The U.S. way? Rich reap good health, while poor toil in sickness

us-cash-184x300Here’s something that many Americans likely would want to think twice about letting happen: Should good health and long lives be just another of the spoils reserved to the rich?

Vox, a news and information site, has posted a provocative dig into national data on longevity — a measure that has raised experts’ concern with its recent rare, two-years-in-a-row dive, notably due to fatal overdoses of opioid drugs, including prescription painkillers, heroin, and fentanyl.

Experts scrutinizing the data, Vox says, keep finding that “what’s often lost in the conversation about the uptick in [U.S.] mortality … is that this trend isn’t affecting all Americans. In fact, there’s one group … that’s doing better than ever: the rich. While poor and middle-class Americans are dying earlier these days, the wealthiest among us are enjoying unprecedented longevity.”

The disparities are big. In the District of Columbia, the poorest quarter of men die on average at age 75, while those in the richest quarter live 11 years longer to 86. In Virginia, the poorest men on average die at 76, while the richest live to 86. In Maryland, the numbers are 76 and 85.

Vox broke down existing data for men, state by state, and found the trends were similar for women. The site reported that Stanford University economist Raj Chetty has analyzed income data for Americans from 1.4 billion tax records between 1999 and 2014, finding that “men who were among the top 1 percent of income-earners lived 15 years longer than men at the bottom 1 percent. For women at the extremes of the income distribution, life expectancy differed by 10 years.”

The wonks who pore through reams of data have some pragmatic recommendations on dealing with inequities in American life spans, Vox says:

[W]hen we talk about life expectancy slipping, what we should also talk about is the growing problem of health inequality in America. And it’s an increasingly urgent discussion, health researchers are warning, because of policy changes on the horizon that are poised to make the mortality gap even wider. Some of these policies will hamper access to medical care (such as failing to fund CHIP, the health insurance program for low-income children) but others that aren’t even directly related to health care — like tax cuts — may have even more insidious effects on the American mortality gap.

Enacting laws that make the rich even richer also makes it harder for the poor and middle-class not only to keep up but worsening economic inequality also can lock people into a place in life where they lack access to medical services while also engaging in behaviors that harm their health. As Vox reported:

We often think about health status in terms of access to doctors, hospitals, and medicines. But access to health care only accounts for about 10 to 20 percent of our health outcomes. Far more influential on our health is our socioeconomic status and certain health behaviors, like smoking, eating healthfully, and getting exercise. In Chetty’s study … researchers found that life expectancy among the poorest individuals was ‘significantly correlated’ with health behaviors like smoking, obesity, and exercise. Poorer people are more likely to be overweight, smoke, and drink compared to their wealthier counterparts. Interestingly, these effects seemed to be mitigated in places that had enacted policies to curb poor health behaviors — such as anti-smoking laws or trans-fat bans in cities.

Racial and economic stigmas also aren’t health helpful. Which is why politicians and policy-makers may wish to think hard about the Republican-led, pell-mell rush to impose work requirements on recipients of Medicaid, which was created as a program to assist the poor and sick but now helps 74 million people — more than 1 of every 5 people in the U.S.

The Trump Administration has decided to allow states to determine which recipients must take on some form of employment or community engagement activities like training, education, job search, volunteering, and caregiving to qualify for Medicaid benefits.

Trump officials exempted pregnant women, the aged, children, and people who were unable to work because of a disability from possible state work requirements. States must also create exemptions for people who are “medically frail.”

Partisans have insisted the work rules are targeted at “able bodied” Medicaid recipients, many of whom are working poor who got coverage when the Affordable Care Act, aka Obamacare, expanded this health care program. But as CNN and others have pointed out, “millions of Americans in the health care safety net program already have jobs. Some 60 percent of working age, non-disabled Medicaid enrollees are working, according to a new report from the Kaiser Family Foundation. That’s about 15 million people. Plus, nearly eight in 10 recipients live in families with at least one worker.”

Imposing work rules on the poor and working poor, critics say, hurts them and their health — especially when many are on Medicaid because they’re too sick to work or can’t find work because of their illnesses and conditions. Research also fails to support a key argument that partisans offer for their new Medicaid plans — that forcing people to work makes them healthier and helps to uplift them economically.

Meantime, Medicaid supporters say that tens of millions may lose critical medical and health services because they won’t, for example, be able to document their job hunting or failure to secure work. Medicaid foes also may force recipients to keep updating this information often, which will discourage or dump them from the program. The Trump Administration barred the use of Medicaid funds to help in job searches or support assistance, such as for transportation to work. Then, too, some current Medicaid beneficiaries already are hard to reach and to serve: Drug abusers, the homeless, and mentally ill may be cut off from needed social support by rules requiring them to work.

Kentucky will be in the vanguard of states testing the new Medicaid work rules but others will follow, likely including Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah, and Wisconsin .

In my practice, I see not only the huge harms that patients suffer while seeking medical services but also their heart-wrenching struggles to access and to afford them and avoid bankrupting themselves. In a democracy like ours, health care cannot be a privilege, it must be a right — not just for the rich few. Its risks, benefits, and costs are best shared equitably. No one wants to see free-loaders and pretenders, taking advantage of taxpayer largess. But if just dollars and cents dance before the eyes of politicians, policy-makers, doctors, and hospitals, Americans may see more shameful situations like staff from the University of Maryland Medical Center Midtown dumping a young woman patient, dressed only in a thin gown, onto a street as night temperatures hovered in the 30s. This is unacceptable.

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