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The Path to Health Equity Demands a Universal System

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“Massive direct-action is needed to raise the conscience of the nation to the segregated and inferior medical care received” by Black Americans. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”

Those words spoken by Martin Luther King Jr. over 50 years ago in Chicago ring just as true today as they did back then. 

While we’ve made significant social progress in the U.S. since the civil rights movement, the structural inequities and the for-profit health system that were intentionally created and allowed to continue perpetuate significant disparities in health outcomes and mortality between Black and white Americans. 

It is true today that Black women have the highest maternal mortality in the U.S., Black men have the highest mortality from colon cancer, and Black, poor, and Hispanic patients are more likely to die young from treatable chronic diseases like heart disease and diabetes compared to white patients. The ability to access health care and to afford treatments plays a large role in determining these health outcomes. 

In a recent study conducted by the West Health Institute, 40% of Americans surveyed said they skipped a recommended medical test or treatment due to cost, and 32% were unable to fill a prescription or took less of a prescribed medication because of cost. The inability to afford or access care is especially magnified in BIPOC and immigrant patients and those from low socioeconomic backgrounds, who are significantly more likely to be uninsured or under-insured. 

For those of us working in health care, not a day goes by when we aren’t witness to this repeated tragedy and trauma perpetuated by our two-tiered health care system. We could fill books with the stories of our patients and how they have suffered from the prohibitive cost of care.

“I haven’t been checking my sugars because I can’t afford my test strips.”

“I didn’t see the physical therapist you recommended because I can’t afford any more co-pays.” 

“I missed our last visit because I was laid off and lost my insurance.”

Studies show that when the access barrier is eliminated, such as in systems like the Department of Veterans Affairs where access to care for those who qualify is universal, racial gaps in health outcomes are reduced or even eliminated. 

The history of our for-profit health system is rooted in racism and power differentials that have defined many unjust American infrastructures. When former President Harry Truman proposed legislation for a universal health care system in 1947, the American Medical Association (AMA) successfully launched one of the biggest lobbying campaigns in early U.S. history to defeat the proposal. 

While the AMA’s opposition to universal health care was multifaceted, the nation’s leading physician’s organization was, at the time, governed by “white patriarchy and affluent supremacy,” forces that prioritized profits and the independence of physicians over the health and well-being of underserved and marginalized communities. 

The process of mitigating and eliminating health disparities today must include an undoing of our two-tiered, for-profit health system. In this system, where access to care is often tied to employment and ability to afford out-of-pocket copays and deductibles, patients with resources are more likely to have access that buys them better outcomes. Meanwhile, other patients are condemned to struggle without insurance or with that “bad” insurance that no one wants for themselves — the insurance that limits where they can go, which specialists they can see, which medications they can take, and which cancers they can afford to treat. 

People often comment that if the U.S. adopted a single-payer, universal health care system, it would lead to rationing of care. The truth is, we already ration health care in America.

If we are to truly advocate for health care reform, reform that is anti-racist and equitable, a universal system is the only answer. 

How do you reckon with the health disparities that are so present in the U.S. health care system? Share your thoughts in the comments below.

Dr. Maalouf is a practicing physician and assistant professor of medicine in Chicago and serves as Illinois President for Physicians for a National Health Plan (PNHP). She has had essays published in the Chicago Tribune, the Chicago Sun Times, and the Hektoen International Journal of Medical Humanities.

Dr. Susan Rogers is the national President of PNHP and a recently retired internist from Cook County Hospital. She is actively involved in health equity and policy work and recently testified with the US Senate.

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