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Healthcare Affordability & Access are Crucial to Mitigating the Health Impacts of Environmental Harm
Anyone even remotely familiar with American political discourse likely knows that healthcare access has, for a relatively long time, been at the center of mainstream debates. Part of the reason for this pertains to the fact that the American healthcare system is one of the most expensive in the modern industrialized world, boasting an average health expenditure per capita of $12, 530 - as of 2020 (1).This fact is even more shocking when considering that the United States has one of the highest rates of Diabetes, Cancer, and Obesity in the modern developed world, with 6 out of 10 individuals being affected by one or more chronic conditions. Polarized views regarding universal healthcare and debates on the increasingly costly medication prices that are characteristic of the American pharmaceutical complex are no secret to the average concerned citizen and have dominated discussions in the political arena for decades. Still today, the United States is one of the only high-income countries not to provide universal healthcare coverage to its inhabitants.
In our time of environmental crisis, ensuring that every citizen has access to healthcare is imperative. Pollution in the United States has decreased since the 1970’s due partly to efforts by the EPA to curtail pollutive output (2). However, exposure to pollutive agents and environmental hazards is still a pressing issue with as many as 135 million Americans being affected yearly (3). From high carbon emissions, lead poisoning, fine particulate matter and ozone exposure, pointing out the main culprit can be difficult. Furthermore, these environmental issues disproportionately impact low-income and historically disadvantaged communities, both of which are especially vulnerable due to their lack of financial and infrastructural resources. The recent events of Jackson, Mississippi are a prime example of the toll that environmental issues, when coupled with infrastructural failure and government inaction, can have on vulnerable populations. To add insult to injury, concerns about global warming are becoming increasingly justified with concrete evidence of temperature increases surfacing around the globe — with the recent summer heat waves in Pakistan, the United Kingdoms and the United States being the most notable examples. These environmental realities create a serious dilemma for contemporary people: they must choose between mindlessly enjoying the benefits of carbon-fueled technology - to the detriment of the environment — or considerably reducing carbon consumption — with the downside of abandoning the comfort and utility provided by carbon emitting devices.
As the most brilliant and innovative minds ponder this dilemma, there are practical steps that can be taken now to mitigate the health impacts of environmental degradation. One such step pertains to providing universal coverage to all Americans. As of 2019, 60,200 deaths were attributed to air pollution with particulate matter as the leading cause (4). This number is staggeringly high, especially given the fact that it is proven that affordable and accessible care could considerably reduce fatalities. We know this because those who suffer the most from environmental pollution tend to come disproportionately from financially disadvantaged backgrounds making them unable to purchase preventative healthcare or treatment.
So how do we make healthcare more affordable? As was previously hinted, implementing a publicly funded universal health insurance program is a great start. The problem with private insurances is that, given that they are businesses with profit-driven goals, they have an incentive to charge as high a premium as they possibly can. As a result, those most vulnerable to environmental pollution — low-income individuals — tend to struggle to afford premiums. Furthermore, for-profit private insurances have an incentive to deny coverage to individuals with high financial liabilities, meaning that individuals impacted by environmental health problems may be denied coverage due to their potential for high medical costs related to treatment (5). In other words, both low-income and high risk individuals are at a disadvantage when purchasing private health insurance, even though they are the two groups most susceptible to suffer from environmental ills.
Medicaid and Medicare are the closest programs to come near what one could consider forms of public universal healthcare in the United States. However, even though they are publicly funded and have relatively affordable premiums, they both have explicit exclusionary criteria, meaning that only specific subgroups of the general population qualify for their benefits — in the case of Medicare people 65 or older and in the case of Medicaid people making below a certain cutoff determined with respect to the Federal Poverty Levels. However, even though Medicaid provides some relief to low-income individuals, it still leaves out anyone making above the FPL cutoff that it deems acceptable, which in most cases is not sufficient to afford care. This income cutoff can even lead to a coverage gap as is the case in states that do not expand Medicaid under the Affordable Care Act, further worsening the plight of some low and middle-income individuals who find themselves in a position where they make too much money to qualify for Medicaid yet not enough to be able to enjoy marketplace subsidies (see figure below for detailed illustration). In other words, both Medicaid and Medicare fall short of their goal of making American healthcare more accessible.
Publicly funded universal coverage is a great alternative to for-profit health insurance because it addresses the accessibility and affordability shortcomings of private insurance by providing insurance indiscriminately at an affordable cost. This means that under a universal, publicly funded healthcare program, anyone, regardless of socioeconomic or disease status, would have access to insurance and would be able to afford life-saving health services. Medicare For All is an example of a universal health insurance proposal that builds on the existing Medicare plan and could successfully replace, or at the very least complement, private health insurance if implemented.
If the United States were to join the developed world in implementing a single payer healthcare system like Medicare For All, the advantages would be plenty. Healthcare spending would drop as less administrative costs and hurdles obstruct medical practice. Pre-existing conditions would be covered. Individuals impacted by environmental issues such as lead poisoning or air pollution would be less worried about being denied care and low-income individuals would be able to afford health services at reasonable costs. There is also the possibility of adding dental coverage and other benefits to the list.
Environmental degradation is real. As the battle for our future rages on and as we continue to advocate for radical environmental action and change, let’s not forget to take practical steps in the present to mitigate possible health impacts of environmental degradation and save more lives now and in the future.
Works Cited
Historical. CMS. (n.d.). Retrieved September 6, 2022, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical#:~:text=U.S.%20health%20care%20spending%20grew,For%20additional%20information%2C%20see%20below.
Environmental Protection Agency. (n.d.). EPA. Retrieved September 6, 2022, from https://www.epa.gov/newsreleases/air-pollution-trends-continue-link-clean-air-and-strong-economy#:~:text=The%20report%20released%20today%20shows%20that%2C%20between%201970,considerably%20across%20our%20nation%20between%201990%20and%202020%3A
Lee, N. (2021, June 2). 135 million Americans are breathing unhealthy air, American Lung Association says. CNBC. Retrieved September 6, 2022, from https://www.cnbc.com/2021/04/22/heres-how-many-americans-are-effected-by-air-pollution-every-year.html
Published by Ian Tiseo, & 21, J. (2022, June 21). U.S.: Air Pollution Deaths 2019. Statista. Retrieved September 6, 2022, from https://www.statista.com/statistics/1137375/air-pollution-deaths-united-states/#:~:text=In%201990%2C%20an%20estimated%20103%2C700%20lives%20were%20cut,is%20the%20main%20cause%20of%20pollution%20related%20deaths.
Historical. CMS. (n.d.). Retrieved September 6, 2022, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical#:~:text=U.S.%20health%20care%20spending%20grew,For%20additional%20information%2C%20see%20below.