Unequal Access: Healthcare in the United States

 

Health and Illness in the Richest Country in the World

• Unlike all high income and most middle income countries, the United States have never made universal healthcare a social right.
• Instead, healthcare is offered through a complex mix of public and private coverage that affords no consistency
• Market-based, for profit industry dominated by insurance giants and drug companies
• This has resulted in the highest healthcare spending per capita in the world and mediocore health outcomes.
• The US has lower life expectancy and positive health outcomes than any other developed nation in the world. Scores much lower on managing chronic disease
• The US has the lowest access to primary care of any developed (and some developing) nations
• Lack of access to health insurance coverge (universal coverage) is the main cause
• exacerbates illness
• shortens lives
• increases suffering

ACA as a response to restricted access

• Increase access by expanding access to medicaid (non-group coverage)
• Creating insurance exchanges to sell affordable healthcare
• Using federal monies to finance programs rather than a hodgepodge of state formulas which left most care un- or under-funded.
• Prohibited
• denying coverage because of preexisting conditions
• charging higher prices for women (gender range)
• canceling coverage after it was issued (excision)
• not including a comprehensive packege of basic services (minimum coverage)
• Protected Insurance Companies
• Risk pooling (risk adjustment, risk corridors, reinsurance
• Provided subsidies and tax credits to keep market affordable
• Problem with Implementation
• 2012 supreme court decision made medicare expansion optional for states
• less than 100% below poverty was now ineligible for financial assistance
• left a new group of poor and uninsured
• "coverege gap" for which people blamed obamacare rather than the states that didn't expand medicare by their own choice- even though the government would have paid 100% of it (for the first two years)
• remains politically contentious which is responsible for its partial and tentative rollout and its lack of acceptance.

The Anthropological Approach to Healthcare Access

• concerned with individual phenomonology as opposed to generalization
• qualitative rather than quantitative data
• shows how differently situated individuals have radically different experiences and these are all valid.
• responsive to multiple points of view
• Three theoretical concerns when understanding access post-ACA
• stratified citizenship- the uneven ways in which people experienced the law
• factors: immigration, race, age, income, gender, state of residence
• health citizenship: social inclusion and marginalization are often produced through unequal access to healthcare, structural barriers to health, and provider attitudes.
• differential notions of "deservedness"
• risk-class membership, sense of vulnerability, social resources
• how it is experienced and navigated in health care
• perceived health risks shape coverage behaviors
• people are also "risks" -subject to subprime rates for healthcare with incomplete coverage and high deductibles (average $3000).
• responsibility- ACA provided new responsibilities for individuals and new opportunities for companies to make money
• healthcare now an individual responsibility rather than an employment perk or universal right- individual mandate
• part of the larger history of welfare reform
• put more responsibility on states for healthcare delivery
• unequally distributed increase in responsibility for healthcare and improved health outcomes falls on the most vulnerable and those in the coverage gap.