise levels will be substantially lowered by the following combination of environmental interventions: providing single-bed rooms, installing high-performance sound-absorbing ceilings, and eliminating noise sources (for example, using noiseless paging).
  • Provide patients stress reducing views of nature and other positive distractions.
  • Improve lighting, especially access to natural lighting and full-spectrum lighting.

The Center for Retirement Research at Boston College, using data from a nationally representative sample of almost 32,000 older Americans, found that the risk of dying from the nation’s leading causes of death – cancer and heart conditions – has declined significantly for high-income Americans, both men and women. No such improvements were evident, however, for low-income men and women. Looking at the death rate the 50 to 74 year old population (where 1 is the rate of death for the overall population), data revealed that for that quarter of the population with the highest incomes the death rate was 0.54 for women and 0.66 for men, but for the poorest quarter, it was 1.35 for women and 1.39 for men.

Current Health Insurance Excludes Dental and Vision Care

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The Affordable Care Act (ACA), while increasing access to health insurance for millions of Americans, generally does not provide for vision or dental care. Neither does the current configuration of Medicare. It is a travesty that routine exams for eyeglasses or contact lenses are not part of mandated health insurance policies and taxpayer funded health care services, but it is shocking that dental care is not included. Lack of oral health contributes to cardiovascular disease as well as endocarditis, an infection of the heart, both of which contribute to early death.

The Mayo Clinic reported that oral health might contribute to various diseases and conditions, including:

  • Endocarditis is an infection of the inner lining of your heart (endocardium). Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.
  • Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke might be linked to the inflammation and infections that oral bacteria can cause.
  • Pregnancy and birth. Periodontitis has been linked to premature birth and low birth weight.

The American Dental Hygienists’ Association reported that esearch has identified periodontal (gum) disease as a risk factor for heart and lung disease, diabetes, premature, low birth weight babies and a number of other conditions. The 2000 Surgeon General’s report, Oral Health in America, has called attention to this connection and states that, if left untreated, poor oral health is a “silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year.”

Clearly, those with the least economic means are also those who will be the least likely to pay for extra insurance coverage or the actual services for vision and dental care.

MY STORY: GETTING FARMED

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What got me thinking about my personal need to see Bernie Sanders elected president so we can have Health Care for All was a recent morning when I woke up with a song playing in my head, “There, but for fortune, go you or I” by Phil Ochs. He was singing about how the fate of one individual is constrained by decisions made by powers beyond one’s control. I was thinking about my current limited access to health care, and how I used to be what be what John Fogerty called a “fortunate one.”

The Cadillac Plan

In the ‘90s, I was an elementary school teacher and proud member of California Teachers Association. I had the Cadillac health insurance plan with negotiated dental and eye care. I went to the doctor whenever I wanted to. When acid reflux woke me in the night, I was referred to a specialist who stuck a tiny camera down my nose to look at my esophagus. He reported that was no damage of any kind, diagnosed Gastroesophageal reflux disease (GERD), and prescribed an expensive pill.

Then the indignities visited on my students by No Child Left Behind drove me out of teaching. I moved to Oregon where I took a year to establish residency and reconnoiter the University of Oregon (UO) and prepare my successful application to graduate school in their College of Education.

For the ten years I was a teacher I spent $28,000 and my employer paid nearly that much. My out of pocket was about $2000 over that time frame. Our insurance paid for about $12,000 in health care costs for me and my family. The insurance company profited $12,000 from me and another $25,000 from my employer as a negotiated benefit. Net gain to the insurance industry: $37,000.

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No Safety Net

Consolidated Omnibus Budget Reconciliation Act (COBRA) insurance was too expensive so I applied for a more economical health insurance. I was denied because I had a pre-existing condition, GERD. I went without insurance for a year but still paid for my expensive GERD medication because I didn’t want to erode my esophagus. That sounds bad!

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Union Benefits for the Win

While I was a student at UO I was a member of another union, Graduate Teaching Fellows (GTF). We negotiated for health care including dental and vision; it was the most important issue on the table for us, always. When GTF positions were downsized in my department I lost my health insurance. Then I used the student health center, paid for by my student fees (well actually, by my enormous student loans and sky-high tuition.)

One of the doctors at the Student Health Center advised me that I did not really need to take the expensive GERD medication. He directed me to an over-the-counter pill, Prilosec, which worked just as well at a fraction the cost.

I also paid $800 a month for COBRA for 18 months, $14,400, to pay for insurance for my family. This investment paid off when my husband incurred $18,500 in hospital bills, of which we paid only $1,500. Net loss to the insurance industry $2600. Grand total gain to the insurance industry: $34,400.

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Waiting for Godot – I mean Medicare

So I got farmed. Plenty of profits were harvested off me, and in the end all the payments I made to “insure” myself added up to nothing. My $34,000 investment has brought me to the place where I have no health insurance at all. I am grateful the fines for not paying for state-mandated for-profit health insurance are so low. If I bought the cheapest of the health insurance plans available to me, with a $5000 deductible, I would no longer be able to afford actual health care. So I skip the insurance and pay for good dental care and vision care and utilize some low-rent strategies to look after my other health issues. Someday I’ll qualify for Medicare.

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THE BIG PICTURE

As participants in America’s capitalist health care system, we are harvested for profit. Members of the 1%, like Dick Cheney, can have all the exotic heart procedures money can buy. Poor folks just do without. The rich get healthier and the poorer get dead sooner. This inequitable system punishes those with the least economic means with ill health, and because people of color make up a greater proportion of the poorest individuals, the health care system in our country is racist.

But there is one piece of good news amidst all these depressing facts. Bernie Sanders is running for president. Bernie Sanders has a strong track record of advocating for single payer health care. It is part of his platform. Some links:

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About the Author

Dr. P-J
Dr. P-J took a Ph.D. in Educational Methodology, Policy, and Leadership from the College of Education at the University of Oregon in 2013. Her scholarly interests include statistics, quantitative methods, qualitative methods, power structure analysis, Gender and Queer Theory, Critical Theory, and labor studies. Her dissertation (published as "An Informed Electorate" and available at Amazon.com) found a statistically significant correlation between a high level of a state’s educational standardization and high level of voter suppression / low voter turnout.

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