By now every American who reads newspapers knows that the average European is passing the average American in height and the apparent reason is that Europeans get better health care. Europeans already live longer; now they're becoming taller than we are. Is anyone listening? Republican buffoons are still telling us the "free market" is the only way to provide health care to Americans. What they really mean is that the status quo is the best way to preserve the wealth and privileges of the affluent class, many of whom are living on inherited money, not on money they earned themselves. What Republicans really mean is that universal health care may mean higher taxes for the rich and less money to spend on the next yacht or next safari.
That's the real issue: Can America afford to continue subsidizing the luxuries of the affluent class by lowering its taxes while watching people die for lack of health care?
We've had the important questions about health care in front of us for nearly 50 years. What is the status of public health in America? Is the current health insurance structure adequate for the needs of the people? Is it myth or reality that poverty produces bad health? Are all people equal in health care, or does racial and ethnic discrimination contaminate the system? Is the current American system of health care the best in the world?
The character of public health in America is not what most people think and not what is usually described to them by politicians and the media. Statistics are manipulated, data is concealed by one government agency or another, the media does its usual job of emphasizing what it thinks will keep the readers and viewers coming back for more. The consequence is a mythology about American health care that pervades every class and every locality.
For example, people generally believe that life expectancy in America is high for everyone regardless of where they live, but the data indicate otherwise. People born in certain rural counties of Minnesota, Colorado, Iowa, or Wisconsin will live on average 25 years longer than people born in 4 counties of South Dakota, 23 years longer than in 12 counties in Mississippi and Alabama, and 22 years longer than people born in Washington, D.C. or Baltimore.
In general, overall disparities in life expectancy between different parts of the United States are greater than for any other nation in the world.
Apart from the character of public health, the problems of health insurance continue to fester in American society. The lack of health insurance by nearly 18 percent of the American population is a serious structural problem that needs attention. The insurance gap affects working families (those with at least one worker) particularly hard. A full 80 percent of uninsured people under age 65 live in working families, many surviving on low wages paid by service jobs. Families with two wage earners do better, but 10 percent of those families lack health insurance. One can take it as a given that any working class family without health insurance sharply limits visits to physicians and clinics for preventive health-care or for potentially serious illness, visits that families that do have health insurance consider ordinary. What is the acquiescence of society to the existence of this insurance gap except a signal that the economically comfortable class believes 40 million Americans are expendable?
It's clear, and has been clear for decades, that people without access to preventive health-care and without access to adequate treatment of disease once disease appears, are less likely to lead productive lives, are more likely to die early, and are certainly more likely to be a major financial drain on the national economy.
The health consequences of poverty are complex and involve more than lack of access to health care. Poverty itself debilitates health, makes health-care necessary, and the lack of adequate health-care soon increases debilitation, produces more serious disease and ultimately magnifies the cost to society. The game of conservative politicians is apparently one of sacrificing a large segment of the American public in order to completely preserve free-market medicine, a sacrifice never explicitly identified by these politicians to the public.
Many people view class disparities as an inevitable consequence of capitalism, or a consequence of "inappropriate" culture, or simply a matter of bad luck. But no matter how class differences are viewed, class differences exist, and differences in rates of premature death, illness, and disability are closely related to socioeconomic status. In general, people in lower classes die earlier than people in higher socioeconomic classes, and the pattern persists from the poorest to the richest classes. In the time-frame 1972 to 1989, people who earned less than $15,000 a year (in 2003 dollars) were three times as likely to die prematurely as were people earning more than $70,000 a year.
Americans need to ponder the question of whether a society that denies people appropriate medical care because they lack the money for it is a society that requires repair.
The sociologist Michael Harrington, writing about poverty in America, about the "other America," closed his classic with the following words: "For until these facts shame us, until they stir us to action, the other America will continue to exist, a monstrous example of needless suffering in the most advanced society in the world."
Michael Harrington was a Socialist, but you don't need to be a Socialist to care about other Americans. We're a group, we call ourselves "Americans," and we need to think about America the way we think about our families: we need to help each other when help is needed.