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RUNNING HEAD: HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL

HEALTHCARE

Healthcare in America

Disparities, Coverage Gaps and a Need for Universal Healthcare

Jennifer Alspaugh

Community College of Allegheny County

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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
Healthcare in America

Disparities, Coverage Gaps and a Need for Universal Healthcare

Despite being considered the wealthiest nation in the world, the United States still fails to

properly care for all of its citizen’s needs. Medicare and Medicaid are two government programs

that attempt to address this problem, but they do not fully meet the need with many individuals

remaining uninsured, underinsured and unable to make copays, or receiving a grossly inadequate

quality of care. The implementation of a universal healthcare system is one way to solve this

problem.

Insurance Coverage and Quality of Care

Uninsured and Underinsured

World odometer estimates the current US population at approximately 329 million

people, of those 40 million Americans have no health insurance, and more still are underinsured.

Medicare covers about 15 percent of the population, approximately 44 million people and

Medicaid covers approximate 72 million people (FeeltheBern). Of those without insurance, 55%

are minorities; two third of those receiving Medicaid are senior citizens and non-elderly persons

with disabilities (Yearby, 2018).

Those individuals not covered by health insurance or without enough insurance to meet

their needs are shown to receive drastically different care, and worse health outcomes than those

with adequate health insurance. Uninsured and underinsured individuals often do not receive

primary care or other preventative services, wait longer to seek care for an illness and become

sicker than those who sought attention at the first signs of illness. They are also more likely to

rely on home remedies, skip dental and vision exams, and fail to fill prescriptions because of

inability to pay. According to Yearby (2018) uninsured adults are 25 percent more likely to die
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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
from an illness or trauma than those with medical insurance. Possible explanations for these

differences include poor health literacy, treatment delays, fewer diagnostic tests and treatments,

worse baseline health status, and increased co-morbidity (Yearby, 2018).

Disparities Along Racial and Ethnic Lines

Many studies have documented disparities in various aspects of healthcare for racial and

ethnic minorities. Minorities have less insurance, greater rates of poor health, receive little

preventative care, poor quality healthcare facilities, and receive fewer tests or treatments from

providers when ill or injured. According to James et al. (2017) only 73.2% of non-Hispanic

blacks and 61.1% of Hispanics had health insurance compared to 83.9% of non-Hispanic whites.

Cost of care prevented 24.5% of non-Hispanic blacks, 23.1% of Hispanics and 19.1% of AI/Ans

from seeking needed medical care compared to 15.0% of non-Hispanic whites. Minorities are

less likely to have a primary care physician with 76.7% non-Hispanic blacks, 61.5% Hispanics,

63.7% AI/Ans and 64.8% NHOPIs respectively, versus 78.6% for non-Hispanic whites (James et

al., 2017). There is less use of preventative cancer screenings with 77.2% of non-Hispanic black

women and 60.1% of Hispanic women receiving mammograms versus 73.4% of non-Hispanic

white women. Only 53.6% of non-Hispanic black men, 43.4% of Hispanics and 53.4% of

AI/AN men received colorectal cancer screenings versus 61.7% of non-Hispanic whites (James

et al., 2017).

Genetic predispositions combined with poor preventative care also lead to specific

populations suffering an unusually high incidence of a certain diseases. For example, African

Americans suffer from increased rates of hypertension, stroke, diabetes and obesity, while

Hispanic Americans suffer from increased rates metabolic syndrome and diabetes (McHenry,

2012). Co-morbidity can also be a problem with individuals suffering from multiple chronic
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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
conditions; 40.3% of non-Hispanic blacks, 40.3% of AI/ANs had multiple chronic conditions

compared to 36.0% of non-Hispanic whites, although only 27.4% of Asians and 20.7% NHOPIs

reported the same way (James et al., 2017). Lack of preventative care leads many diseases to go

undetected and surpass significant treatment stages. African American and Hispanic women are

more likely to be diagnosed at a later stage of breast cancer; males are 1.4 and females 1.2 times

more likely to die from cancer than their white counterparts (McHenry, 2012).

Underinvestment in hospitals in racially segregated neighborhoods has caused a great

number of hospitals to close, leaving the remaining hospitals to care for their patients (Yearby,

2018). The remaining hospitals attempt to meet the needs of the larger client base with the same

resources as before leading to overcrowding and deterioration of both facilities and overall

quality of care. As the hospitals leave, they often take their providers with them, leaving

communities lacking an adequate number of primary care physicians. The lack of primary care

physicians causes a decrease in preventative treatment options, and a greater reliance on

overcrowded and understaffed emergency rooms for regular care (Yearby, 2018).

High Costs for Poor Care

Healthcare in America costs more than anywhere else in the world, spending almost

twice as much per person. The average total cost of care for family of four with health insurance

purchased through an employer is $28,166 annually with $13,430 paid by the employer and

$6,050 paid by the family. Health care debt is the number one cause of bankruptcy in the United

States (FeeltheBern).

Greed of the pharmaceutical and insurance companies coupled with an inability of the

average person to negotiate pricing or shop around for services has led to sky high pricing.

Prescription drugs can cost approximately ten times more in the US as when compared to
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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
neighboring Canada. Prices continue to rise with some drug prices increasing 100 to 1000 times

over only a few years (FeeltheBern). Drug switches from brand name to generic

disproportionately adversely affects minority groups. These practices are legal and designed to

decrease costs to the insurance company and increase profit for the pharmacy (McHenry, 2012).

High costs for prescriptions, testing, and treatment not only affect individual consumers but are

also placing a great deal of financial strain onto government health care programs like Medicaid,

Medicare, the Department of Defense, and the Department of Veterans Affairs. Government

intervention on generic drug prices alone could save taxpayers an estimated $1 billion over 10

years (FeeltheBern).

The unequal sharing of resources leads to serious health disparities that cost tax payers an

estimated 74 billion dollars a year. As minority and low-income individuals fail to receive

primary care and preventative treatments, diseases are not discovered until the opportunity for

less invasive and less expensive treatments has passed. This results in more complications and

reliance on costly drastic treatment options that could have been avoided, costing taxpayers more

money than the preventative care would have cost (McHenry, 2012).

Necessary Reform

Universal basic healthcare would eliminate insurance gaps and decrease healthcare

disparities. Selective programs often carry a stigma and attitudes reminiscent of the English

Poor Laws defining who is worthy or unworthy of receiving aid, and raise criticisms from the

conservative social justice interpretation. Universal programs do not carry the same stigma as

selective programs, often universal programs are viewed as an entitlement that has been earned

or pre-purchased by years of paying taxes. Selective programs are often faced with low budgets

problems and sparse legislative support, while universal programs generally receive strong
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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
support from both sides of the aisle and are less likely to have major budget cuts (Dolgoff &

Feldstein, 2013). Universal programs have significantly lower administrative costs because they

do not require the same extensive income reviews as selective programs. Selective programs

also induce a notch effect: “as people’s incomes rise, they become ineligible for some kinds of

selective programs so that their net positions may be worse than before. This is one of the

disincentives to work that has been built into the current welfare system” (Dolgoff & Feldstein,

2013).

Expanding Existing Programs

Medicaid and Medicare are examples of existing social programs in the United States to

help provide quality healthcare coverage to at risk groups. Many have suggested that expanding

these existing programs is the best approach to implementing universal healthcare in the United

States. Past expansions of the Medicaid program provide evidence of the effectiveness of this

strategy in decreasing healthcare gaps and reducing disparities. In the early 2000s New York,

Maine and Arizona implemented large Medicaid expansions. Compared to states that did not

expand Medicaid programs at that time these three states showed dramatic decreases in mortality

rates, with the largest improvements in vulnerable groups such as racial and ethnic minorities

and residents of the poorest counties (Sommers, McMurtry, Blendon, Benson & Sayde, 2017).

The Affordable Care Act (ACA) implemented in 2010 granted federal money to expand

Medicaid coverage among other things, states have the option to accept this money or not, 33

states chose to do so (Dolgoff & Feldstein, 2013, FeeltheBern). Comparing states that chose to

use federal dollars to expand Medicaid versus those that did not expand Medicaid has shown

significant gains in health insurance coverage for lower-income and minority groups with

reduction in the uninsured rate of African Americans and Latinos twice that found for whites
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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
(Sommers et al., 2017). There were also gains in access to quality primary care physicians and

the affordability of treatment services. States that choose to expand Medicaid reported higher

overall quality of care; in the highest income group 12.6% of individuals in non-expansion states

rated their care as fair/ poor versus 8.0% in expansion states (Sommers et al., 2017).

Costa Rica’s Healthcare System as a Model

Costa Rica developed a universal healthcare system in three phases over 60 years. Their

healthcare system is revered by both Costa Ricans and scholars abroad as a model for successful

implementation. Dissolving their military allowed them to reallocate those funds towards

improving healthcare and education programs. The first phase between 1940 – 1960 provided

protections for the working class and raised the insured rate from 3.0% to 15.1% (Vargas &

Muiser, 2013). The second phase between 1961 – 1980 shifted the system from selective to

universal covering all Costa Rica citizens regardless of age or income. This phase also included

legislation requiring hospitals to treat all patients equally. The second phase saw significant

improvement in health measures, including a change in the leading cause of death from

infectious disease or parasite to cardiovascular disease. During this phase the number of medical

doctors tripled. The third phase between 1981 – 2000 emphasized expanding primary health

services and patient education for all residents (Vargas & Muiser, 2013).

Costa Rica uses a three-part system for insurance coverage; the first regime is illness and

maternity insurance, the second regime disability, old age, and death insurance, and the third

regime is non-contributors or those unable to pay because of poverty or disability. The first two

regimes are financed by a combination of employer, employee and State; employer employee

contributions are based on percentage of wages, covering 90% of program costs (Saenz,

Bermudez & Acosta, 2010). The third regime is financed by taxes on liquor, beer, cigarettes,
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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
and the lottery, with State contributions from the Fund for Social Development and Family

Welfare. They also use a three-part system for healthcare facilities; the first level includes

primary care clinics and mobile care teams, the second major clinics and regional hospitals, and

the third national specialty hospitals (Saenz et al., 2010, Clark, 2011).

Major successes of the program are in improved health outcomes and accessibility for all

citizens, regardless of geographic location or ability to pay. Major criticisms are of the

accessibility of national specialty hospitals which cannot keep up with patient need and

experience long waits for specialty diagnostic or major surgery care types. To deal with this

problem Costa Rica has invested more money into strengthening existing specialty hospitals and

building new ones (Clark, 2011). The wealthy have the ability to purchase private health

insurance which allows them to receive specialty care more quickly, but they are still required to

pay into the national healthcare program. However, private health insurance is too expensive for

most citizens and is mainly utilized by travelers (Clark, 2011).

Conclusion

The existing United States healthcare system is not meeting the needs of all citizens, causing a

large number of people to live without adequate health insurance, receive poor quality of care,

and fail to live happy health lives. Universal healthcare would allow all citizens to receive the

care they need without worrying about how to pay and help to repair the disparities for many

minority communities. Using a system of gradual implementation through expansion of existing

programs similar to Costa Rica’s would make universal healthcare in the United States possible.

Afterall, should the goal of every great nation not be to properly care for all of it’s citizens?
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HEALTHCARE DISPARITIES AND THE NEED FOR UNIVERSAL HEALTHCARE
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Dolgoff, R., and Feldstein, D., Understanding Social Welfare: A Search for Social Justice. 9th

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