For the most part I think the logic in Gopal Sreenivasan’s “Health Care and Equality of Opportunity” is well reasoned. While he argues well what he sets out to, my issue with his paper is not how he reasons through his argument, but what his argument is. As highlighted in the title, Sreenivasan article discusses how health care interacts with the equality of opportunity. I believe that we should not be talking about equality in terms of opportunity or health care, but rather equity. In our current world equality is not something that exists on a large scale and it is unreasonable to believe that we can solve this problem or even come close to a solution. So when talking about health care I think we should try to base our discussions in reality and center our discourse on how to move towards equity rather than equality.
Sreenivasan spends a large portion of the article outlining why it is better to put money towards decreasing socioeconomic inequality rather than putting that same amount of money towards universal health. While considering the data and options he presents this appears to be a correct conclusion, it is based off the incorrect assumption that these are the only options. It would be possible to use the money for other programs such as a progressive health care plan. In a progressive health care system, the lower someone’s income the more support they get from the government and vice versa. While this system is not at all equal, it is equitable. A progressive health care program would access many of the benefits of universal health care and decreasing socioeconomic inequalities without have to pick one or the other.
To be optimal, this system would also have to take into account some of the social determinants of health (i.e. “those social factors outside the traditional health care system that have an effect-either positive or negative-on the health status of individuals in a given population” (23-24)). It is not clear what the balance should be between progressively funding health care and working on public health initiatives to decrease/increase the negative/positive social determinants of health especially focusing on those which affects people in lower income brackets more than others. More in depth research would be needed to be done to figure out the optimal balance between funding these two options and the ideal amount would vary on a case to case basis. Due to this variation, it would be impossible to get the absolute best solution, but I believe that a system can realistically be developed that is better than Sreenivasan’s framework allows for if we strive for equity instead of equality.
I do also believe that Sreenivasan’s approach to health care is idealistic. There are just too many external factors in the world and in society that can greatly impact health status that make it difficult to create a change in just one factor of healthcare let alone just pinpointing one group. Health care should be offered and provided for all; leaving a group out is discriminatory, unfair, and risky. Why leave the rich without healthcare? It can be equated to leaving a whole ethnicity without healthcare. That is morally and ethically wrong! It is unfair because their luck in life,what they were born with, is what is causing them no health care assistance and also opening doors for disease and illness. Everyone should be offered equality of opportunity, and that means providing EVERYONE with health care. Yes, it can be morally acceptable to vary the amount of health care assistance that is offered to different groups of people because maybe these groups have MORE. This variance in health care assistance will help to place equity in society. Though the health care may not be equal, the opportunities offered will help to equate society.
While I did think that Sreenivasan’s point about decreasing socioeconomic inequity as opposed to putting that money toward universal health care, I also feel that this argument is missing something. I do believe that diminishing the socioeconomic gap would prevent a lot of health problems from occurring in the first place, and thus, increase overall health of the nation to a certain extent. However, this still argument disregards how to address a wide variety of other health problems that will still persist. For example, cancer is a disease that requires a lot of hospital time, treatment, medication, etc. Cancer is also a disease that will still effect populations at every socioeconomic level. Therefore, it is important that everyone has some basic level of health care in order to protect them in these situations. Improving socioeconomic status will still leave individuals without the funds and resources to get the proper treatment that they deserve. Thus, health care is the only measure that provides a basic level of protection against any type of disease that can possibly occur.
I agree with your argument and comments in class today about treating healthcare like taxes. Furthermore, it seems the most fair to me. With Sreenivasan’s system, it seemed like the wealth and middle class would end up paying entirely for the healthcare for all. Even though the wealth and middle class can afford to give up more of their livelihood, this would force them to pay with no benefit to them and it would probably cause resentment between the classes. In a progressive healthcare system, the distribution of resources is logical. The poor are afforded more healthcare resources and the wealth less because they are able to pay for healthcare. But in the end, the same relative percentage of the poor and wealthy’s income is spent on their own healthcare. No one group is unfairly paying for another group.
I like how your argument addresses the fact that it will be hard to determine the “perfect” approach to public health. Sreenivasan’s argument only focuses on socioeconomic determinants, yet he hints that this is just one of many factors that affect public health. As you have stated in your argument, the government must do more research in order to figure out how much money should be allocated to each area that affects public health. Unfortunately, it is almost impossible to balance the funds perfectly; thus, there will be a slightly unequal health distribution amongst the people. However, this should still be better than allocating funds to solve one specific facet of public health.
You are absolutely correct that it would be impossible to get the absolute best solution for both the public healthcare initiatives and social determinants of health. There is no doubt that most large-scale social issues such as, health, poverty, education and environment are complicated. These problems don’t have a simple solution, and even if a solution was known, one individual or organization cannot be in a situation to force all those who are involved to accept it. However, the complexities of the problems are not necessarily because of shortage of resources and solutions, but our failure to correctly see the resources and solutions that best fit the circumstances. This is exactly what Sreenivasan is trying to say in his article; we have the resources, but we are using them or placing them in wrong places. For example, water-related health issues are the most important to address. With clean water, general bodily health increases, food resources would increase, and the poor living conditions of the impoverished would become slightly better. However, Sreenivasan points out that instead of investing in providing clean water supply to those who need it, the healthcare initiatives invest in providing remedies to those who get sick from drinking dirty water.
I think the idea of a progressive healthcare system is definitely something worth considering. The fact that we already have a progressive tax system I think would make the idea of a progressive healthcare system more approachable in the public eye because it’s something they’re familiar with already. I also really like the idea of social determinants some how being worked in to the health care that would be offered. I definitely think it’s much harder to identify what would be included in that regard than it would be to decide what things should be included as traditional health services. Perhaps something along the lines of a foodstamp program that would provide families with healthy foods?
I see your point that avoiding talking about equality as if it is opportunity, and rather speaking to equity brings more reasonable change, but would like to highlight why. It is in the nature of opportunity for it to be “taken advantage of”. Thus, even if everyone is given the same opportunity, and everyone attempts to use it, they will get all different ranges of benefits out of it, based on education and other factors. That is why the point of equity is so important. Just as discussed above and in other blogs’ comments, the problem is upstream. The only thing is that we must consider expenses and take that very seriously when distributing them in a just way to appease the social determinants of health.