Would you really be surprised to hear that wealthy people live longer than poor people? Probably not. It’s almost predictable, right?
But what if you heard that the gap in life expectancy between rich and poor people has been steadily growing since the 1970s? Yes, back then a man in the top 50% of earners could live about 1.2 years longer than a man in the bottom 50%. According to the Social Security Administration, by 2001 that richer man would outlive his poorer neighbor by nearly 6 years.
Researchers at the The Brookings Institute decided to take a closer look at life expectancies, this time comparing the very highest earners (the 90%’rs) and the very lowest earners (the 10%’rs). What they found was jaw-dropping.
The highest income men born in 1920 enjoyed six more years of life than the poorest income men born that year. But by 1950, that difference had MORE than doubled to 14 years.
The numbers are very similar for women, among whom the gap grew from 4.7 years to 13 years.
Again, it’s not especially newsworthy that rich people would live longer than poor people, but the fact that the gap is so dramatic and growing should be alarming.
Of course, like with everything, the experts jump on the same old bandwagon to explain this. Their usual “go-to” is the impact of “personal choice” on health. Rich people smoke less, eat less and abuse drugs less than poor people do, they say.
It’s brilliant to blame the poor if you don’t really care about changing the conditions that create health disparities. “If only those poor people would make better choices, this problem would go away!”
But as usual, reality is far more complex. If we are to implement public policies that promote wellness and health, we need to take a hard, honest look at ALL the factors that impact health, and not just “blame the victims.”
Let’s start at Ground Zero, where the experts begin and often end their analysis: personal choice. Obviously, if we don’t take care of ourselves, we’ll get sick. We have to make choices that lead to wellness. What is the foundation of good choice? Education is the key to making good, healthy choices.
Public policy point #1: If we invest in education, especially critical thinking, it will tend to result in better decision-making regardless of socioeconomic status.
Why “critical thinking?” Because so many of our choices are only possible because existing public policies insufficiently regulate the sale of inherently unhealthy products such as tobacco, guns and unhealthy food. The Brookings Institute researchers were hasty to point to the higher rates of smoking and obesity among the poor to explain health disparities, but the root of the issue goes far beyond personal decisions. In fact, it’s public policies supporting corporate welfare that make possible the very availability of these unhealthy products. These products are paraded past us in the media and alleged to make us more mature, safe, sexy, etc. Let’s face it. Our so-called “personal choices” are driven by advertising campaigns.
Other major factors affecting health are social determinants. It’s well documented that gender, disability status, documentation status, age and other such characteristics impact health. Disabled, older, and/or undocumented people are more likely to face health challenges. They often face problems accessing or affording care. Women have different risk factors than men because women have babies. The point is, we all start out unequal in our health challenges, yet we all deserve to get the care we need. That’s what equity is all about.
Public policy point #2: Programs that promote equity also promote wellness.
Even less recognized but just as important are the economic, geographic and environmental factors that impact health. Without a doubt, being poor is a risk factor for lots of bad stuff. Just go to cdc.gov and search under “health disparities!” Poorer communities tend to live in older housing constructed under older building codes, often with lead paint. These communities are often located near freeways with vehicle air pollution, or other unhealthy areas, like industrial zones or toxic waste dumps. They often face limited access to fresh food and health services.
These factors are part of the reason that people who live in Beverly Hills enjoy a life expectancy that is nearly 20 years longer than people who live in South Los Angeles, just a few miles away. Rural communities also lack significant resources that promote wellness.
Public policy point #3: Improving our infrastructure to guarantee everyone, no matter where they live, access to basic necessities such as clean water, healthcare facilities, sanitation, economic opportunity, and more, will promote good health.
Lastly, let’s look at the proverbial “elephant in the room.” What’s practically never talked about but has a HUGE impact on everybody’s health? This takes us way beyond the choice to smoke, or being born Black or Brown or female. It goes beyond living in substandard housing or in a fresh food desert.
It’s our healthcare system itself. Yes, healthcare systems – on their own – have huge implications for people’s health. How do we know this? Because of the facts.
It’s a fact that people who have access to universal, single payer healthcare systems – people who live in countries like France, Canada, Sweden and Australia – enjoy measurably better health and live longer than people who live in the United States.
What’s “universal, single payer?” Great question!
“Universal” refers to healthcare systems in which everybody is included and nobody is left out. By contrast, under the Affordable Care Act, there are still over 30 million men, women and children with no health insurance.
“Single Payer” refers to a method to pay for healthcare that is used in many advanced countries. Instead of having hundreds of different private health insurance companies there is one public agency – the “single payer” – that pays the bills. It works like this: Instead of our having to pay premiums, coinsurance, co-pays and deductibles, we would all contribute to a shared healthcare fund, on a sliding scale based on income, like a payroll tax deduction.
Besides being more fair (because the cost is tied to income), having a non-profit, public agency that pays the bills is tremendously cheaper. It is estimated that in the US alone, 30% of healthcare dollars (up to $1 trillion a year) are lost to administering our unnecessarily ultra-complex system of private health insurance.
It’s a fact that the cost of universal, single payer systems, both to the overall economy and to families and businesses, is dramatically lower.
It’s a fact that our own, true-blue American single payer healthcare system – Medicare – has meaningfully (but not perfectly) reduced racial disparities in health and dramatically increased the financial security of our parents and grandparents.
If we were to take the Affordable Care Act to the next level by gradually expanding Medicare to everyone, we would reduce the complexity in our system producing savings that would allow us to broaden coverage (such as adding dental and vision) while achieving universal coverage.
This would work because single payer systems eliminate administrative waste in health care, so there is more money for the public policy solutions we just outlined above: Education, infrastructure and wellness programs!
So don’t buy into the BS that the Affordable Care Act is “good enough.” It does not get at the root core of the inequality problem. Any public policies that intentionally or unintentionally promote inequality must be questioned and re-worked.
The Affordable Care Act does not address the widening gap in life expectancy caused by disparity in wealth because it does not address the high costs of healthcare for individuals, families and businesses. In our killer healthcare system, when you can’t afford to get care, you don’t get care. And when you don’t get care, you suffer.
We deserve better. Join HEAL California and together, we will win!
Learn more:
Growing Wealth Gap in Life Expectancy (NY Times)
Definition of Single Payer (HEAL-California)
How Medicare Desegregated Southern Hospitals
Medicare and Reduced Disparities in Healthcare
International Comparison of Healthcare Systems (Commonwealth Fund)
The Affordable Care Act is a misnomer. Even families covered by insurance find the costs associated with accessing health care to be prohibitive. Our family premium for the employer-provided insurance we have costs one-half of my husband’s monthly pay. With a separate deductible for each person covered, there is additional out-of-pocket expenses we have to pay before the insurance covers costs. It is well past time for our country to adopt a single-payer system.
Thanks so much for sharing about your high health insurance costs, and it’s impact on your family’s finances. We are sorry that it’s so hard. It would definitely be better to shift to single payer, which we could do by gradually expanding Medicare to cover people at younger and younger ages. This would not only strengthen Medicare financially by means of the new premium flow, it would also bring healthier people into the Medicare risk pool reducing overall costs.
As for how much single payer would cost a typical family, there are various financial models out there. Until the specifics of the legislation are worked out, it’s not possible to develop hard numbers. However, the single payer plan that is proposed by Senator Sanders says that a family of four earning $50,000 per year would pay $466 in premiums. Period. Even if it turned out to be more than that, it would still be bargain compared to private health insurance. Good health and good luck to you!