Health and Medicine

Low and Middle Class Americans Now Receive Less Healthcare Relative to Their More Affluent Counterparts

Healthcare Cost

A study, published in the July’s edition of Health Affairs magazine, reveals that the gap in healthcare services between different social classes in America is getting higher; low and middle class Americans now receiving less healthcare support relative to their more affluent counterparts.

The authors of the study, who examined the results of 22 nationwide surveys carried out in the last half decade, expressed the view that based on the results of the survey a dramatic reduction in the disparity of healthcare consumption among various income groups was observed. This was in contrast to the previously existing trend, and a closer examination of the data revealed the mid-2000s to be the decisive moment.

The study concluded that the wealthiest 20% of Americans got 43% more healthcare ($1,743 extra per person) than the poorest 20% of Americans, and 23% more care ($1,082 extra per person) than middle-income people in 2012. (Figures are adjusted to account for the brunt of illness which, relative to the rich, is greater in middle income and poor people).

Before MedicAid and MediCare were passed into law in the United States in 1965, the rich received double the amount of healthcare as opposed to the poor. After both programs were passed into law, the gap in healthcare consumption decreased, and lower-income people eventually overtook the rich in terms of healthcare received (however, it was discovered that the gulf in healthcare received remained fairly unchanged after the figures were adjusted to account for the higher brunt of illness among lower-income Americans).

Consequent to the sweeping decline in medical expenditure from the year 2004 through 2012, healthcare consumption among the richest 20% of Americans showed a 19.7% increase, surpassing that of middle-income earners by almost 60% (57%), while the bottom 20% posted a 3.7% decrease in healthcare consumption.

Data on the elderly, with nearly their entire population under MediCare program, showed no increase in the disparity of healthcare received.




Research work was carried out at the City University of New York at Hunter College, Boston University and Harvard Medical School, and the researchers arrived at individuals’ healthcare consumption by using their total expenditure on healthcare, regardless of who was responsible for paying the bills e.g. government, the individual or insurance companies. It was observed that the uppermost 20% income group had recorded a frequency of doctor visits in 2012 that was 40% higher than those of the other income groups constituting 80% of the study population.

For the year 2012, income threshold for a 3-person household was found to be less than $22,689 in the bottom 20%, while the top fifth of Americans had a value of $101,094. The other classes (60%) between these two classes were regarded as middle-income earners.

According to the authors, three factors; the steep increase in deductibles and co-payments which made health insurance less appealing to middle income and poor Americans, the recession that occurred from 2007 through 2009, and the subsequent slow recovery made by middle class and poor people were jointly responsible for the disparity observed in the healthcare received by Americans.

Presently at San Francisco General Hospital the lead author of the study, Dr. Samuel Dickman whose research was done at Harvard Medical School, stated that Americans were the global leaders in expenditure on healthcare, and rich people; who were responsible for majority of these expenses, were able to procure good insurance covers with co-payments and deductibles that were beyond the reach of the other income groups. Economists recently lauded the slump in growth of the healthcare cost. The slump however, seemed to be as a result of middle class and poor Americans being limited to spending their income on any of healthcare, groceries or rent.

Senior author of the study and Harvard Medical School lecturer, Dr. David Himmelstein, who also doubles as City University of New York at Hunter College professor, stated that the richest Americans were receiving needless and even deleterious healthcare, whereas the middle-class and poor Americans were forced to cut critical healthcare services. The climbing disparity in mortality rates was a pointer to the growing inequality in healthcare received by the different income groups. Life expectancy in nations where the distribution of healthcare was on the basis of need rather than wealth was increasing, leaving that of the United States in its wake. Finally, he said the findings of the study highlighted the need for a health insurance program that would cater for the healthcare needs of Americans – a first-dollar, single-payer coverage – ensuring that each and every American gets the medical services they desire.