Читать книгу The Uprising of the Pandemials - Federico Dominguez - Страница 18

In the inaugural address of his second term in office, President Abraham Lincoln told the crowd in front of the Capitol that the government would provide medical care to those wounded in the civil war “to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan.” (32) Lincoln passed a bill that established what became known as Freedmen’s Bureau to assist the wounded during the Civil War, their families, and the neglected. The program consisted of 40 hospitals that employed 120 doctors who provided free medical care to more than 1 million former slaves. At the time, it was one of the largest public healthcare programs in the world. (33)

One and a half centuries later, now a much richer country, things are entirely different. In spite of Obama’s 2010 healthcare reform and having some of the best hospitals in the world, it is the only large, developed country without universal healthcare. This is so extreme that 530,000 families declare bankruptcy every year because they cannot pay their medical bills, which represents 66.5% of total bankruptcies, (34) A low-income individual without health coverage who has cancer or needs a transplant may have to face the decision of losing their house and all their assets in order to pay the cost of their treatment.

Michael Flor is a 70-year-old American who was admitted to Seattle’s Swedish Medical Center on March 4, 2020, with coronavirus. When he was discharged two months later, he received a 181-page bill for a total of over $1 million. (35) The country spends 17.5% of its GDP on healthcare, as opposed to 10% spent by most developed countries with universal health coverage. Many factors come into play here: high rates of obesity and related diseases, high cost of medication, an excess of unnecessary tests, lack of competition between healthcare companies, and overmedication.

The average American pays seven times more for medication than the Japanese, and four times more than other developed countries. (36) This difference is absurd when you consider that we are talking about the exact same medication. Many diabetics who live close to the Canadian border cross over to buy insulin because it costs 10 times less. (37) Laboratories argue that their high prices are due to the high cost of research and development (R&D) but the main companies have quarterly earnings twice what they spend on R&D. (38) The government is the main culprit behind the consolidation of these high prices, given that programs like Medicare and Medicaid (state healthcare coverage for adults and children) are responsible for 40% of total spending on prescription medication. (39) Granting universal healthcare coverage to all Americans would cost $2.8 trillion annually, which would put the government in a complex fiscal situation. First, they must tackle the issue of costs through a medium-term plan before expanding the system to all citizens. (40)

Experts recommend greater price transparency, more competition between healthcare providers from different states, reduction of administrative costs, improved preventative care, lowering the malpractice litigation culture, taxing sugary products, healthy diet and exercise campaigns, and reducing the cost of medication. On the other hand, we will later see how this sector is protected by powerful lobbyists who work the technocratic apparatus of states and legislators to ensure bills that would help reduce costs aren’t passed.

The cost of healthcare plays a central role in the issue of inequality in the United States. In the following graphic, we see the percentage of income that Americans spend on taxes. When you include the health insurance payments made by workers to their employers, the tax rate of middle-class Americans is practically twice that of the 400 people with the country’s highest incomes. (41)

TOTAL TAX RATES

The issue of healthcare has a strong cultural component. A significant part of the increase in healthcare spending is associated with chronic diseases, many of which are related to obesity such as type 2 diabetes and high blood pressure. (42) Obesity grew from 30% in 2000 to 42% in 2018, (43) affecting African Americans and Hispanics in a higher proportion.

Many families, especially those with fewer resources, have a high consumption of high-sugar products, soda, fast food, processed food, sodium-rich products, and diets without any fruits or vegetables. On top of that, they do very little exercise and in many cases consume excessive amounts of tobacco and alcohol. Many of these factors explain the large differences in life expectancy between the rich and poor. According to several studies, the richest Americans live between 10 and 15 years longer than the poor. (44) For example, only 7% of Americans who earn over $100,000 a year smoke, as opposed to 14% among people who earn between $35,000 and $100,000, and 21% for those earning under $35,000. (45) A packet of cigarettes costs an average of $6.28. (46) A person who smokes a packet a day from the age of 18 will have spent $110,000 on cigarettes by the time they turn 65. If that money had been saved and invested with an average annual return of 5%, they would have saved an extra $431,000 for retirement. If this same person replaced their soda consumption with tap water, adding another $4 to their daily savings on cigarettes, they would have an extra $691,000 to improve their quality of life in their old age.

Cooking healthier foods and drinking water instead of soda involves not only a financial saving in a family’s monthly budget but also a major saving in medium and long-term healthcare expenses. Buying fresh ingredients and cooking them yourself usually costs less than buying pre-made or canned foods. The habit of cooking as a family, spending time preparing food serves a very important social purpose. The problem is a lot more complex given that obesity, tobacco use, and junk food consumption are closely linked to anxiety and the ecosystem we live in does not make it easier for people who struggle to correct these habits. (47) Our sickly habits translate to sickly bodies.

The pandemic unveiled the health inequalities through the highly skewed mortality rates between high-income and low-income sectors. For instance, in Wisconsin, though African Americans make up 6% of the population, they represented close to 40% of Covid-19 deaths. (48) This is due to African Americans being the group with the highest rates of obesity, (49) diabetes, (50) and high blood pressure. (51) All of these factors exponentially multiply the risk of dying of Covid-19.