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.
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.