Here's to your health

There are a lot of opinions about how to improve health care in America, and I won't go into my own partisan views, but one thing is worth mentioning. All the discussion about national health care ignores a very basic fact about being healthy in the US: improving access to health care doesn't actually improve health. It helps with secondary and tertiary prevention (finding disease and preventing complications from those diseases), but it doesn't do anything to prevent those diseases from developing.

Nobody wants to deal with the roots of health disparities, but the ugly truth is that poor people are less healthy than the wealthy. The poor don't eat fresh vegetables or whole grains, don't work their dream jobs, don't live in gated communities, don't run for fun, don't shop at Whole Foods, don't know about trans fats. The poor simply do not have the means to be as healthy as the rich. The poor have less control over their financial future, their living situation, even their own personal safety. All morality aside, the poorer you are, the worse your health.

Having universal health care won't fix that. Improved access and more doctors won't fix that. Changing the Medicare and Medicaid pay structures won't fix that. If being poor is the primary constituent to the dramatic health disparities in the US, then the only fix is to change what it means to be poor and rich. Now, if that sounds alarmingly Communist, that's because it is.

I would argue that Capitalism creates health disparities by creating social inequality, and as such, is intimately tied to how we define ourselves as a nation. Thus, it becomes a fundamental question of identity to ask if we are willing to accept this. Because the alternative is to be socialist.


Evan said...

Why is 'disparity' an inherently bad thing? The default is not everyone living happy, healthy lives, with the people who are wealthy driving the poor in to bad health. Rather, those who have the means are able to take steps to care for themselves better than they otherwise could. If a new medication is developed that is very expensive, is this a 'bad' thing, because it further increases the health gap between those who can afford it and those who can't?


éloignée said...

Your blog offers truly amazing insight into what it means to be a doctor - and what it means to be lonely.
I'm surprised (and pleased) at how long you have kept blogging; it's true that it's not easy devoting to something, anything, for years. And I hope that you continue to blog for years to come, but no guilt, of course, should you choose to stop.
Thanks for being selfless, selfish, and a blogger,


premedgirl90 said...

Just found your blog. Hurrah for introspection and tragedy and picking up other people's slack. I have to confess I have a crush on you already.

Ben said...

It's interesting reading this a few years later. It's doubly interesting because I'm an informaticist working with use of EHR tech to reduce disparities, and triply interesting to get a physician's perspective as I consider going to medical school.

Thanks for the food for thought.