Comments
ACCORDING TO LIZ - Yes, the United States has cutting-edge medical technology and facilities. Yes, the American healthcare system is extensive.
But it’s also pretty damn expensive and very complex. And the results? Pretty meh.
And as a New York Times editorial headline recently put it, “Many Patients Don’t Survive End-Stage Poverty.”
This in a country that perceives itself as the leader of the free world, not one of its outliers. Yes, the U.S. may be on the forefront of medical development, but how well does it serve the masses who came to its shores, yearning to be free.
Healthcare cannot continue to end at the exit doors of clinics, hospitals and doctors’ offices.
Causes of poor health – bad nutrition, limited education, overwork, crowded/unhygienic housing, crime, unaddressed addiction and mental health issues, despair – must be addressed holistically and not separate from their inevitable aftermaths.
Exacerbating poor health is lack of preventative care, the high costs of medical care and medications, an inability to access support that only the well-heeled can pay for, exposure to other diseases in public schools, in factories, in hospitals and prisons, in life on the street, consequences of crime.
Complications of poor health are shorter lives, poorer quality of life, intergenerational poverty, increased illegality. A vicious circle.
Mental illnesses proliferating on the streets of our cities are too often ascribed to issues of the individuals, but more and more research shows that climate change is an underlying cause of stress and other mental health challenges.
The wealthy can move to where air and water are cleaner, but the poor are stuck in the shadows of freeways, downstream of toxic factory farming and fracking operations, and in Cancer Alleys across America.
Over 100 million Americans owe over $220 billion in outstanding medical bills. Almost twice as many Blacks carry medical debt compared to Caucasian Americans. About a third of cancer survivors now suffer from credit liabilities, and 3% have filed for bankruptcy.
56% of Republicans and 85% of Democrats support some relief to those with medical debt – but... who pays?
Rising Democratic leader Ro Khanna believes along with many Americans that people should not have to go into debt to see a doctor or go to the emergency room.
Medical debt has become a fiscal crisis, decimating people’s savings and stopping them from seeking healthcare leading to more serious prognoses and greater costs, both to families and to the state and federal programs that then have to step in.
Fifteen percent of all working-age adults in the United States carry medical debt loads of $2,000 or more.
Three-quarters of U.S. adults worry about unexpected medical bills, almost a quarter report foregoing medical treatment including almost 20% who have health insurance.
Millions of Americans are being driven into poverty due to medical debt.
As chair of the Senate health, education, labor, and pensions (HELP) committee Bernie Sanders says “People in our country should not be going bankrupt because they got cancer and could not afford to pay their medical bills. No one in America should face financial ruin because of the outrageous cost of an unexpected medical emergency or a hospital stay.”
In the New York Times article, the University of California San Fransico’s Dr. Lindsay Ryan who had worked in a South African health center addressed what medicine was unable to cure there: babies wasting away from malnutrition and people dying of treatable infections because they couldn’t afford transportation to get care.
Then pointed out the problems of poverty in the United States which mean practicing medicine here is not so different. In a San Francisco hospital disproportionately serving people on Medicaid or without insurance, she routinely saw patients suffering from variations of malnutrition due to sporadic meals, junk food diets that lead to heart problems, obesity and scurvy.
Her thesis was that more often than not, it isn’t medically curable conditions but end-stage poverty that ultimately kills too many Americans.
How do you reach patients with urgent test results who lack phones or have been evicted?
Medical training doesn’t address fixing a patient’s housing, making sure they have enough food and a way to get to a clinic. But people keep on dying due to such simple deficiencies.
Illnesses in patients drawn from the desperately poor, recent immigrants and people of color isn’t just biological; it’s the physical manifestation of social inequality.
People on the street can’t keep wounds clean, their medications get stolen, they sicken from poor diet, psychological trauma, the lack of preventive care…
Conditions that medical schools don’t address.
An example she uses is of a homeless man who doesn’t want to live after he hears that an amputation is necessary when antibiotics won’t cure an infection.
That’s not suicidal intent, just a reasonable assessment of a dire situation. Handicapped people can’t survive on the street where they become easy targets for assault and robbery.
What’s unreasonable is that the taxpayer funding of the man’s medical care exceeds a year’s rent.
On paper, the cause of death might be a bone infection but, ultimately, he would die from being too poor to survive in one of the world’s wealthiest countries.
Medical advances are amazing, and billions of tax dollars are invested in helping our soldiers recover. Why can’t America keep its men and women safe at home and invest that money in improving the lives of our most needy?
Medical miracles produced by American ingenuity are routinely applauded but, despite spending almost twice as much per capita on its health system, life expectancy here is significantly lower and rates of preventable death far higher than in Canada, the United Kingdom, and other First World nations.
Because the solution is massive investment in housing, addiction treatment, free and low-barrier health care and social services. Appropriations that are anything but glamorous.
The solution is long term commitment and incremental and lacks the glory to make the news and afford politicians a chance to posture.
America needs to invest as much time and money innovating in the social sphere as in cutting-edge medical development. The United States must own up to the inequity that is putting too many of its people on a downward trajectory to death.
It must embrace a holistic approach so never again will inequality resulting from race, religion, education, gender or country of origin be the fundamental cause of emergency room visits.
Caring for people must be embedded in every step of their lives from pre-natal nutrition to a palliative passing – with far more quality years in between than is the current norm for all but the elites.
Aspirationally, medicine must be a lifelong practice, not pills and one-offs given out piecemeal.
Instead of teaching only about the principles of medicine in all its multitudinous varieties, more focus needs to be put on tapping community resources, thinking creatively about barriers and troubleshooting how patients can continue to get better after leaving the supports of the hospital.
At least until this country can care for all Americans equally.
Even as the inequality gap is exponentially widening, there is mounting evidence that narrowing that gap makes societies stronger and more responsive to everyone’s needs.
For too long the United States has moved away from what FDR called for in his Four Freedoms speech on the eve of the country’s entry into the Second World War.
“For there is nothing mysterious about the foundations of a healthy and strong democracy. The basic things expected by our people of their political and economic systems are simple.
“They are:
· Equality of opportunity for youth and for others.
· Jobs for those who can work.
· Security for those who need it.
· The ending of special privilege for the few.
· The preservation of civil liberties for all.
· The enjoyment of the fruits of scientific progress in a wider and constantly rising standard of living.
“These are the simple, basic things that must never be lost sight of in the turmoil and unbelievable complexity of our modern world. The inner and abiding strength of our economic and political systems is dependent upon the degree to which they fulfill these expectations.”
Does the United States eschew the United Nations because of its failure to live up to the standards espoused in Article 25.1 of the Universal Declaration of Human Rights adopted on December 10, 1948?
“Everyone has the right to a standard of living adequate for the health and well-being of him/herself and of his/her family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his/her control.”
That the United States hasn’t moved faster to embed the values variously ascribed to Thomas Jefferson, Gandhi and others but were contained in an address by former vice president Hubert Humphrey on November 1, 1977:
“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped.”
American leaders have known for generations of the need to invest in its infrastructure to maintain its place in a rapidly changing world. They must also acknowledge that its people are an important part of that infrastructure.
And act accordingly.
(Liz Amsden is a contributor to CityWatch and an activist from Northeast Los Angeles with opinions on much of what goes on in our lives. She has written extensively on the City's budget and services as well as her many other interests and passions. In her real life she works on budgets for film and television where fiction can rarely be as strange as the truth of living in today's world.)
