The social lottery of life

Coming from a middle-class family, where my parents had stable jobs, medical insurance was never a topic of concern. I always went to the doctor for my yearly check-up, whenever I was feeling sick or to the hospital for accidents and emergencies. It was  not until the 2011 presidential debates that I became aware of the lack of equal access to healthcare in the United States. It never crossed my mind that some people would avoid doctors and hospitals due to the lack of insurance.

According to  Brody’s article “Access to Health Care,” I have a high social lottery, but not everyone is fortunate as myself. In the U.S., we do not have socialized medicine, but we believe that everyone has a natural right to health care and thus should have equal access to it. This is why we have free clinics and hospitals which are required to treat all patients without question in emergency situations. Additionally, over the past century, the government has established Medicaid and Medicare, programs for the disabled and the elderly, respectively. Medicaid provides free health insurance to individuals and their dependants who are deemed indigent for which each state has its own criteria. On the other hand, Medicare is provided to everyone over the age of 65 and the benefits are uniform across the country. Both are funded by the federal government, but the government will only allot a certain allowance for every diagnosis and any additional expenses must be absorbed by the patient and ultimately the hospital.

Our current medical care system is flawed and it results in tension between providing the best health care, providing equal care for all, maximizing provider and consumer choice, and cost containment (Brody). One of the biggest problems is cost containment, for it is a vicious cycle. There are approximately 8-11 percent of Americans do not have any form of health insurance. These Americans often have diseases that go undiagnosed or untreated until it becomes a serious medical emergency and are transported to the hospital where they are treated immediately. The cost of this type of treatment is exponentially higher than if that same person had affordable or free access to healthcare and was treated earlier. Furthermore, these patients usually can not cover the costs, and so the hospital absorbs the costs. To account for these losses, hospitals increase the cost of treatment, insurance companies raise premiums, and the government hikes taxes. Ultimately, the taxpayers and the insured end up paying for the uninsured.

There is no simple solution to this problem that pose no downsides, but the government’s goal is to find a compromise of how to provide the best healthcare for all while maximizing provider and consumer choice. There are two popular models of socialized medicine, that of Western Germany and that of Britain.  In the Western German system, individuals under a certain level of income are covered and they may choose to purchase additional coverage in order to have the benefit of a semi-private room versus a ward. This results in over 99 percent of the population being covered while maintaining freedom of selection of physician, whose salaries are not severely diminished in the process. In the British system, the National Health Service covers everyone and they are provided a local physician, who refers patients to specialists where they will be wait-listed for an appointment. This system is completely free, yet if a person so chooses they are able to see physicians on a fee-for-service basis. The British system is better at maintaining lower health-care costs than West Germany and the US, but the disparities in the timeliness of care and the physicians salaries is much worse in Britain than West Germany and the U.S. Personally, I believe that the U.S. should try to model its healthcare system after West Germany. A simple first step, while we continue to debate this, is to place everyone under the Medicare system regardless of age.



Brody, Baruch A., and H. Tristram Engelhardt. Bioethics: Readings & Cases. Englewoods Cliffs, NJ:Prentice-Hall, 1987. Print.

16 thoughts on “The social lottery of life

  1. While I agree with your argument in theory, that every person should be adopted into Medicare I simply do not know how feasible this is. Looking at the high level of economic criticism on the current reform bill I do not think the US, with the way view healthcare, can afford to make this sort of choice to complete cover people. In many ways we are moving towards that model, attempting to increase coverage – but looking at the high backlash to Obamacare I find it hard to believe that a sweeping reform in that sense is possible in the near future. That would require a big change in the amount of care given per patient – how patients are treated and an overall shift away from high technology, expensive care. In that same article he stresses how the type of care – if costly surgeries have few barriers – dictates the percentage of GDP that healthcare spending will cost.

    To approach a model closer to West Germany, we first have to change the way treatment is given and focus on getting PCP to those who need it.

  2. Addressing the concept of social lottery brings up a lot of different factors. It’s not just based on the wealth of one’s parents but is dependent on their life course and yours as well. This social lottery can prohibit or enable a person to have insurance. The Kaiser Foundation provides general information and statistics of uninsured individuals. The cost of insurance is a major barrier for some people, but other reasons include job loss, no need for insurance, aged out of the family plan, left the school system, there was no offer for insurance or other reasons (Kaiser Foundation. Family income and family work status are also important factors in the social lottery. Surprisingly, the majority of uninsured nonelderly people have at least one or more full time workers in the family (Kaiser Foundation). It is also interesting to note that the majority of uninsured people under the age of 65 are White non-Hispanics (Kaiser Foundation). Residency location can also be a factor in the social lottery. Seventeen states spanning the south of the United States and Alaska have uninsured rates of above 18%, while states in the northeast and central United States have uninsured rates of less than 14% (Kaiser Foundation). As you mentioned there is no simple solution to this problem, however something’s need to change in order to decrease the gap between those who are insured and those who are not.

  3. I, too, was unaware of the lack of equal access to healthcare until recent years. I agree the cost containment is a huge issue. If we were to just increase preventative care than the amount of patients in emergency situations without the insurance or money to pay would be decreased. This is why I think the focus needs to be on lifestyle changes. I also think the Western German system is the best solution. Having a basic level of care given to every person and then the ability to purchase more coverage seems the most fair way to do healthcare. I like the fact that they are still able to choose their own doctors rather than being provided with a local physician.

  4. It’s hard to imagine politicians (because it would take many of them in agreement to make anything happen) in the US government making such a big decision about healthcare, such as adopting a health care system like that of West-Germany. There seems to be consensus that our healthcare system is inefficient, but the way to fix it is far from clear. The issue you raised about how 8-11% of americans don’t have health insurance, and their issues go undiagnosed until they become emergencies should be a clear sign that there is something wrong with the way our healthcare system is set up. And fixing it is becoming more and more of an emergency. Political leaders are in a position to make change happen, but the issues in our political system are yet another barrier preventing an improvement.

  5. I agree with you that we definitely have the right to health care. I liked your point about how people who are uninsured basically have to wait until they are sick enough to need serious help from the emergency because I think this is extremely important and ridiculous. In my blog post I talked about the idea of medical emergencies and think that your comment touched up on this. We need to take the initial step: providing health care for all or, at least, providing people with sufficient information about health in order for them to make better personal decisions that benefit their health. The issue is that people cannot afford emergency healthcare. Though it’s easy to say that the government should provide health care for all, it’s actually extremely difficult. At what point does the government draw the line in providing health care to everyone? Unfortunately, there is always going to be this gap between those who can afford health care and those who don’t. If health care would be provided to all, those who can afford it would still be getting treated better.

  6. I found your post on the topic of health care and social lottery very intriguing. To just clear up a misconception, the United States does indeed have a form of socialized medicine with medicare as it is administered by the federal government and is derived from taxation. Our current healthcare system spent around $8,915 per person in 2012 (The most per person in the world). In 2007, the US ranked 17th for men and 16th for women in life expectancy compared to the rest of the world. While health care doesn’t necessarily determine life expectancy, it does play a significant role. To me, these figures are justification enough to expand coverage to all Americans. Our current system has failed to help our citizens extend their lifespans to the levels of our peer countries. Additionally, our system is absurdly inefficient and we are certainly not getting our bang for our buck. Moving towards universal health care would most likely help drive this cost down and drive life expectancy up.

  7. I have lived in Taiwan for almost my entire life, and I never have to worry about the money when I go the hospitals, because in Taiwan we have universal health care. Each time we go to the hospitals, we only have to pay 5 dollars and most of the medications are covered by the government. However, Taiwan is actually facing some health care crisis because the government is running out of money to pay for the citizens. So why did I bring up Taiwan’s health care system? It’s because each health care system has its own problems and that it is hard for one country to be like another. You mentioned that US should try to be like West Germany, but the problem here is that Germany and US are actually really different. Even though both of these countries are well developed, their health disparities, economies, and cultures are quite different. There are many factors that affect health care system. Therefore one country can’t just simply copy other country’s health care system.

  8. I really like how you interpreted comparison of the idea of access to healthcare to a “social lottery”. I’m trying to view the positive and negative connotations associated with the West Germany plan of action for healthcare. Though individuals under a certain level of income are covered and they may choose to purchase additional coverage, I don’t see many taking advantage of additional coverage unless the provided coverage was subpar.
    The questions I would ask would follow along the lines of: would the requirements of medical schools be lowered/would more medical schools be created in order to account for the greater need of doctors? What infrastructure would be put in place to ensure that new medical practices would follow the guidelines if less knowledgable doctors are produced by lower standards?

  9. Not only is cost an issue (for the patient and as you say when the hospital ultimately absorbs the rest…) but so is the system itself in that it has a loop hole. When people are able to avoid payment for their health, they do, prolonging important check-ups and diagnostic tests. These preventative measures are lost and what results is even more expensive care, burdening not just the patient as a consequence, but also all citizens that contribute to the healthcare system. The issues are indeed complicated, but it is mostly because they are part of a larger vicious cycle, so productive solutions should intervene at a larger scale.

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