U.S.
healthcare: America's apartheid By DON LONG
Medical Device Daily Executive Editor
Let me acknowledge something right away and up front. I
know it's not cool to talk about class and class
differences in America. This country is the melting pot,
where race, religion, sex, or even sexual preference,
shouldn't make a difference — equal opportunity and all
that.
And it's true that you can succeed here, become Oprah or
Obama, Britney or Ellen, Tiki or Tiger. We've knocked
down many of the artificial barriers that separate us.
And so we don't talk about class, class differences,
since they shouldn't matter.
But they do.
And in failing to acknowledge class and class barriers,
we too often sweep things under the social and political
rugs, so we don't have to look at them directly in the
eye. In particular, by ignoring class inequalities we
don't face up to the most important issue in this
country today and its most critical unmet need: a
healthcare insurance plan providing basic medical
services for all Americans.
It is of course well known that this is the only
developed country in the world that does not have such a
plan . . . that the number of those without healthcare
insurance is increasing . . . that we spend more on
healthcare than any other country in the world . . . and
that we are far from the healthiest of developed
countries.
The reason?
One reason is apartheid — healthcare apartheid — a
profound division between the haves and the have-nots in
this country, the result of a largely unacknowledged
agreement among the haves to keep those that don't have
medical insurance from getting it.
I have an uncle who was a doctor. And I don't know how
many times, as I was growing up, I heard him — and
others — refer, fearfully and sneeringly, to
"socialized medicine."
But any oft-repeated terminology such as this is really
just code, a shorthand for more complex statements. In
this case, "socialized medicine" meant something like
the following:
"We have something that other Americans don't have, but
if all Americans had it, then we might not have quite as
much as we have now, and deserve to have, as a result of
who we are." Underlying this, I think, is something
like, "Well, those people without insurance just haven't
worked hard enough to get it." Or, "They just need to
save up enough to cover whatever medical bills they
have" (even if they're making minimum wage).
This attitude is perhaps a mix of factors: some
prejudice, some snobbery, maybe simple ignorance
concerning the impact of inadequate healthcare. Whatever
it is, its effects are to keep many Americans from being
as healthy as they might be — and damaging the entire
system.
And that is the main effect of healthcare apartheid, of
any apartheid, that the failure to treat some in the
group with real fairness, does damage to the entire
group.
And the effects of poor healthcare add costs to the
entire system and are at least partly to blame for why
we pay so much more than we need to and get worse
results — and an increasing source of financial failure
and bankruptcy.
But these effects are not just financial, they are
human: babies not getting the proper care in utero, or
in the earliest years of development; people, employed
and unemployed, not pursuing diagnostics as preventive
medicine; delays in treatment of sickness; failure to
receive adequate or aggressive treatment when sickness
is diagnosed; and all the multiple permutations of these
circumstances that those of us with health insurance can
hardly imagine.
Apartheid is a disease — an insidious one — one that
we have not had the will to address in this case
Of course, it is standard operating opinion to blame the
politicians, to say that the politicians have not had
the "political will" to pursue this, to pass and
implement the necessary legislation to create a
comprehensive system.
But it is not just the fault of politicians. The
healthcare community must share this responsibility,
this blame.
The healthcare community sees the impact of medical
apartheid every day, in all of its varieties and
impact. But it apparently believes that it is better to
keep doing business — that it is more profitable to do
business — in a healthcare environment that is itself
sick, rather than attempting to create one that is
healthy and delivers better health.
Aside from pronouncements at panels and conferences that
comprehensive health insurance is a necessity, the
leaders of the U.S. healthcare community have failed to
lead the way, to provide the necessary blueprints and
templates for such a system. There has been lots of
talk, but little real buy-in.
Whatever the politicians do or don't do, the healthcare
community must not just speak. It must highlight the
abuses of healthcare apartheid and become a major player
in crafting a system that actually attempts to deliver
healthcare for all of us.
What did you think of this article? Do you have an
opinion you would like to share with us? We would like
to hear from you. Please e-mail us at
mddperspectives@bioworld.com
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