On this national day of celebration, I always reflect on Dr. Martin Luther King, Jr.’s most famous comments on health care in America.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Why would he say such a thing? Injustice in health care has taken many forms and resulted in predictably poor outcomes for those affected; we tend to call these disparities in healthcare. Today, I address the inequity in insurance coverage that formed the premise for the Affordable Care Act (aka Obamacare).
According to the Kaiser Family Foundation, in 2009-2010, when the Affordable Care Act (ACA; aka Obamacare) was signed into law, 41% of low-income adults were uninsured, and 45% of poor adults were uninsured. Contrast this with the fact that only 6% of those who make four or more times the poverty rate were uninsured. This pretty clearly makes the case that health care is a desirable asset for Americans who can afford it, and a choice that too often couldn’t be afforded for others. Now consider that 14% percent of white Americans were uninsured, while 22% of African-Americans were uninsured, and 32% of Hispanic Americans were uninsured. Whether you believe this is just a correlation, coincidence or reflection of something more damning, it is a situation that screamed to be addressed and improved.
Even more recently, the Centers for Disease Control and Prevention released a survey showing that more than 45 million U.S. residents didn’t have health insurance during the first nine months of 2012, immediately prior to implementation of the ACA. Still even more people, 57.5 million, were uninsured for at least part of the 12 months before being polled (Be reminded that the total U.S. population is just over 311 million.).
Please take a moment and ponder the enormity of the numbers just presented. It begs the question “How can such be allowed to exist?” Dr. King’s comment begged the same question. The answer of course lies in the fact that the American health care system isn’t built on producing equality of access or outcomes. You’ve heard me say before that the American health care system remains the only system among all the major industrialized nations on earth that doesn’t ensure access for all its citizens. The American health care system is a business enterprise that has captured approximately $3 trillion annually, representing over 1/6 (17%) of the gross domestic product, and all the while leaving more than 45 million Americans uninsured. We are number one in money spent on health care by a large margin; in fact, the U.S. spends more on people aged over 65 than any other country spends on its entire population. The business of medicine in America is business first. It is largely expected that good health care outcomes will result from good business in the same way that good cars, computers, smartphones, etc. are produced (theoretically). It’s important to note that according to the World Health Organization (the monitor of such things), the U.S. health care system was ranked #38 in the last WHO ranking based on standard health outcomes produced.
President Barack Obama’s health care reform law aims to extend health insurance coverage to a large portion of the uninsured. According to the Congressional Budget Office, health care reform will reduce the number of uninsured people by 27 million between 2014 and 2023. At this point, approximately 18 million Americans can come off the uninsured rolls since the implementation of the The Affordable Care Act (ACA). The ACA targets its assistance to the poor and near-poor who are least likely to have health care coverage. The ACA will provide Medicaid coverage to those with incomes up to 133 percent of the poverty level ($15,282 for a single person this year) — unless their home state opts out of the Medicaid expansion. People who earn between the poverty level and four times that amount will be eligible for tax credits for private health insurance.
Access to health care is the beginning of the process by which health care disparities can be erased. As long as failure to have equal access exists to the extent that it does, the types of disparities in life expectancy, disease rates and disease survival will remain predictably dismal for certain populations. As long as total our population is unhealthy in general and pockets of our population are more disproportionately unhealthy, we will remain less productive and cohesive than we could be, and that will perpetrate a host of additional problems within our society. 
Finally and furthermore, the question that still begs to be asked is why does the US choose to remain the only major industrialized nation in the world that fails to provide universal health care for its citizenry? What part of life, liberty and the pursuit of happiness involves doing so without health? How is that Justice?
Happy MLK Day. Remember the Dream, but also remember how that plays out in our lives.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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