Imagine that you are on vacationing on the English coast and decide to head to a public beach for a relaxing day by the ocean. Let’s assume that the beach contains a broad mix of people from varying socioeconomic classes. The people are clad only in bathing suits, and so their clothes give no hint of their wealth (assuming you, like me, can’t tell the difference between $20 and $100 bikinis). Can you tell, just by looking at someone’s body, if they’re wealthy, poor or somewhere in between?
You probably won’t be able to ascertain income levels for the majority of the people at the beach, and most people would agree that this is a good thing. In modern, developed nations, almost everyone can afford the essentials necessary for a healthy life, such as adequate nutrition and basic medical care. Thus, except for the extremely destitute, there are no visible health-induced differences in physical appearance between those in the higher and lower-income brackets.
Now imagine yourself at the same English coast only 150 years ago. If the working class was out of the factories and at the beach with the upper classes, you’d be much more successful in picking who was who. Upper-class adolescent boys were, on average, four inches taller than their working class contemporaries. Unlike today, the working class did not receive the basic nutrition and medical care that the upper class enjoyed.
We should applaud our society for remedying these basic inequalities. The quality of health care has improved radically in the past few decades and this trend is likely to continue. Yet with increase in quality comes a sizable increase in cost. In 1970, 7 percent of the U.S. GDP was spent on health care; by 1997, that number had doubled to 14 percent of the GDP. The issue is further complicated by the fact that the public sector pays for approximately 40 percent of health care costs in our country.
Why are the costs of health care increasing so rapidly? Technological progress, which is largely responsible for the dramatic increase in quality of health care, breeds more expensive treatments. Moreover, our current health care system supplies no incentive to consider the costs of medical treatment. Patients demand any potentially beneficial diagnostic, therapeutic, or surgical procedures regardless of cost; health insurance or Medicare/Medicaid pays for most of the treatment with little additional cost to the patient.
An old advertising slogan says, “When you’ve got your health, you’ve got everything.” We accept the high costs of health care because we subscribe to the philosophy that everyone deserves the best care regardless of socioeconomic status. While our health care system isn’t perfectly egalitarian, it’s pretty close. In 2001, employers were willing to foot the bill that provided high-quality treatment to workers, and workers were willing to pay 6 percent of their income towards government-provided health care.
By 2040, the U.S. proportion of the elderly will have increased drastically relative to people of working age. Will employers provide that same health insurance when costs rise by a projected 150 percent? Will the workers be willing to part with a projected 14 percent of their payroll (in addition to a projected 16 percent for Social Security) to ensure relative equality of health care in America?
Therein lies one of the most important moral dilemmas facing us in the upcoming decades. Will our country be willing to spend an ever-ballooning proportion of its income to retain the egalitarian nature of our health care system? If not, we have no choice but to accept a system by which quality of care is inextricably tied to socioeconomic status. The relatively well-off will be able to afford the all-inclusive plans which provide premium health care. Those with lower incomes will be forced to accept plans which place cost-limits on health care. If the costs of medical treatment continue to skyrocket and genetic therapy becomes a reality, this could produce significant gaps in care between the rich and the poor.
In 1965, the country faced a similar dilemma on a smaller scale and made a choice that set it on course towards an egalitarian health care system. President Lyndon B. Johnson signed into law the bill that created the Medicare system. Without Medicare, only the elderly rich would be able to afford the hip surgeries and coronary bypasses; the ordinary citizen would be out of luck.
In 2001, the country took a screeching turn away from equality in health care and set itself on a frightening path by enacting the Bush tax cut plan. The tax cut eats up $1.2 trillion over the next 10 years, which could have been used for government savings for the drastic upcoming increases in the cost of Medicare/Medicaid and Social Security. Under the tax cut, after-tax income of the rich will rise much more as a percentage of their current income, than that of the middle class or the poor; approximately 40 percent of this tax cut will go to the wealthiest 1 percent of the nation. This tax cut does little to help working class families increase private savings and solve the health care dilemma; it’s a tax cut that unquestionably brings the greatest benefits to the wealthy.
A year and a half later, projected surpluses for the 2000s have turned to deficits and little money is being saved for Medicare/Medicaid and Social Security. We can still choose a different path, but time is running out. I don’t want to head to a Florida beach in 40 years and know that almost everybody over age 90 (probably a pleasant age due to new medical advances) is affluent; it would be truly depressing if the poor couldn’t afford the health care that would allow them to reach and enjoy that age.