In his article, Health Care and Equality of Opportunity, Gopal Sreenivasan argues that universal healthcare isn’t really the answer to our call for equality of opportunity. Yes, a loss of health can take away one’s fair share of opportunity, but health is not the same as healthcare. There are social determinants to health that make a much bigger impact on health than any healthcare system. These social determinants boil down to income levels. Poorer people suffer from more chronic conditions and have on average, lower life expectancies. That’s not surprising. But Sreenivasan wants to make it clear that having access to a doctor and a clinic won’t change that. It’s poverty that influences key factors to health like diet, living conditions, health literacy, and education. Without addressing this poverty – and since equal opportunity is based on relative shares, reducing the income disparity as a whole, we will be doing little in the long run.
It seems that Sreenivasan has overlooked the fact that providing universal access to healthcare is a crucial step to centering the social gradient in the same way that a system like public education is. Imagine living in a country where access to public education was as limited to lower-income families as healthcare is today in the US. Sreenivasan could plausibly make the same logical argument. There are other social determinants that determine educational and career success. Addressing income inequality is the real solution, one might argue. The false assumption being made here is that these systems do little or nothing to change the social gradient itself.
Healthcare can be extremely expensive, and it pushes people into poverty. Poverty rates rise considerably when healthcare costs are taken into account. In fact, covering healthcare costs for the poor has the potential to make the biggest difference according to census data. The current measure of how many people are officially living in poverty does not take medical costs into account. If out-of-pocket healthcare costs were included, 10 million more people (a 3.3 point increase in the poverty rate) would be added to our count.
Sources:
S. R. Collins, New Census Poverty Measure Shows Medical Expenses Push 10 Million More Americans into Poverty, The Commonwealth Fund Blog, November 2011.
Sreenivasan, Gopal. “Health care and equality of opportunity.” Hastings Center Report 37.2 (2007): 21-31.
I agree with some aspects of your argument and other aspects of Sreenivasan’s. Regarding Sreenivasan’s, it is true that health is not the same as healthcare and the less fortunate are automatically put into less safe/clean environments. I 100% agree that having access to a doctor will not change the fact that impoverished people could still go home to an unsafe living environment with poor air quality or unclean water, etc. The clear problem is the difference in income distributions throughout the US.
On the other hand, I think that creating a universal healthcare system has both ups and downs. This could potentially save impoverished people the out-of-the-pocket money they put forward in emergency medical situations. Also, saving this money could make them relatively wealthier and allow for cleaner living conditions, therefore disproving Sreenivasan’s argument. However, we do not know where these people would choose to spend their money after saving the out-of-the-pocket costs. If they choose to spend their money on unnecessary goods instead of improving living conditions, then technically this access to healthcare does not change the poor health conditions associated with those living in poverty.
I think it’s important to recognize how “equality” in health is a relative term. Sreenivasan makes the argument that everyone should have the right to relative health. This means that everyone has a preexisting level of health and we, as a society, should make sure that those levels don’t fall unreasonably low.
Buchanan makes another argument that relativism matters, because if we make all standards the same, the result would be unfavorable. He gives the example of a mentally disabled child falling off the charts because he wouldn’t be given his relative level equality, since he requires more healthcare services than an average child.
So, we can claim that equality is the best thing for us, but it does have its disadvantages.
Your concerns are valid, and although Sreenivasan may be too ambitious in emphasizing the importance of the social determinants of health and their contribution to health inequalities, reading some of his other articles (Health and justice in our non-ideal world) show how, together, we can definitely make progress in solving some of the world’s greatest issues. In terms of global health, we have really come a long way. We have decreased the number of deaths caused by infectious diseases in low income countries. One unsettling statistic is the rise of deaths caused by stroke and heart disease in high and middle income countries. It is a statistic we can definitely improve upon. If more people got involved in trying to achieve the MDGs, we as a human race, could make HUGE strides in improving global health and living conditions around the world. If we can educate people in low income countries, they will be able to improve their lives by escaping structural violence, and we will then see the number of deaths caused by HIV/AIDS decrease, as well as seeing various national literacy rates rise. Education is key, but since that is an ongoing, long-term strategy, we need to continue to do as much hands-on work as we can. The quest for global health, while ambitious and difficult, is not impossible. It’s not possible to have 100% of the human population healthy, but we should aim to make that percentage as high as we can get it.
I agree with this post. Whilst Sreenivasan does have a point in saying that we need to attack social determinants of health head on if we want to achieve good health on a societal level, this is a lofty goal and at best would take years to accomplish. Reforming a health system is more tangible, and is an important aspect of maintaining health. If there were true universal health care, poverty stricken populations could go in for regular check-ups, learning more about steps that need to be taken to ensure good health and catching signs of disease and illness before they spread or becomes worse. I appreciate the insight given in this post regarding the role that health care plays in increasing rates of poverty. The more expensive health care becomes, the more middle class families and individuals are sinking into poverty to keep up with the costs. Thus, the current system actually furthers disparities in social determinants of health among U.S. citizens. Health care reform or complete restructure via a more efficient insurance scheme, controlling and/or standardizing costs of medical technology and pharmaceuticals is needed to achieve good health in the U.S. It is not the only series of steps to improving health on a national scale; however, it is an important piece to the puzzle.
I definitely agree with you interpretations of Sreenivasan’s idea of why access to health is a necessity in terms of equal opportunity, specifically looking at the rates of poverty. Something that I think is extremely important to keep in mind is that if healthcare is a basic human right, falling the umbrella of life, liberty, and pursuit of happiness (with life), healthcare being a “trade-off” is not acceptable. That is to say, the lower socio-economic strata should not have to give up their opportunity for education because they cannot afford to have both healthcare and pay for tuition.
However, when delving deeper into the idea of healthcare access, I think it’s vital to choose words carefully. Personally, I feel all people deserve equal access to healthcare, not equal healthcare, which is an important distinction. It is not realistic to offer everyone in the United States the exact same healthcare, nor is that what many people want.
Is he going to do his best to tear it apart and perhaps ingest part of it.
The power unit will simply plug into a standard wall socket
and no further installation will be needed. Here is a list of some of its advantages and
disadvantages:.
If you are going for finest contents like I do, just pay a quick visit this
web page everyday as it gives quality contents,
thanks
I have fun with, result in I found exactly what I used to be taking a look for. You’ve ended my 4 day long hunt! God Bless you man. Have a great day. Bye
Thank you for every other magnificent post. The place else may just anybody get that kind of information in such a perfect method of
writing? I have a presentation subsequent
week, and I’m at the look for such info.
Next in line, the outdoor lighting must be regarded as
crucial when you consider installation off the wireless security camera.
8GHz frequency is relatively clean, and subsequently, the
successful wireless camera installation rate is higher.
s developed by the technical sector and these software.
Hurrah, that’s what I was exploring for, what
a material! present here at this blog, thanks admin of this website.
Yo lo hice en la Clínica Las Nieves y llevé la donante, entonces el
caso es distinto. Le hicieron ecografías, exámenes para ver su reserva ovárica y partimos.
Además era joven: tiene veintisiete años. Más allá de que en este momento estamos terminando un ciclo y
tomamos la decisión de que no haremos más tratamientos después de estos cuatro años, para mí la ovodonación fue una gran posibilidad, un camino muy especial para ser madre.