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I look for different measures to assess the impact of social determinants of health on patient outcomes or accessibility to affordable care. I also look to these measures when "race" is used as a placeholder for something else. There is the American Community Survey, US Census Bureau, Bureau of Labor Statistics, Centers for Disease Control, Centers for Medicare & Medicaid Services, U.S. Bureau of Economic Analysis, and a wide variety of other data sources.
The majority of us are reading news streams trying to stay informed but it can be frustrating. Discussions of innovation and drug costs are basically just echoes of what someone else said a time ago and it lodged into the collective cortex of discussion. We don't choose our words with care. For example, when does the Affordable Care Act stop being what it once was, as it is slowly dismantled? Reporters that keep calling it something it no longer resembles are disingenuous.
Why do we like to say that healthcare is a free market commodity? Would a free market harness novel drugs to enrich one segment of the market (industry) at the expense of market competition, individual rights, and consumer protection for 12 to 20 years through patent protection? Do patients choose to enter the market place? Is it like shopping for a new car where you can read manuals and make decisions on price, trim levels, and functionality? Or are the prices out of the equation and we are forced (coerced) to pay whatever the market will bear? What about the complexity of understanding our healthcare plans, deductibles, and what it means if we live in states that did not expand medicaid? What about work requirements like those recently approved that require minimum work hours? Do hourly workers really have control on the number of hours they are assigned? What if I told you that sandwich shops make low-wage workers sign non-compete agreements? Discussions around drug pricing never distinguish if health care is a human right in the US but I think that is because we know the answer. Biosimilars are not generics. Stop saying they are. Don't use words like value without clarifying, "value for whom?" Stop saying you don't want government health care. Why not? The healthcare economy is already regulated by government. It is a large profit centered entity creating favorable markets for access, cost, economies, price protection, incentives, R&D just to name a few. The only thing missing is you. Collective bargaining is not only for Unions. The least we should ask for is protection from utter financial devastation if we need chronic care.
Why does any of this matter? Policy created the inequalities of the middle class and only policy can fix it. Intentional public policy protects the wealthy and profit centers but not the individual. Why is it only the patient or individual citizen subjected to the whims of a "free" market while healthcare industry enacts self-serving regulation and industry supported protections?
Income and wealth are not the same thing. One devastating illness and you can lose both. Unless you are mega-wealthy you are not immune.
I attended an important discussion at the Brookings Institution, The Future of the Middle Class. The panels were populated by chief economists, leaders in socio-economic inequality, political policy experts and more. There are reasons why we struggle to define "the middle class" and why the definitions are often not comparable.
I learned a new tool to consider when evaluating populations. Mobility is the measure missing from discussions of economies like wages, unemployment, educational attainment, and poverty. If the schools in your neighborhood are low performing can you choose private schools? Can you move away from crumbling public infrastructures to better communities, change jobs or careers, access capital for a new business? This is the real meaning of mobility. 
It is time to change the dehumanizing narrative and rethink how we look at our communities.
Are we angry enough to mobilize for change? Comments are closed.
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