Aug 06, 2009

Unequal and Sick

In this season of American healthcare reform, we frequently hear comments that begin: “In the richest nation in the world….” and finish with some variation of “….we should be able to provide decent affordable care to all our citizens,” or “….we should have better health outcomes than some 30+ nations that are not nearly as wealthy.” The assumption being that, while money can’t buy you love, it certainly can buy you the best doctors, hospitals, technologies, and drugs.

Unfortunately, America allows some 20% of its healthcare spending to go to sickness profiteers in the insurance and pharmaceutical industries. Since non-profit, single-payer solutions were not even allowed into the current debate — the “public option” proposal, in its current form, is more frustrating tease than radical transformation — it seems inevitable that post-reform healthcare in America will continue to function as a massive transfer of wealth from ordinary Americans to the rich.

This is indeed most unfortunate because it feeds into an even greater problem facing America: the vast and ever-widening gap between the wealthiest 5% and the rest of us. This income inequality is not just crassly immoral, as so puke-ishly personified by greedy financiers grabbing billions in booty for themselves, while millions of their “fellow Americans” lose jobs, homes, and health insurance. As British researchers Richard Wilkinson and Kate Pickett explain:

Until recently, most of the argument about the scale of income inequality in modern societies has been about fairness and unfairness. But it has recently become possible to compare the scale of income differences in different societies and see how the social fabric of society is affected by how much inequality there is. Research using this data carried out since the early 1990s shows that many of the most pressing health and social problems are worse in more unequal societies — often much worse. Societies with bigger income differences between rich and poor seem to suffer more of a very wide range of health and social problems.

Wilkinson and Pickett call income inequality “the scourge of modern societies.” They provide evidence for a range of social problems, including physical and mental health, obesity, drug abuse, teen births, homicides, and child well-being. “For all of these health and social problems,” they say, “outcomes are very substantially worse in more unequal societies.”

The wider the gap between rich and poor, or between CEO salaries and their workers’ pay, the more divided a people are, the more screwed up a society becomes.

They’re testing their theory in two different areas: “internationally among the rich countries, and then again among the 50 states of the USA. In almost every case we find the same tendency for outcomes to be much worse in more unequal societies in both settings.”

unequality

As in the above image, America’s standing in every area of measurement is nearly off the charts, and not in a good way.

Income inequality hurts societies, according to Wilkinson and Pickett, mainly because it places everybody, over-class and under-class alike, under greater stress. The stresses of constant battling for social status, of running in a rat race, of working sixty hour weeks, of feeling forced into a forever struggle for dominance against one’s neighbors — such stressors all increase in unequal societies and fall as seriously on the over-class as the under-class.

For the 95% of Americans who make up our under-class, the stress is obviously worse, and the poor have poorer outcomes in all of Wilkinson and Pickett’s measures. Yet as they make clear, the problem is not merely that so many people lack the money to make their lives better: a grossly divided society is a seriously sick society and everyone suffers.

None of this bodes well for American healthcare reform or for the continuation of America’s dominance in the world. In his study of how and why civilizations collapse, Jared Diamond explains why it is so difficult for seriously sick societies to right themselves:

The elite are particularly likely to do things that profit them but hurt everybody else, if the elite are able to insulate themselves from the consequences of their actions. Such clashes are increasingly frequent in the modern U.S., where rich people tend to live within their gated compounds and to drink bottled water … Failure to solve perceived problems because of conflicts of interest between the elite and the rest of society are much less likely in societies where the elite cannot insulate themselves from the consequences of their actions.

If, for instance, there was one healthcare system that served everybody, then the American elite would have the proper motivation. But our politicians and their corporate masters all have great healthcare and no incentive to tinker with a status quo that just keeps adding to their wealth.

Or, as Bill Gates, Sr. once put it: “We can either have a situation where we have a small number of people with a huge amount of wealth or we can have a democracy. But we can’t have both.”

Keep that in mind as our democratic-process-turned-farce pretends to reform healthcare.

Michael Sky | CommonHealth