Without a doubt, the Medicaid and Medicare programs need to be reformed so as to ensure their long term sustainability. However, I am increasingly concerned that certain populations of people, namely children and the poor, are being increasingly marginalized and ignored for the sake of political power and economic profits.
Children and the poor have often been the subject of re-occuring and pervasive injustices throughout history, but two recent articles (one a Wall Street Journal news article, and the other an empirical study reported in the New England Journal of Medicine) suggest that here and now those who hold a greater share of power in its various forms continue to marginalize and disrespect those classed under these groups.
The Wall Street Journal article notes, in particular, that amidst budget talks and the pressing need to curtail federal spending, there is substantial bi-partisan support to make cuts to the Medicaid program, which provides public insurance to those with lower incomes who may not be able to obtain affordable private insurance. While it may be necessary that Medicaid undergo some cuts or other substantial reforms, it is deeply suspicious that many of those with considerable political power are not willing to make similar cuts or reforms to the Social Security Program or Medicare. Of note, is the fact that both Social Security and Medicare serve the interests of senior citizens who comprise a substantial voting block for both Republicans and Democrats. Thus, the willingness to make cuts to Medicaid without equal attention to other entitlement programs looks like an effort to keep a certain voting block happy at the expense of those who wield less political power, namely those with less disposable income and time to dedicate to political campaigns.
In this week's issue of the New England Journal of Medicine, a research study has been published in which researches coordinated and scripted calls by actors to 273 medical specialists' clinics in the Cook County, IL area with the aim of trying to arrange an appointment for a child with pressing medical conditions. The only variable amongst the actors making the calls was that some were trying to make an appointment for a child with public health insurance and others for a child with private health insurance. The results are disheartening to say the least. Over 50% of the medical clinics refused to accept any patients with public health insurance, but did accept private health insurance. Of the clinics that did accept both public and private health insurance, children with private health insurance had to wait only 20 days for an appointment, while children with public health insurance had to wait 42 days. Thus, for two children reporting identical symptoms, medical specialists consistently made children with public health insurance wait longer for an appointment than a child with private insurance.
I find the latter study to be especially saddening insofar as it presents evidence of a considerable injustice perpetrated against children who have little or no control over the factors on which they are being discriminated against.
Amidst the discussions about reform in health care, more must be done to protect the interests of those that are often marginalized in our society, namely children and the poor. Certainly, our health care system has to work with finite resources, and as such, difficult decisions are and will have to be made about how best to distribute all of those resources. But what these articles draw our attention to is that at least some in our political and health care systems either directly or indirectly sponsor further harms to those that lack substantial economic and political power. That is, some in our society are being pushed down so that others can rise up. One need not advocate for radical equality amongst all members of a society to recognize that where those with power act to keep others down or push others lower, that is always a wrong, and one that should be immediately redressed.
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