Your Wealth is Your Health

Monday, January 27th 2020. | Care

By KIM BELLARD

We’ve been spending a
lot of time these past few years debating healthcare reform. First the
Affordable Care Act was debated, passed, implemented, and almost continuously
litigated since. Lately the concept of Medicare For All, or variations on
it, has been the hot policy debate. Other smaller but still important
issues like high prescription drug prices or surprise billing have also
received significant attention.

As worthy as these all
are, a new study suggests that focusing on them may be missing the
point. If we’re not addressing wealth disparities, we’re unlikely to
address health disparities.

It has been well
documented that there are considerable health disparities in the U.S.,
attributable to socioeconomic status, race/ethnicity, gender, even geography, among other
factors. Few would deny that they exist. Many policy experts and
politicians seem to believe that if we could simply increase health insurance
coverage, we could go a long way to addressing these disparities, since coverage
should reduce financial burdens that may be serving as barriers to care that
may be contributing to them.

Universal coverage may
well be a good goal for many reasons, but we should temper our expectations
about what it might achieve in terms of leveling the health playing field.

The new study, by Paola Zaninotto, PhD, et. alia, in The Journals of
Gerontology
“examined socioeconomic inequalities in
disability-free life expectancy.” It compared cohorts from England
and the U.S., looking not just at life expectancy but also how healthy those
lives were, as measured by presence of disability — the
“disability-free” life expectancy. Long study short:

people in the poorest group could expect to live
seven to nine fewer years without disability than those in the richest group at
the age of 50.

The study looked at men versus women, at different ages, by disability level and wealth status. Most importantly, it compared results for those in England versus the U.S. The authors found that: “we showed that within each country, there was a consistent advantage for people in high socioeconomic groups, particularly for wealth and education, so that they could expect to live a higher number of years without disability.”

Source: Zaninotto, et. alia, The Journals of Gerontology

Dr. Zaninotto told Yahoo:

We
were not surprised. In fact, the reason for looking at wealth and not
income is that we know how important a socioeconomic indicator it is. This
measure of wealth is based on housing, savings, investments — something that
takes a long time to accumulate. It’s a measure of past and present
circumstances.

Still, when it came to
the similarities between the two countries, Dr. Zaninotto admitted: “It
was surprising to find that the inequalities are exactly the
same.”

It
was surprising because, unlike the U.S., England does have universal
coverage. The National Health Service provides access to care to
everyone, without financial burdens. There may (or may not) be access
issues with the NHS, but they are not, for the most part,
financially-driven. And yet the differences of the impact of wealth on
health between the two countries are similar.

One
could speculate that the wealthy in England are somehow buying their way into
better care — perhaps jetting off to Switzerland or even the U.S. — but that
is unlikely to account for those seven to nine extra years of disability-free
life they are getting.

It’s
about the money.

There
has been much furor about the obesity crisis in the U.S., with the childhood obesity crisis presenting a ticking time bomb for future
health care problems. Same for diabetes. But what we’re not paying enough
attention to is that a wealth crisis is looming for younger people as well,
which the new findings suggest will result in major health
implications.

Economist
Gary Kimbrough has been studying the upcoming wealth gap, with some alarming
results:

Millennials
are way poorer than previous generations at their age, burdened by student debt
and stagnant wages.
Christopher Ingraham, writing in the Washington Post, warns:

It’s
a hole they’ll never truly be able to dig out of, given the way that money
draws other money to itself via the gravitational pull of compound interest:
The less money you start out with, the less you’ll make during the rest of your
life.

Some argue that
it will all be OK, they’ll eventually inherit significant wealth from their
parents –“the Great Wealth Transfer” — but that assumes that those parents
won’t end up spending that inheritance on their own health care and other
financial needs.

Equally as worrisome, it
ignores the adverse health impacts that the reduced wealth is already having on
their health. Lack of wealth is not the only hole that you may never be
able to dig out of; poor health is at least as hard.

Dr.
Zaninotto thinks the results should be a call to action, telling Yahoo:

We
really think this inequality should be addressed much earlier in life.
When people are older, you can’t give them an education — it really should
start much earlier in life. It’s looking at improving opportunities across
community and education much earlier and trying to help younger people to buy a
house. It seems it is quite important.

The
U.S. could, and should, move to universal coverage. It is the right thing
to do. We could, and should, find ways to lower costs, both for coverage
and for care. It is the right thing to do. But we shouldn’t expect
that those actions would level the unequal playing field that wealth
creates.

We
need to address affordable housing. We need to reduce student debt
burdens. We need to ensure people are paid living wages. We need to
provide parents with affordable child care options, such as day care,
preschool, after-school programs.

Arguably,
these are more important than universal coverage, or at least their long-term
impacts on health will be greater.

We can’t, and shouldn’t, try to equalize wealth. That’s not what America is about, and not what most Americans want. But there are some aspects of life where wealth should make less of a difference. It shouldn’t dictate opportunity, and, as these findings suggest it does, it shouldn’t determine health.

Kim Bellard is editor of Tincture and thoughtfully challenges the status quo, with a constant focus on what would be best for people’s health.

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