Human Rights and health: the USA's healthcare crisis paradox

Cutting-edge technology for a few, healthcare inequality for many.

  Articoli (Articles)
  Caterina De Rosa
  19 December 2024
  4 minutes, 42 seconds

Health and Human Rights: the Healthcare crisis in the USA

Translated by Giulia Maffeis

Many believe that people in the United States don't eat well. Many believe there are more guns than people in the country.

Many also believe that, in the United States, not having health insurance means not having access to basic medical care. This statement, like the others, is part of the common misconceptions about the U.S. that we’ve all heard or said at some point. It’s what’s known; it’s what’s talked about.

But what is the real state of the U.S. healthcare system? Let’s clarify the issue.

How the U.S Healthcare System Works

As it's known, the U.S. healthcare system is primarily based on insurance, without a universal, government-funded system like in many other countries. These insurance options can be:

  • Private: acquired through employers or purchased individually by the citizen. 

  • Medicare: a federally funded program for people over 65 or with disabilities. It offers basic coverage, but it excludes many services.

  • Medicaid: for low-income people, jointly managed by federal and state governments, with eligibility criteria varying by state.

  • CHIP (Children’s Health Insurance Program): for children from families with incomes too high for Medicaid but unable to afford private insurance.

In an article, The New York Times described the American healthcare system as the most expensive and least effective in the modern world. Despite an annual investment of $3.8 trillion— way more than other countries spend—this model fails to provide fair access to medical care for all segments of the population.

Obamacare and new Healthcare laws

Over the years, U.S. healthcare has gone through numerous changes, both positive and negative. In 2010, to make the system more inclusive, the Affordable Care Act (ACA), commonly known as Obamacare, was introduced. The reform's goal was to make healthcare more accessible to Americans. Its key goals included:

  • Medicaid expansion: increasing eligibility for individuals with incomes up to 138% of the federal poverty level (FPL), with federal funding for states. For example, someone earning up to 138% of the minimum income level qualifies for Medicaid.
  • Creating Health Insurance Marketplaces:  creating online platforms to compare and purchase insurance plans, with subsidies for middle- and low-income families.
  • Individual mandate: requiring all citizens to have insurance or receive a fine, encouraging even healthy, young individuals to join the system.
  • Consumer Protections: Prohibiting discrimination based on pre-existing health conditions and mandating that plans cover essential services since many private insurers previously denied coverage for those with poor health conditions.

The reform aimed not only to increase inclusivity but also to compete with private insurers, pushing them to lower their prices.

In 2017, however, Donald Trump introduced changes, creating a law that got rid of fines for those without insurance. The law also granted states more freedom to regulate Medicaid access based on income, narrowing eligibility and making it harder for many to qualify for the program.

Finally, under Joe Biden’s Democratic administration, Medicaid was further incentivized, promoting its expansion through federally funded subsidies to make it more inclusive—especially in Republican-led states that had adopted Trump’s system. While these incentives have improved coverage, 10 states still refuse to expand Medicaid, leaving millions of low-income citizens without coverage.

Current Situation and the Dichotomy: The Very Best and the Very Worst

Today, 27.5 million Americans remain uninsured, and this number increases if we include undocumented individuals. The United States experiences a striking dichotomy between advanced private clinics and a significant portion of the population unable to afford medical care.

A striking example of this paradox is the Texas Medical Center in Houston. This hospital complex is the largest medical centre in the world, hosting internationally renowned research facilities like the MD Anderson Cancer Center, a leader in cancer treatment. It represents cutting-edge technology and medical research. 

Just five minutes from these facilities lies a completely different world, where low-income neighbourhoods are home to people—employed and unemployed —who often cannot afford even basic medication like aspirin. While Texas Medical Center hospitals provide emergency care, as all hospitals in the U.S. do, access to preventive and long-term care remains limited for those without insurance or financial means. 

Patients without insurance often face the dilemma of choosing between paying medical bills or meeting basic needs like rent or groceries. Essentially, we’re talking about a hospital for the wealthy in a neighbourhood of the poor.

Houston exemplifies the best and worst of the American healthcare system and is a symbol of the strong inequality in one of the most technologically advanced healthcare systems in the world. It is thought-provoking to consider how access to care is recognized as a fundamental right by organizations like the United Nations, while in the U.S., it is often a privilege.

This paradox is not merely an economic or administrative failure but a violation of human rights. Having access to the most advanced technological and scientific resources is insufficient if they remain inaccessible to those who need them most. As long as a healthcare system prioritizes profit over human dignity, millions of Americans will remain trapped in a cycle of inequality, where health becomes a matter of luck or income.

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Caterina De Rosa

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North America

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USA UnitedStatesofAmerica healthcare humanrights