If you think that the American healthcare system is an equal-opportunity market, you either aren’t paying attention or you have deliberately chosen to ignore a reality faced by millions of people. The sad truth is that in the U.S., healthcare was built for inequality. COVID-19 has only made that clearer.
With study after study showing more severe impacts faced by communities with higher concentrations of ethnic minorities and low-income families, the global pandemic has illustrated a pressing issue. Our healthcare system does not serve every American equally. As a result, the medical industry perpetuates racist and classist outcomes.
The reasons for this are many. But by understanding why the system works the way it does and how COVID-19 highlighted the disparities in healthcare, you can begin to understand the immediate need for change across the system.
How the System was Built for Inequality
From the outset, the American healthcare system was never designed to serve everyone. The refusal of American politicians to provide a public healthcare option that ensures that you have affordable access to healthcare no matter who you are means that millions go uninsured every year. The number of uninsured individuals has now risen to 30 million people, with many more underinsured or with such limited access to care options that it essentially makes no difference.
And while public safety net programs such as Medicare and Medicaid can help you afford care and cover your prescriptions — if you have the right plan and understand the system — these programs are limited. For example, Medicare is designed to help those over the age of 65 on limited incomes, while Medicaid is more directed toward exceptionally low-income Americans.
The result is a system rampant with loopholes and gaps in coverage that leaves Americans with no option to afford care. More recent legislation such as the Affordable Care Act (ACA) was designed to close these gaps. The reality, however, is that gaps remain wide open with individual states being able to refuse Medicaid expansions. Instead, the nation supports a market of incredibly high insurance premiums.
Then, there is the problem of accessibility discrepancies in healthcare institutions. For example, after segregated hospitals from the Jim Crow era became integrated, the hospitals built for and managed by Black Americans often ended up being shut down, leaving too few hospitals overall. The reverberations of historical inequality are still being felt through a lack of access to care in certain communities, exacerbated by the fact that people of color statistically are insured at lower rates than White Americans.
With a system built on the bones of inequality, it probably shouldn’t come as a surprise that the COVID-19 pandemic has highlighted these healthcare disparities.
How COVID-19 Made Healthcare Disparities Clear
The majority of ethnic minorities in America live in dense urban areas. Meanwhile, these areas are also made up of individuals who live below relative poverty rates. The impact of limited resources for these traditionally underserved groups in terms of healthcare creates something of a perfect storm for disparities in health outcomes.
When COVID-19 struck, we saw these outcomes across the nation. Here are just some of the statistics revealed by the pandemic:
- Black Americans make up 50% of COVID cases in densely populated regions.
- Up to 70% of COVID fatalities in these regions are Black Americans.
- Hispanic Americans live more commonly in multigeneration households, making it difficult to shield higher-risk older family members from COVID exposure.
- Black Americans are three times less likely to be insured than White Americans.
- Social determinants for care outcomes statistically put minority groups at higher risk for COVID-19.
The fallout of the COVID-19 disaster has impacted minority groups harder largely due to a history of complicated factors that all impact care outcomes. Lack of insurance is chief among these factors. For example, 45% of Black working-age adults and 36% of Latinos live in the 15 states that have resisted the Medicaid expansion. As a result, these individuals remain uninsured at higher rates than their White, peers while statistically occupying more frontline public service jobs.
Meanwhile, even attempts at fiscal support have risked exacerbating economic inequality. With some Republican-majority states refusing federal aid, the low-income and minority workers in these states have the most to lose, while rejected funds could end up serving the already wealthy, making inequality gaps worse.
So while working-class Americans on Medicare may have coverage for COVID-19 testing and care, the millions of people across the nation who have lacked access to care or insurance maintain a higher risk. Combating these outcomes will take addressing systemic inequalities in the American healthcare system.
The Beginnings of More Equitable Solutions
The COVID-19 pandemic has ravaged the nation. It has placed many in precarious financial situations, ended lives, and emptied savings accounts. For the more statistically disadvantaged groups in America, these effects have been only more devastating. Recovering from this and planning for a comfortable retirement will require comprehensive and ethical strategizing from the individual to the federal level.
Fortunately, however, the pandemic has also offered a glimmer of hope for future change. For example, the free rollout of COVID-19 vaccines across the nation has illustrated what free and unquestionable access to healthcare can look like. If we as Americans can focus on the fast and easy convenience that comes from equitable, universal access to care, we can make greater strides in protecting everyone.
The alternative means situations like what occurred in South Dakota, where government officials completely ignored the crisis: that is, higher rates of death and disparity.