Sarah Boehm, The University of California – Santa Barbara
Abstract
This article addresses how the corrupt healthcare system of the United States directly represents the deprioritized problems that stem from socioeconomic factors. Marginalized populations are repeatedly overlooked, widening existing gaps and deepening long-standing disparities due to US systemic choices. The policies in place do not create an equitable quality of life for all citizens, showing, for example, how where you live can determine the extent of your life span, representing location as a factor of unfairness. When compared to other high-income countries, the US has a poor international representation, ranking lowest among most public health and satisfaction statistics. Considering the social barriers that impact community access to healthcare, along with the implicit biases that cause further complications within the healthcare system, the once confined to only marginalized communities is shown to affect the country as a whole, undermining long-term economic and public health stability.
- Introduction
The common assumption that residing in different environments and countries results in unequal levels of health quality often shocks people by revealing that healthcare disparities differ even within closer proximities. In Kansas City, Missouri, two towns, Armour Hills and Blue Hills, differ in lifespan, where those who live in Armour Hills are estimated to live 14 years longer than Blue Hills residents. This contrast raises a central question for this paper: to what extent does a person’s environment shape their health outcomes and overall life expectancy? And if this pattern amongst communities is universal, how does the United States’ approach to healthcare compare to other countries that provide universal healthcare for all citizens?
Due to the social biases and inequalities within the United States healthcare system, socioeconomic disparities continue to affect those in under-resourced communities. Across the United States, healthcare quality and accessibility ranges depending on where you live. In underserved communities, there is a struggle to access overall healthcare and further problems with the quality variance amongst healthcare providers within different communities, resulting in more privileged populations getting better care. This healthcare gap is a result of deprioritizing the impacts on affected communities, because it doesn’t impact the lifestyles of those in higher social classes or leadership positions in society. Many lower-income families struggle due to a lack of resources, including the barriers of inequitable access to care, financial burdens, implicit biases from primary care providers, and systemic neglect. The United States struggle to maintain high-quality healthcare equitably across all communities makes it an outlier compared to other high-income countries. This is due to a gap between socioeconomic status and equitable access to healthcare. Although socioeconomic status is a common distinction for healthcare inequality, it is not the only factor in the disparities in the United States. Unlike many other high-income countries, the United States does not offer universal healthcare, which ultimately impacts those most from underserved communities. The treatment of healthcare being a “privilege” within the US, depicts the priority amongst policymakers to reform the negative implications coming from this system, which are affecting the overall health of the public. The evaluation of the US internal structure having a majority of the population struggling to receive healthcare only does a disservice to the community. On a global scale, this will continue to contribute to the financial impact, decreasing the average lifespan and weakening the United States’ international reputation. Established research demonstrates the well-known fact that healthcare within the United States is not sufficient long-term due to poor health outcomes, but it also will continue to impact the financial stability of the country. Although not much is done to impact these effects or reform the policies in place. The deprioritized problem of the United States health care system needs immediate reform, due to the continuously imposed barriers and struggles on the underprivileged communities. By looking at several sources discussing the barriers of implicit bias, economic and financial burdens caused by universal healthcare, and the lack of concern for these underserved communities, the comparison to other high-income countries allows for strong evidence of what the US could benefit from by partaking in similar systemic choices.
- Literature Review
The recognition that the United States healthcare system faces deep structural problems is not new. Scholars typically focus on the range from the implicit biases implemented by primary healthcare workers to the avoidable cost of healthcare expenditures annually, which will lead to overall economic weakness. The US spends a lot of money annually on healthcare, yet continues to have poor health outcomes. Among all the previous research, scholars broadly agree on the boundaries that underserved communities face in terms of accessibility to healthcare and how this negatively impacts our community and weakens the economic status of the country. Many researchers have argued that the impacts on healthcare inequalities are founded not only on geographical boundaries but also on the biases of healthcare providers.
Researchers depict that as of 2023, the United States of America spent 4.5 trillion dollars on healthcare expenditures overall, yet continues to rank lowest in life expectancies compared to other high-income countries. Despite environmental health problems, healthcare providers unconsciously have biases about patients based on race, gender, social class, weight, etc. These implicit biases imprinted in society cause those in structurally disadvantaged communities who are limited because of these categories to continue to have barriers to accessibility to a higher quality of life. This leads to a wider gap in disparities in the overall public health of the country. These disparities are continuing to not only impact the overall health and life expectancy, but also the strength of the economy. Similarly, other scholars focus on how the US health care system can not afford the continued growth in health inequalities in society. The current high cost of healthcare is due to the system spending money treating preventable illnesses that are caused by the results of the non-universal healthcare approach. The lack of focus on the insurance problems, lack of accessibility to healthcare, and geographical boundaries that stop underserved communities from accessing quality healthcare continue to cost the economy unnecessary amounts of money because of the lack of improvements within these impacted populations.
Equally correlated, some researchers analyze the structural barriers caused by marginalizing groups, showing how the specific healthcare system implemented in the US is holding many people back from access to high-quality healthcare and financial stability. These marginalized groups are not being taken into consideration when improvements to healthcare are being assessed, as evidence suggests. This is not only a country wide problem, but globally shows the United States’ weakness as a country. Although the United States spends more money on healthcare than any other nation, it continues to rank lower in life expectancy and basic health outcomes compared to higher-income countries. Among 10 other high-income countries, the US ranks last overall in accessibility to healthcare and equality. This low ranking depicts that the disparities are not unavoidable and can be fixed, as shown through examples of ways other countries have implemented alternate healthcare systems. The United States does not treat healthcare as a human right like many other countries, but treats it as a privilege that only some may have access to if in the right tax bracket or environment. Another research perspective showcases proof of the positive benefits of countries that implement universal primary care systems and overall achieve healthier outcomes in society. Although there has been a variety of research on the negative impacts of the United States’ chosen Healthcare system, this paper fills the gaps between these ideas by implementing a connection between the geographical and biased interaction that highlights the continuous cycle of where you live determines your quality of life.
- Approach/Methods
This study implements different perspectives to analyze how health inequalities emerge in the United States and how this affects the overall public health and economic stability. The focus on implicit biases from healthcare providers, geographical-dependent disparities, economic consequences of inequality, cross-national comparison between the US and other high-income countries, and the overall urgency to fix the US healthcare system is shown.
These sources were specifically selected to give contextual findings on prior research to bring light to the problem, gathering multiple scholarly perspectives to form a substantive argument. These measures help represent different additions to the overall arching problem of a corrupt healthcare system in the United States. All together, these publications provide empirical support to the geographical barriers in underserved areas, the global differences in healthcare, and how other countries benefit from universal healthcare systems provided to every citizen. Studies examining the gap between socioeconomic differences show evidence of the continuous cycle of those who are less privileged continuing to have healthcare troubles and be held back due to financial limitations.
This analysis relies on the statistical data found in peer-reviewed reports that examine the distributional imbalances in healthcare, shown through implicit bias, the economic consequences that follow the wide range in healthcare disparities amongst society, and the international comparison amongst healthcare systems. The analytical lens will focus thematically to represent the common patterns of impacts of biases in society, economic effects, and global comparison. To represent other ways to approach this problem, a comparative lens will be used between the US and other universal healthcare countries. To specifically respond to the research question, the case study based on the two cities within Kansas City will be elaborated to depict how impactful an environment can be on the quality of life of a person.
The observations within this paper are organized through the main topics of inequality to healthcare access dependent on socioeconomic status, economic consequences based on the continuous healthcare inequality, and the global comparison to other countries with universal healthcare. Within these sources, there are various life expectancy reports. This represents an inconsistent variability within the life expectancy data, which can strengthen or weaken the evidence when comparing. This study also cannot measure the cause of these effects, only the overall pattern that is seen societally or economically. Despite these limitations, the strength of these sources supports the overall validity of the findings.
- Analysis/Evidence
Residency determines and shapes their access to healthcare, quality of life, and how long they live. Impacts in marginalized communities through implicit bias continue the debate over economic waste on annual healthcare expenditures, and a lack of equitable healthcare in the United States. The US spends the most money yet is ranked the lowest in health and life expectancy. The implemented healthcare system within the United States continues to increase the inequality gap within different socioeconomic statuses. Based on economic results, the United States can not continue the widening of healthcare disparities, as the annual cost will severely weaken the economy. Across the United States, inequities, education opportunities and community public health have limited those of underserved populations. The inequalities continue to impact these underserved communities, creating costs that could be avoided but are continuing to impact the health of the community based on socioeconomic status. Empirical findings estimate that the health inequities currently cost the US $320 billion annually, a figure projected to reach $1 trillion by 2040 if no corrective action is taken. These costs are spent mainly on the hospitalization and medical attention of those from disadvantaged populations, lacking financial stability or insurance. Struggles with insurance, delayed access to care, and lack of healthcare accessibility in their direct community, lead to trips to the emergency room that cost the economy money. Within 2020, 50 percent of US adults with below-average income reported within the previous year, to skipping needed medical attention due to the cost. These unavoidable costs don’t just impact the overall health of the community, but also the strength of the United States economy, as the unnecessary costs because of health inequalities amongst communities are using taxpayer money to make up for this large gap in healthcare accessibility.
Underserved communities represent the workforce of essential jobs within the community. When implementing more financial and healthcare barriers, this only impacts the overall public health, as these populations are forced to choose between financial debt and sickness, resulting in sick workers, who are then serving the communities around them. This financial problem is not only a community problem, but globally can affect international affairs, leading to pandemics that can globally deplete worldwide health. Many equity-seeking communities find it difficult to get insurance, especially with the financial struggle as an additional barrier. Without insurance, this results in trips to the emergency room, delayed access to care, and premature deaths in society. The average emergency department visit by an uninsured patient costs 10 times more than a regular office visit, showing the direct impact of not offering universal care to every citizen. The more people are sick and dying, the overall impact on the US workforce productivity and economic status. Health disparities cost around 42 billion in lost productivity per year. By prioritizing healthcare, the cost of unnecessary healthcare spending while also improving the health outcomes of those within the community. Due to the healthcare system the United States follows, many are uninsured due to the expense that comes with paying for healthcare. This causes gaps in the nation, leading to 16 percent of people in the US not being insured. This cycle of illness and poverty, as those who are uninsured and are limited financially delay or avoid access to care. Elaborating on the previous set of economic consequences of healthcare disparities, where those who lack access to healthcare utilize the emergency room as an alternative source for medical attention. The influx of patients lead to understaffed hospitals and overworked staff, further impacting public health, and overall productivity of the economy.
The impact of implicit biases on top of the geographical restraints on the healthcare system continues to increase the overall struggle of public health and will continue to economically weaken the US as a whole. The main population that is impacted by these ongoing disparities is the under-resourced communities, who lack access to healthcare, financial stability, and are limited due to subconscious bias placed on them by society. In these neglected communities, many are uninsured or are unable to access the privilege of high-quality healthcare. Healthcare services tend to be disproportionately located around wealthier communities, while rural, low-income communities lack access to high-quality care and better resources. This is partially due to the workforce recruitment that occurs from higher-income communities. Workers who are from these underserved communities or could potentially work in these communities, overall helping decrease the gap of disparities between communities, tend to choose to work in the higher-income communities. Primary healthcare providers tend to want to be located in higher-income communities, which leaves marginalized communities lacking access to clinics, healthcare, and continues the cycle of poverty amongst those involved. The continuous trend of healthcare services being disproportionately distributed around well-developed communities, leaving those with limited resources at a disadvantage. This causes society to create more boundaries based on implicit biases and stereotypes.
Primary Healthcare providers are meant to take care of every patient and strive to provide equal, higher-quality care, although these implicit biases get in the way, causing a variety of quality of care across different populations. Providers unconsciously have biases about patients based on race, gender, social class, weight, etc. These implicit biases imprinted amongst society cause those in marginalized communities that are limited because of these categories to be dismissed, misdiagnosed, or receive delayed access to care. This leads to bigger disparities in the overall public health of the country. The main communities affected by implicit biases are African Americans, women, elderly patients, LGBTQIA+, and low-income populations. These marginalized groups, specifically, underserved communities, receive lower quality of care, less empathy, and fewer resources, resulting in a continuous cycle of being trapped in the boundaries of poverty. Poor healthcare within communities represents the lack of resources implemented in these underserved populations of people who reside within. Less attention to these communities not just limits access to healthcare but also education and opportunities to move up in the economic bracket.
This creates an intergenerational cycle in which poor families remain disadvantaged in both health and income, while wealthy families retain both privilege and better health outcomes. This displays how area codes can determine the higher risk of diseases and lower life expectancy. As mentioned previously, the two neighborhoods located in Kansas City show how these inequalities impact life expectancies, dependent on different environments as close as neighboring communities. Although they live in the same city, their environments cause a difference of 14 years in life expectancy. In the neighborhood comparison of Blue Hills and Armour Hills, Blue Hills has an average that people die 14 years earlier due to the socioeconomic disparities compared to those in Armour Hills. Making healthcare more equal could increase life expectancy and enable individuals within society to thrive, not limiting them based on where they live as a factor in their quality of life. This highlights the importance of cutting down costs caused by healthcare disparities, but more importantly, the need to improve the quality of life.
The United States differs from the typical healthcare perspective that other high-earning countries take. The United States does not see healthcare as a human right for every citizen and instead sees it as a privilege that is only accessible to those of the proper economic status. Many countries guarantee healthcare as a human right through a universal healthcare system. Although the US is the outlier, it is considered a wealthy nation, yet it does not have universal healthcare. Healthcare within the United States is actually expensive, and varies in expense in different communities. Compared to other high-income countries such as the United Kingdom, Australia, New Zealand, etc, the universal healthcare benefits are only positive. These benefits include improvement in life expectancy, reduction in economic inequality, financial protection, and equal access to quality healthcare. Universal healthcare allows every individual to receive healthcare without the discrimination or biases that come with low-income lifestyles. When given a survey across multiple communities in these countries, the US was ranked the lowest in terms of public satisfaction. Much research has been conducted amongst high-income countries to display that equitable access to primary healthcare is central to the overall better health of the population. In further studies focusing on access to care, care process, administrative efficiency, equity, and healthcare outcomes, across 11 high-income countries, the US ranked last overall despite spending far more money on healthcare expenditures. The US specifically ranks the lowest in access to healthcare, administrative efficiency, equity, and healthcare outcomes. Based on research results, the four distinguishing factors that the top-performing countries have that the US doesn’t implement are universal coverage, removal of cost barriers, investment in primary care to ensure high-quality care to all communities, reduction in administrative burdens that cost time and divert efforts, and investment in social services. This displays that the avoidable costs and disparities within the US healthcare system can be resolved through the implementation of universal healthcare.
These problems don’t get as much attention as needed, since they don’t impact the wealthier population that tends to fill the role of policymakers and leadership roles who can impact these effects. This leads to systemic neglect and is represented as not a societal problem as a whole. This leaves those in underserved communities to continue to suffer. The reform of these policies and the lack of prioritization reflect that the healthcare system of the United States focuses on the profit of the people and not the quality of life among citizens.
- Counterargument
The public health of the United States could benefit from adopting similar social and financial choices implemented by other countries that guarantee universal healthcare for their citizens. If the United States could mirror social and financial choices similar to other countries, the gap in life expectancy across neighborhoods and marginalized populations could be decreased to raise the overall quality of life for the entire country. Some argue that healthcare outcomes stem primarily from individual choices rather than systemic shortcomings. Through the data representing the environmental and socioeconomic barriers, the limitations of what those in underserved communities can have the opportunity to have access to are different compared to those above the average median income. Modern scientific breakthroughs that can significantly increase the lifespan of those who are sick, such as gene editing, will still be cost-prohibited for the vulnerable population due to insurance. This continues to represent that those below the poverty line are continuing to be impacted by socioeconomic factors. Another common claim that many highlight in the US is that the policies in place emphasize freedom. Although these aspects of free choice and opportunity only support benefits that can be obtained through a higher socioeconomic status, continuing the same outcomes for the poorer population. Universally, approximately 40 percent of citizens below the average national median across 5 countries reported times in the previous year when they did not get dental work because of cost. These continuous observations represent the impact of those financial burdens when their choices have to be between overall health and impending debt. Dividing perspectives surround the healthcare system debate in the United States; the benefits drawn from comparison to other high-income countries, which implement universal healthcare, overcompensate for the counterarguments concerning reforming the current policy.
- Conclusion
This paper addresses the corruption of the United States’ healthcare system by analyzing the geographical factors that are caused by the inequitable socioeconomic gap. Through the collection of statistical evidence highlighting the continued systemic neglect, there is an obvious need to urgently reform current policies. Compared to other high-income countries, the United States continues to spend the most money, yet has the poorest outcomes in public health. Reviewing economic and social findings, the US is drastically impacted by the current systemic choices it has made to uphold healthcare as a privilege instead of a human right. To stop the continuous cycle of poverty, containing those within underserved populations in intergenerational struggles of healthcare forever, diminishing any room for advancement in the socioeconomic hierarchy in the country.
The Global Affairs Journal 
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