Healthcare is a social justice issue, mainly when focusing on how health is provided in the United States. Over the years, the cost of healthcare in the United States has been a concern, especially to the public. The high cost of care means that only wealthy individuals can access quality healthcare, while the poor sometimes cannot afford the high cost, or if they do, they do not receive quality healthcare services. Nevertheless, healthcare in the United States is not just about how affordable it is, but also there are prevalent inequalities in how various groups of people receive care. One of the starkest differences relates to how the white majority receive care compared to the minority groups, such as African Americans, Latino, and Native Americans (Mossialos et al., 2016). Focusing on a country like Australia, which is considered to be a developed country just like the United States, it has better health outcomes, because of the existence of a universal health coverage program and favorable health policies. All social groups in Australia, including the minority Aboriginal people, can access essential health care services without worrying too much about running bankrupt. The healthcare system in Australia is funded by the national government, state, and local authorities, as well as private health insurance companies. All these entities fund healthcare and make it much more affordable than it is in the United States. For the United States, healthcare is mainly financed by private insurance companies, and there is no proper regulation to control the skyrocketing prices of healthcare services.
Although there have been considerable improvements in the provision of healthcare over the years, social discrimination in the United States remains to be a significant factor in the incessant adverse health outcomes by ethnic and racial minorities in the country. D’Anna et al. (2018) define social discrimination as the differential treatment of particular groups of people based on their perceived or actual characteristics such as age, ethnicity, race, gender, medical condition or income status. In the context of healthcare, such treatment manifests in the form of behaviors, opinions, beliefs, as well as attitudes of clinicians that could impact disadvantaged populations negatively. A good example is when a healthcare provider withholds a full range of treatment options from specific patients because of their personal conscious or unconscious perceptions that such patients are less likely to embrace or follow specific therapies.
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According to a study conducted by D’Anna et al. (2018), from a sample of the feedback given to the Behavioral Risk Surveillance System (2005-2013) from respondents who received healthcare services in the previous 12 months, the comparable probability of reporting discrimination against equal treatment was nearly four times for Black people, while Whites of Hispanic origin had a 50% higher probability of reporting discrimination in comparison to non-Hispanic Whites. Subsequently, health-compromising outcomes linked with social discrimination comprise of increased risk of physical stress respondents, patient disengagement, non-compliance or poor compliance with medical treatment guidelines, and healthcare avoidance attitudes. Consequently, these outcomes cause higher mortality and morbidity rates, which are prevalent among minority groups. On the same note, a national survey exposed that 65% of non-Hispanic White patients expressed satisfaction with the quality of care they received, while only 45% of Asian and 56% of Hispanic patients expressed their satisfaction with the quality of healthcare services they received from the years 2016 to 2018 (D’Anna et al., 2018). Although sometimes self-reported statistics could attract considerable critics, they inevitably portray an overview of the inherent problems of the United States healthcare system. The objective of this essay is to demonstrate that despite the U.S. investing in healthcare significantly, accessibility and affordability is still a problem, but the country can still improve the system by emulating some aspects of the Australian healthcare system.
Literature Review
Presently, about 48% of healthcare expenditure in the United States is drawn from public payers, 40% from private payers, while 12% comes from out-of-pocket payments by patients (Rice et al., 2014). The two main public purchasers of healthcare are Medicare and Medicaid, and they cover about 40% of the population (Moses et al., 2013). Concerning Medicare, it is the largest public purchaser of healthcare, and the kitty is financed by a combination of federal tax revenues, payroll taxes, and enrollee payments or patient cost-sharing requirements. To be specific, Medicare covers United States residents who are older than 64 years, patients with end-stage renal disease, and persons living with disabilities (Moses et al., 2013). It is estimated that more than 50 million people in the United States are covered by Medicare (Rice et al., 2014).
Before the Affordable Care Act (ACA) was implemented, Medicaid covered approximately 59 million people, while the Children’s Health Insurance Program (CHIP) covered approximately 6 million children (Rice et al., 2014). The two programs are managed by the respective states and have historically covered mothers from poor backgrounds as well as their children. The Medicaid program also caters for the health care needs of disabled adults, and together with Medicare, it covers low-income adults (Moses et al., 2013). Most states cater for the costs of long-term care for people who have depleted their assets and incomes. The other public health payers funded by general federal revenues include Indian Health Services, targeted at the indigenous Indian ethnic communities, Tricare addresses the healthcare needs of military personnel on active duty and their families while the Veterans Affairs is meant for military personnel who have retired from active service.
The private payers of healthcare in the United States consist of individuals with employer-sponsored health insurance, people with personal private insurance, and the uninsured. Regarding employer-sponsored health insurance, it is estimated that about 90% of people who have private insurance in the United States (about 150 million people), have acquired it from an employer (Rice et al., 2013). This type of insurance is typically financed through consolidation of employer and employee payments, as well as cost-sharing arrangements. On the other hand, approximately 10% of employees in the United States; about 15 million people, have purchased health coverage individually (Rice et al., 2014). Individual health insurance is paid entirely by the enrollees or through patient cost-sharing requirements. With the introduction of the Affordable Care Act, private health insurance is expanding. In 2012, approximately 47 million people in the U.S below the age of 65 years were uninsured, although that number has reduced to below 30 million people (Rice et al., 2014). Additionally, minorities, young adults, and people with low incomes are especially likely to be uninsured. Although the number of uninsured people has decreased over the years, still more than 20 million people, especially below 65 years, are uninsured, and that is a significant number that cannot just be wished away.
The healthcare system in the United States witnessed some significant transformations after the Affordable Care Act became law in 2010, and most of the provisions were implemented in 2014. One of the most important provisions of the Affordable Care Act was the expansion of private insurance coverage (Center et al., 2017). Health insurance coverage was expanded through the expansion of subsidies to help uninsured individuals and families to buy the required health insurance coverage. In particular, subsidies are given to individuals and families that have incomes below 400% of the federal poverty level (Center et al., 2017). ACA also requires all residents and documented immigrants to have health insurance coverage. Individuals who fail to enroll for health insurance cover are supposed to incur financial penalties, although the enforcement aspect presents the biggest challenge.
The United States healthcare system is complex because of several varied players. As a consequence of the complexity of the healthcare system of the United States, the country ranks first among twelve developed countries in the aspect of disease burden (Sawyer & Gonzales, 2017). Some of the countries that rank lower compared to the United States regarding disease burden are the United Kingdom, Germany, Australia, Netherlands, Sweden, and Switzerland. This means that the latter countries’ healthcare systems provide some relief to the citizens when spending on healthcare. U.S citizens are likely to deplete their incomes and savings when dealing with their healthcare needs, especially those who require long-term care.
Medical sociologists have striven to create an understanding of the way healthcare services are delivered in the United States for many years. Wright& Perry (2010) provide key findings of healthcare delivery in the United States across the years. The first finding is that healthcare in the United States is unequally distributed, and that contributes to health inequalities across different groups of individuals. The unequal distribution of healthcare means bias in the distribution of resources among the different groups. Literature suggests the better distribution of healthcare resources among neighborhoods with the majority of whites compared to residential places of minority groups, especially those of Blacks and Latino (Boulware et al., 2016). Better healthcare outcomes are also associated with equal distribution of infrastructural facilities, especially roads. In case of emergency medical needs, ambulances, and other evacuation services have to get easy access to the areas to provide healthcare services to the patients in critical conditions. The typical situation in the United States is that inner cities, which usually have majority Black groups or Latinos, are often congested and lack essential infrastructure and healthcare amenities. In the event of a fire accident, it would be relatively hard to access some of the inner cities compared to residential neighborhoods of White majority groups.
Another aspect that affects how minority groups receive healthcare services relates to socio-economic disposition. Most of the minority racial and ethnic groups in the United States are low-income earners. Therefore, structural issues inherent in the American system probably were never meant to address the needs of the minority groups. Racial discrimination, which has been reported over the years, affects the type of occupations in which minority groups participate(Abramson et al., 2015). For instance, it is common knowledge that African Americans were treated as slaves in the past years in America. Although constitutional changes might have been made to address the question of equality, the design of the system might have been made to ensure that they do not get equal opportunities. Consequently, minority groups are likely to work in low-income occupations, which make it quite a challenge to afford expensive healthcare services. A study by Abramson et al. (2015) reveals that minority groups, especially African Americans and Latinos, are likely to suffer from chronic conditions, because of their poor living standards. Chronic conditions typically do not have a cure, and the best that healthcare professionals do is to manage them so that patients live for longer periods. However, the cost of managing chronic conditions is always too high, and the insurance premiums for such diseases are way above board for low-income earners to afford. Therefore, the system is structured in a way that promotes inequality, subsequently exposing minority groups to various health risks, which deplete all their financial resources, leaving most people poor.
Phelan et al. (2010) posit that the unequal distribution of healthcare services in the United States is also affected by the providers’ opinions, stereotypes, and perceptions about the minority groups. Most of the minority groups do not have adequate healthcare professionals among themselves, especially because of the expensive education or training. Most minority groups cannot afford the expensive out-of-pocket tuition fees for the medical or health courses, and the only viable option usually is taking student loans. However, the thought of paying back the loans will most likely scare students from minority groups from taking expensive courses. On the other hand, the majority of White students can afford such courses. They come from relatively wealthy backgrounds and sometimes can afford the tuition fees without having to apply for the loans. Therefore, ultimately most healthcare professionals are Whites, and out of this group, some hold various stereotypes or institutionalized beliefs about the minority groups. Definitely, with such beliefs, the healthcare providers can be biased, and therefore, will fail to address the healthcare needs of minority groups adequately.
One important theory that can explain the healthcare disparities between the various groups in the United States is the theory of fundamental causes. This theory states that socio-economic status comprises an array of resources such as knowledge, money, power, prestige, and beneficial social connections that cushion health regardless of what mechanisms are relevant at any given time (Phelan et al., 2010). In this case, the wealthy individuals in the United States will always benefit the most from whatever mechanism is put into place to ensure equality in the distribution of healthcare resources and services. With each system or intervention that is put into place, the wealthy, as well as the socially privileged groups, will always benefit the first and receive the best services because of their connections and power. In contrast, the minority groups will receive those services the last, and sometimes, in poor quality. Therefore, this theory explains why with the desire and push to equalize health delivery in the United States among all ethnic and social groups, significant disparities still seem to be existent.
Solution
Australia boasts of one of the most accessible, affordable, and comprehensive healthcare systems in the world. Health care services in Australia are administered by the Commonwealth Department of Health and Ageing. Through this department, Australians have access to important health and family services which include: family and children’s services, aged and community services, public health initiatives, disability programs, Medicare and pharmaceutical benefits, health care services for Aboriginal and Torres Strait residents, hospital and healthcare funding, as well as emergency services for people in distress (Dixit & Sambasivan, 2018). Evidently, the Australian healthcare department considers many aspects that cover healthcare, as well as tries to ensure that even the minority groups are recognized and given priority in receiving health care services.
The Australian healthcare department has come up with a far-reaching policy of leadership and funding in health issues where the federal government focuses on research, public health, and management of public information. In contrast, the various states, territories, and local governments focus on the delivery of public sector health services, as well as the control of health workers in the private and public sectors. To be specific, the states, territories, and local governments provide psychiatric and public acute health services, which comprise of dental health, school health, environmental health programs, as well as maternal and child health (Dixit & Sambasivan, 2018). All levels of the Australian government, including the consumers and other non-governmental organizations, have various roles in the financing, directing and giving care to older adults. For example, residential aged care is funded and controlled by the Commonwealth government but provided mostly by the non-government sector, which comprises of religious, charitable, and for-profit organizations. On the other hand, the Commonwealth, territories, and states through joint efforts finance and administer community care, which is always in the form of home help, transport, and delivered meals. The local governments also play important roles in the provision of healthcare services, particularly through the provision of food safety, sanitation, and hygiene as well as water quality monitoring.
Australia is one of the countries that provide the best healthcare services in the world, and the manner in which the system is designed promotes equality among the various groups. Australia’s healthcare system ranks second overall after the United Kingdom, according to a study that compared various health aspects such as the care process, access, administrative efficiency, equity, and health outcomes (Sawyer & Gonzales, 2017). The other countries that were included in the study are the Netherlands, New Zealand, Norwich, Switzerland, Sweden, Germany, Canada, France, and the United States. The United States ranked last overall in this study. It is sporadic to hear about criticism of the Australian healthcare system in relation to discrimination of various minority groups, and therefore, the United States can get important insights from this system. In the Australian healthcare system, all citizens, permanent residents, and specific visa holders are eligible for high-quality, free public inpatient, and outpatient healthcare. The care comprises of free emergency department visits through Medicare. Although many people also incur an out-of-pocket cost to see a doctor in the community setting, the cost is usually affordable. The main reason the Australian government has a national healthcare financing system is to provide to all Australians, regardless of their personal or social circumstances, access to health care services at an affordable cost or no cost at all (Sawyer & Gonzales, 2017).
Australia also has a private cover for individuals who do not prefer the public cover. According to Dixit & Sambasivan (2018), about 57% of Australians choose to get private insurance cover. The private insurance cover can enhance allied health services, dental, and optometry. Secondly, the private cover also enhances access to private hospitals of an individual’s choice and reduction in waiting times for elective procedures. On the same note, the Australian government also gives a subsidy for private insurance costs to families. The Australian government funding of the public health cover is done through general taxation, and on top of that, all Australians pay a 2% Medicare income tax levy (Dixit&Sambasivan, 2018). Again, an additional tax levy of 1% is charged on high-income earners who opt not to take private cover.
According to Willis et al. (2016), another strategy that Australia uses to cap medical costs is that it has established a Pharmaceutical Benefits Scheme (PBS), which controls the out-of-pocket costs of various medications for all citizens. Therefore, the Australian government plays a central role in deciding how much citizens pay for various medical services and drugs. As such, healthcare professionals and pharmacists do not have the freedom to decide their prices. Coupled with the regulation, the government also enforces these regulations and policies so that unscrupulous individuals face the consequences of breaching them. Ideally, the Australian government recognizes the importance of being in charge of the healthcare system, compared to the U.S government that seems to have left the healthcare system, as crucial as it is, to private players. The change of the U.S healthcare system is always a political issue, and with the intense lobbying from private players, major changes rarely see the light.
From the Australian healthcare system, the United States should nationalize its healthcare system because most of the countries, which have managed to reduce healthcare disparities among various social groups have universal healthcare (Percheski&Bzostek, 2013). Having a universal healthcare cover in the U.S means that basic and essential healthcare services will be funded through tax levies. To install such a system, there ought to be an enabling political environment or a willing government. A national healthcare system means that all people, regardless of their social backgrounds, will receive essential healthcare services. Secondly, it will be less expensive cumulatively to fund the healthcare system because the funding will be spread across all the citizens.
Secondly, it is also important for the government to regulate the out-of-pocket medication costs, because the lack of control makes healthcare professionals set their prices, which are usually too high. In addition, the government also needs to regulate the private health insurance sector, especially regarding how much they should charge for insurance premiums, and what type of cover they need to provide. Some insurance companies could charge high premiums but offer only limited cover. For instance, before the Affordable Care Act, many insurance companies did not provide cover for preexisting conditions, and that made many groups vulnerable. Since minority groups are likely to suffer more from chronic conditions, the insurance covers were almost useless, and even with the cover of preexisting conditions, some insurance companies are raising their premiums across the years (Archibald & Rankin, 2013). Some of these companies could likely exploit various groups because of the lack of regulation by the government. Therefore, to cushion various groups and achieve equality in the provision of healthcare services, the government needs to regulate the health insurance industry.
It is important to realize that the Australian healthcare department recognizes minority groups and gives them priority in the provision of health care services. For example, the Australian Aborigine group is considered a minority in Australia. Compared to minority groups in the United States, such as African Americans and Latino, the Australian health care system realizes the need to direct resources to solve the healthcare needs of minority groups to narrow the gap between the majority of whites and these minorities. In the same way, the United States needs to organize and mobilize significant amounts of resources to address the healthcare disparities between the majority of whites and minority groups. If the United States government continues to address the healthcare needs of all groups in a conventional way, then the theory of fundamental causes may still apply even in the coming years. The reason is that if healthcare needs will be addressed the same way, then the healthcare needs of the wealthy will continue to improve, and while those of the minority groups may still improve considerably, there will still be a gap. Therefore, to bridge the gap, radical action is needed; vast resources need to be invested in addressing the healthcare needs of poor people and minorities so that their outcomes are at par with those of the wealthy and traditionally advantaged groups.
Conclusion
The American healthcare system raises social justice issues because of the different health outcomes among the various social, racial, and ethnic groups. From the literature, minority groups, in particular, Blacks and Latinos, receive poor health outcomes because of the issues dealing with the design of the system. For example, the healthcare system is very expensive, such that only wealthy individuals can afford quality healthcare. Most people from minority groups are low-income earners, primarily because of the history of the United States, where minority groups have been discriminated against, across the years. With the low income, clearly, it is difficult to afford the high insurance premiums charged by private insurance companies or the unregulated out-of-pocket payments. Some of the insurance companies are also selective in terms of the cover they provide, especially on chronic conditions, or choose to charge skyrocketing prices on such covers. Since minority groups are likely to suffer from chronic conditions because of the environment and their lifestyles, the system does not favor them. Hence, the disparities are likely to be evident across the years as the theory of fundamental causes suggests and predicts.
The solution to addressing the health disparities across the social groups in the United States lies in borrowing from the best practices of the Australian healthcare system. The United States government needs to have universal healthcare coverage funded by taxes. Secondly, the government needs to regulate the various stakeholders such as insurance companies, and healthcare organizations, especially in relation to what they ought to charge on the various medical services. Taking control of the healthcare system and initiating, as well as implementing the healthcare regulations, will promote equality in service access across all social groups. Lastly, and most importantly, the minority groups will be cushioned across crippling financially in the event of serious illnesses, especially chronic conditions. The savings can be used to improve the quality of their lives, and therefore, reduce the vast gaps between these groups.
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