By Florian Direny || Contributing Writer
Anyone even remotely familiar with American political discourse likely knows that healthcare access continues to be at the center of mainstream debates, and for good reason. 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 1970s due partly to efforts by the EPA and other environmental regulatory bodies 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, identifying the main culprit can be difficult. To add insult to injury, concerns about global warming are becoming increasingly justified with concrete evidence of temperature increases surfacing around the globe. These 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 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 being the leading cause (4). Moreover, as many as 85% of lung cancer cases are caused by environmental pollution from various causes. These are massive losses in human life and it is proven that affordable and accessible care could considerably reduce fatalities. 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. Given that private insurances are businesses with profit-driven goals, they have an incentive to charge exorbitant premiums to buyers. 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 people with high financial liabilities, meaning that individuals impacted by environmental health problems may be denied coverage due to the potential for high medical costs related to their 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 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 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 health insurance indiscriminately at an affordable cost. This means that under a universal, publicly funded healthcare program, everyone, 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 program that builds on the existing Medicare program and could successfully replace, or at the very least complement, private health insurance options if implemented. There are many other universal insurance alternatives that could be implemented, each with their own caveats and benefits.
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.
Florian Direny is a senior and a contributing writer. His email is: fdireny@fandm.edu.