In his new book, The Death Gap, David Ansell, physician and author based in Chicago, writes about present inequality in the U.S health care system and what the Affordable Care Act did to reduce that inequality. In the political news blog ThinkProgress, Casey Quinlan interviews Ansell about his book and how the Republican health care proposal now in Congress fits into the picture.
One of the main points of Ansell’s book is that economic disparity can and does bleed into health care disparities, and our system of health care today makes it so that poor people have generally have worse health outcomes compared to richer people, even when it comes to things that one would expect to be undiscriminating, like medical tests for chest pain. This inequality has a racial component to it as well, as concentrated poverty frequently manifests in urban, black neighborhoods, which leads to these lesser health outcomes.
When the Affordable Care Act was signed into law in 2010, it increased the overall number of insured people in the United States by 20 million and reduced the gap in mortality rates between black and white people by a significant amount. Most of the increase in health care coverage came from the expansion under the ACA of Medicare, raising the minimum income level requirement so that more people were eligible. Additionally, with respect to the quality of coverage provided, insurance companies were required, for the first time, to cover mental-health care as well as preventative care without a co-pay, among other things. Coincidental with these changes is a decrease in the disparity between black and white mortality rates, according to the Centers for Disease Control and Prevention, especially for the elderly.
But Ansell argues that there are big problems in our health care system that the ACA did not address, namely the difference in quality of health care institutions that serve different parts of the populace, financially and geographically. Those with more money tend to have better insurance and live in areas that have better hospitals. Someone with insurance from an ACA online marketplace will likely not have equally good insurance, and they probably will live in an area with worse hospitals, so that in case of the need for, say, a transplant of some sort, they likely will not get one. The same goes for someone on Medicare. According to the National Center for Policy Analysis, one-third of primary-care physicians today will not take Medicare insurance.
In Ansell’s view, the current efforts by Republicans in Congress to pass what has been called “TrumpCare” are failing because they cannot take the 20 million people back off of insurance, and the ACA actually was conservative enough in its content that Republicans have little to complain about: it left private-sector insurance and pharmaceutical companies to continue to determine the quality and cost of care.
Ansell believes that a single-payer system is the best way to reduce the inequality, as it takes away profit incentives for these companies and creates the opportunity for truly widespread and equal coverage.