Understanding Health and Health Care Disparity in the U.S. and the World (“The Health Gap”)

The health gap is like the wealth gap, except for in healthcare, it describes the gap in access to quality healthcare between different demographics.[1][2][3]

Generally, the Health Gap refers to disparities in health and health care between population groups. Disparities (of access, quality, cost, etc) occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, sexual orientation, etc.[4]

That makes the health gap a complex issue with a lot of moving parts.

With the above in mind, there is a health gap in the United States, where those with lower incomes, some minorities, and generally the groups noted above tend to have generally lower quality care and less access to care. This then impacts regions with those demographics, this then creates a cycle. It also drags on the country as a whole in a number of complicated ways (and while it does have a few benefits, those benefits tend to only help the most well off demographics).

These disparities matter because it not only hurts specific populations, but because it drags on regions, states, and the country as a whole through a chain reaction. Thus, it affects those who aren’t directly part of the demographic (it drags on everyone’s healthcare).

So while Hispanics, Blacks, American Indians/Alaska Natives, low-income individuals, rural individuals are the groups directly effect in America, those indirectly effected essentially include everyone.

TIP: The global health gap mimics our national health gap, where health disparity between nations has a dragging effect. The focus here is on the U.S. health gap, but it works as somewhat of an analogy for the global health gap.

Can Public HealthCare Solve the Problem? What Can Be Done to Address the Health Gap?

One solution to many, but not all, issues surrounding the health gap is the expansion of coverage. As expanding coverage means more providers, more competition, more demand, more supply, and thus less health disparity (by many, but not all measures).

With that in mind, critics of public healthcare (public delivery and funding) say it will lead to long wait times, the rationing of care, subpar care, and stagnant innovation.

This is partly true in some respects, in the U.K. and Canada there are wait times and one could argue less innovation. Meanwhile, we could argue some of the best care in the world is in the United States.

However, the above is only strictly true for a small portion of top earners with gold-plated healthcare plans and not the general population. In other words, the above is true for some, but only speaks to a portion at the favorable end of the health gap.

The average American does not enjoy the same level of care, does experience rationing based on cost at the whim of an insurer, does face steep cost increases, and does feel other effects of the health gap (and in some cases, the negative short term and long term effects of attempts to address it).

  • First off, in terms of coverage, about 28 million are without coverage today, so they have extreme rationing and no access to care. This includes those in the Medicaid gap (one of the health gaps that has a name) who have no coverage due to states rejecting Medicaid expansion.
  • Then before the ACA, and under TrumpCare, an additional 22 million or so would be in this same position.
  • Now consider the tens of millions on Medicaid and the tens of millions more on low-cost private or insurer plans. Then consider low-cost Medicare plans. All these people generally get lower quality, higher cost, and more restricted care than those one better plans.
  • Now consider those who are currently employed and have a good health plan, but might not if they lose their job or retire.

Between all the above, perhaps half the country, if not more, are having their care rationed by the current system and its health gap.

They don’t have the best plan, insurers dictate their networks and care, and they end up with long wait times, the rationing of care, and in many cases sub par care. And that is only as long as they can keep paying the bills. If they can’t, they end up in the uninsured group.

Then, those without access to quality care don’t get care. This means that hospitals don’t have customers, this causes providers to raise prices and hire less. That in turn results in less quality care for everyone who would use those providers.

Here, although it brings its own complications, we can say that expanding quality care has some notable positive effects on entire populations (although not every problem can be fixed this way; such as rationing).

This is to say, as good as the U.S. healthcare system is, there is rationing, there is a general health gap, and there is a number of residual effects that impact the majority (see statistics on the health gap here: The costs of inequality: Money = quality health care = longer life).

Meanwhile, for all the cons of countries with universal healthcare solutions, one pro is that no one is excluded fully and all demographics have an interest in ensuring a quality health care system.

In the U.S. it may not make sense to go fully public, but that doesn’t mean we shouldn’t be looking at other universal healthcare models to see if we can’t move toward a system that works better for ALL Americans.

FACTThe U.S. is the Only Very Highly Developed Country (AKA Major Country) Without Universal HealthCare. Learn more about what that means.

Other Ways to Address the Health Gap

Everything in life is a trade-off, just expanding coverage alone isn’t likely to solve all of our problems. If coverage is expanded, but providers aren’t, then rationing and unequal care can easily still occur (or generally there could be a dip in equality of care).

Also, if we close the gap by funneling the quality of care the top earners enjoy down to the lowest earners, without changing anything else, then we risk creating another set of problems.

Still, there is sense in making sure a baseline of care is available to all citizens while helping to ensure the gap between the haves and have-nots isn’t so intense that it drags on providers and populations. Today we can see in general that in rural areas there are less plans offered, often higher costs, and often a lower quality of care. We can also see that other areas of the country are pushing innovation which trickles down to those underserved areas. The general goal would be to bring underserved areas up without stifling other areas, that is a balancing act. But with tens of millions uninsured and rising costs, as difficult as a simple answer is to come by, the general problem is something we shouldn’t ignore (and in many ways aren’t.)

Learn more about programs that were being done to fight health disparity under Obama to understand why it is important that they continue under Trump and into the future.

Citations

  1. The costs of inequality: Money = quality health care = longer life
  2. The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid
  3. The health gap: the challenge of an unequal world
  4. Disparities in Health and Health Care: Five Key Questions and Answers

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