Buoying single-payer advocates' call for system that covers everyone and underscoring the nation's inequality, a new study finds that the wealthiest Americans are the ones receiving the most healthcare.
Published Thursday in health policy journal Health Affairs, the findings show a reversal of a decades-long trend of more equality in healthcare that follwed the 1965 passage of Medicare and Medicaid.
The researchers used data from 22 national surveys conducted between 1963 and 2012, and divided the population into income quintiles. The wealthiest group contained those with an income of $101,094 for a family of three, and the poorest quintile had family incomes below $22,689.
Though medical spending overall slowed between 2004 and 2012, the different income groups showed vastly different spending. The results suggest "that a redistribution of care toward wealthier Americans accompanied the health spending slowdown," the study's abstract states.
Beginning in 2004, the study found, health spending fell for the poorest quintile, but rose for the wealthiest group. In fact, from 2004-2012, expenditures for the wealthiest—a group that already tends to be healthier—rose nearly 20 percent. That's 57 percent more than the growth of the middle-income groups. The poorest, meanwhile, had a 3.7 percent drop in health spending.
The authors note that the disparity was not reflected in the elderly, a group widely covered by Medicare.
A contributing factor to the healthcare inequality, the authors say, were rising costs of co-payments and higher deductibles.
"In recent years," lead author Dr. Samuel Dickman, who conducted his research at Harvard Medical School, said in a statement, "economists have celebrated a slowdown in healthcare cost growth. But the slowdown seems to have been achieved by forcing poor and middle-class Americans to choose between paying rent, buying groceries, or going to the doctor when they're sick."
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"Our overall life expectancy is falling further and further behind nations that distribute care based on need, not wealth."
—Dr. David HimmelsteinFor senior author Dr. David Himmelstein, a professor at the City University of New York at Hunter College and lecturer at Harvard Medical School, the study offers yet more evidence of the need for a single-payer system.
"While poor and middle-class patients are skipping vital care, the wealthy are getting unnecessary and even harmful care," he said in a press statement. "And the widening inequalities in healthcare are reflected in rising inequality in death rates. Meanwhile, our overall life expectancy is falling further and further behind nations that distribute care based on need, not wealth."
"Our findings dramatize the urgent need for national health insurance—a single-payer reform with first-dollar coverage—that would assure that all Americans can get the care they need," Himmelstein continued.
Such reform has the backing of the National Nurses United.
The union is holding a press conference Friday in Orlando, Florida, where the full Democratic Platform Committee will be meeting to finalize the language it will present at the convention later this month in Philadelphia.
The drafting committee's decision last month to reject a proposal to place a commitment to "figh for Medicare-for-all" in the party's platform was a mistake, the nurses union said, and it's urging the committee to put such a promise in the platform thereby fulfilling its obligation to fight for coverage for all.
"While the Affordable Care Act has implemented some important improvements, the law has still left for too many behind," NNU Executive Director RoseAnn DeMoro writes in a commentary in the Orlando Sentinel. "Guaranteed healthcare" through an improved Medicare- for-all/single-payer system "must be a uniform, national obligation that the Democratic Party makes a priority."