This month’s Health Affairs carries an article examining the correlation between one’s income and one’s perceptions about one’s own health and health care. Worldwide, those with the lowest incomes feel that their health is worse than those with the highest incomes do. They also are more likely than those with higher incomes to skip necessary treatment because they can’t afford it, and are more concerned that if they become seriously ill, they won’t get the best treatment their country has to offer. Perhaps not unsurprisingly, the United States has one of the greatest disparities between those with the lowest and highest incomes. But at least Americans are also the most aware of this disparity: 67% of US respondents, the highest number of any in the world, agree that “many” people in the US do not have access to the health care that they need. This is a good thing: awareness of a problem is the first step towards fixing it.
But what if we are aware of the problem, yet don’t really think it’s a problem? Only 54% of us in the US think it’s unfair that people with higher incomes can afford better health care than those with lower incomes. What if we see unfairness, but don’t recognize it as unfair?
In his post to this blog on June 6th, Mark McQuain asked what our number one bioethical issues are. As a physician who is privileged to care for a wide diversity of patients — from higher-ups in large corporations to those struggling to support a family by working two jobs and driving Uber — I see daily the very real differences between those who are granted full access to all our health care system has to offer, and those who get only the scraps from the health-care table: differences not just between healthy and sick but between life and death. The ones on the lower end are disproportionately the poor, the widows and single mothers, the aliens among us. I am pro-life; since access to health care can be a life-and-death issue, it is part of my pro-life identity to advocate for access to health care for all. The disconnect between recognizing inequity in access to health care and recognizing that we should try to do something about it is deeply disturbing to me. At this time and place, the injustice (and the recognition that it is injustice) in the inequity of access to health care based on income is the number one bioethical issue on my list.