It’s the Inequality, Stupid!

“Make America sick again,” goes the chant of Democrats around the country to resist the Republican repeal and replace agenda for the Affordable Care Act, also known as Obamacare. In the midst of all this noise, we have forgotten something fundamental: the ACA was engineered to reduce inequality. In 2010, when it was passed, President Obama famously said at the signing, “We have now just enshrined…the core principle that everybody should have the same basic security when it comes to health care.” The ACA made great strides in reducing inequality of care, but it also plays a huge role in reducing economic inequality as a whole. By providing insurance subsidies for low-income Americans, it not only reduced the immediate amount of money needed for health insurance, but by increasing the number of insured, it reduced the number of people who were financially devastated by unexpected health expenses. The repeal of the ACA would only serve to give the wealthy a huge tax cut at the expense of the pocketbooks and health of the poor and middle class.

We don’t need to say “Make America sick again,” however, because America is already sick, comparatively speaking, according to WHO data! Sick with obesity and excessive weight. Sick with suicide rates in the young. Sick with depression. Sick with addiction. A new case of diabetes in America is diagnosed every sixteen seconds. America has fallen behind in life expectancy compared with other advanced nations. Yes, there are large pockets of topnotch medical care, at the forefront of medicine, but only for those who are well-insured and can afford it. Because of this unequal distribution of adequate health care, the national average is lowered in child birth morbidity and mortality. It is aggravated by chronic diseases brought on by poor nutrition, unhealthy life styles, and lack of education in the poor. Every nation on earth must contend with this inequality of health care in its disadvantaged and destitute, but most developed countries handle it much more effectively than the USA.

Beyond ethics and simple humanity, this inequality is the equivalent of a medical time bomb for society as a whole. One can try to build a wall to protect against immigration, but there are no walls that can protect the whole population from chronic diseases, which – and this is important to understand – multiply co-morbidity, like a petri dish that festers with bacteria. Unequal distribution of health care fosters transmissible diseases like infection, which is a risk for the population at large. For example, AIDS increases the prevalence of tuberculosis, or the lack of vaccinations increases occurrences of the targeted disease. The chronically uninsured, those who struggle with poor health, congenital disease, or invalidity, not only deserve our care, we benefit from their care. Equality of adequate care helps everyone. Disease knows no boundaries. Why do you think we sent an army of physicians to West Africa to throttle the outbreak of Ebola?

The poor in the US, the roughly 15 percent of the uninsured before the ACA, were – on average – not in good health. Lower income households, where nutrition is deficient, where education is lacking, are plagued by poor health. This is true for any nation. Obviously, having unhealthy consumers join the national health insurance marketplace will bring health expenditures up for all insurance companies, thus premiums rise – unless compensated for by young healthy individuals, which, of course, argues for mandatory health insurance, or at least expanded pools.

But this is a singular problem for the United States! Take Switzerland, for example, where the median income level is roughly $60,000 and the health care system is private. They are still having trouble with high insurance premiums after their system’s introduction over twenty years ago. How can the US introduce health care insurance with a median income level of roughly $27,000 and health care prices that are known to be the highest in the world? That’s why the equalizing effect of the ACA investment tax of 3.8% on all household income levels above $250,000 is absolutely necessary and justified.

Repealing the ACA and that 3.8% tax would be one of the single most regressive changes in government policy in recent history, affecting not just equality of care, but economic equality as well. If the ACA were to be repealed, the top 0.1% of households would see an average tax cut of $197,000, while the average American would actually owe more in taxes, not to mention the fact that millions would lose access to thousands of dollars in subsidies for health insurance that would otherwise be unaffordable. Somebody must pay for subsidizing the health care exchanges to cover the uninsured – until the overall health of the nation improves…Let’s be honest, whose income has increased over the last decades? In comparison, that 3.8% tax is a pittance.

It’s the inequality, stupid!

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