Are Poor Americans Being Denied Access to Critical Care?

As some of you probably know, I am a Canadian citizen and have lived most of my life in Canada. I moved to the United States about a year and half ago. I now live in St. Louis and am privileged to be working at the Federal Reserve Bank of St. Louis. The Fed, incidentally, offers what I think is an excellent health benefits package. And so far, I have been mightily impressed with the health care services provided at Barnes Jewish Hospital. I am fortunate.

When I first moved here, I did not know too much about how health coverage worked in the U.S. Heck, I am still not entirely sure what to believe. I have some vague recollection of hearing stories about poor Americans being denied access to critical care, just because they could not afford it. I wonder whether this can possibly be true.

Here is an excerpt from Paul Krugman’s piece “A Tale of Two Moralities:”

There’s no middle ground between these [conservative and liberal] views. One side saw health reform, with its subsidized extension of coverage to the uninsured, as fulfilling a moral imperative: wealthy nations, it believed, have an obligation to provide all their citizens with essential care. The other side saw the same reform as a moral outrage, an assault on the right of Americans to spend their money as they choose.

Wealthy nations, liberals believe, have an obligation to provide all their citizens with essential care. The implication, of course, is that the United States does not do so; at least, not prior to Obamacare. But is what Paul Krugman asserts true? (He is also asserting that conservatives, as a matter of their moral philosophy, do not believe that all citizens should be provided with essential care–an outright lie, of course–but a different matter that I do not wish to pursue here).

And here is Kevin Horrigan, a columnist in St. Louis with his article today: “A Commodity or a Right?

Health care, regardless of its considerable effect on the economy and the national debt, is not just another consumer item. Like food and water, health care is a fundamental right. We don’t let people starve or freeze to death in this country (usually), so why do we routinely let them suffer and die for lack of access to health care?

Again, I ask whether this last claim is factually correct? Do people in America routinely suffer and die for lack of access to health care?

Personally, I cannot say for sure one way or the other. My inclination is to doubt these claims (which is not to deny the existence of many other problems associated with healthcare). But the evidence supporting my view is mainly anecdotal.

When I first got to the bank, I became friends with one of the janitorial staff at the gym. We got to talking and I learned that she had at one time needed a lung operation. Evidently, she was poor and uninsured at the time. She is now healthly as a horse. I’ll let you fill in the blanks.

Shortly after that, I attended a lecture by Steve Lipstein, CEO and president of Barnes Jewish Hospital (and Chairman of the Board of the St. Louis Fed). The talk, as far as I can remember, was largely devoted to espousing the virtues of the Obamacare legislation. In his talk, he made a remark that made my jaw drop to the table. He told the audience that Barnes-Jewish does not turn anyone way; they do not ask whether people have insurance…they do not even ask if they are American citizens. I would like to believe that this is true at all U.S. hospitals, but perhaps it is not.

So it seems to me, though I stand corrected if wrong, that the U.S. already has universal health care coverage. Of course, when the uninsured go for treatment, someone has to pay for it. That someone, it appears, is the rest of us who regularly make insurance premiums (this is another point made by Lipstein in his talk). In other words, the U.S. already has a system whereby the “rich” subsidize the insurance and health costs of the “poor.”

Of course, recognizing this (if it is even true) is not the same thing as claiming that the current system is any good or in no need of reform. I found this article by Randall Hoven quite interesting: “A Conservative Case for Universal Health Coverage.”

The impression I am forming is that the healthcare debate has more to do with insurance than it does with healthcare availability. It appears to be a quirk of the American system that health insurance is tied to your employer. So, if you lose your job, and suddenly become sick (afflicted by a pre-existing condition), you may suddenly find yourself uninsurable. You will still have access to healthcare, of course–that is not the issue (even if liberals like Krugman and Horrigan would like us to believe this to be the case). But if you have any assets, you will have to use these assets to pay for your healthcare. This can be a terrible hardship and, evidently, is a major cause of personal bankruptcies in the U.S. Of course, if you are poor, you have no assets and so this does not apply.

So I am wondering: Have I got this just about right? If I have missed the boat on this one, please set me straight.

About David Andolfatto 91 Articles

Affiliation: Simon Fraser University and St. Louis Fed

David Andolfatto is a Vice President in the Research Division of the Federal Reserve Bank of St. Louis. He is also a professor of economics at Simon Fraser University.

Professor Andolfatto earned his Ph.D. in economics from the University of Western Ontario in 1994, M.A. and B.B.A. from Simon Fraser University. He was associate professor at the University of Waterloo before moving to Simon Fraser University in 2000.

His current research is focused on reconciling theories of money and banking. His past research has examined questions relating to the business cycle, contract design, bank-runs, unemployment insurance, monetary policy regimes, endogenous debt constraints, and technology diffusion.

Visit: MacroMania, David Andolfatto's Page

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