POLICY: On Social Class and Health Care by the Industry Veteran

A WEEK AGO, the NY Times ran
a front-page article presenting three case histories of people who sustained
MRI’s.  The article by Janny Scott, “Life at the top in America isn’t just
better, it’s longer
,” is part of an ongoing series examining the effects of
social class in the US.  I highly recommend it to all THCB readers as the
real heart and soul of what health care analysis is all about, or at least
should be.It will come as no surprise that Scott finds social class
determines every aspect of each patient’s episode, “from the circumstances of
their heart attacks to the emergency care each received…It shaped their
understanding of their illness, the support they got…[and] their relationships
with their doctors.  It helped define their ability to change their lives
and shaped their odds of getting better.”  In the best traditions of
feature journalism, Scott supplies copious detail to illustrate that the
enormous treatment differences meted out to patients and the commensurate
outcome disparities varied according to social class.Just within the
realm of health care services, the same disparities apply to stroke, cancer,
diabetes, chronic viral infections (HIV, hepatitis C) and a raft of other
episodes and conditions.  Of course, we could examine most of the other
issue areas at the core of contemporary life — education, retirement, child
care, leisure, on and on — and find in these that social class is also at the
root of discrepant life chances and life styles.The Times’s
article also underscores a point that you and I have both made on TCHB several
times, namely that the holy-of-holies under Reagan-Bush-Bush, the omnisciently
unregulated market, is a piss poor way of delivering goods and services that
have such enormous impact upon the length and quality of lives.  Markets
stratify the public into segments, they often require long periods to
self-correct, and they tend to evolve in ways that subvert the very
preconditions for a market.  Some of those market system shortcomings,
within moderate limits, may be acceptable for consumer packaged goods, luxuries
and certain other sectors.  Health care is too important, however, to leave
in the hands of the oligopolists and plutocrats who run markets.

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