Although some of the best health care in the world is available in the U.S., the U.S. health care system falls far short of international human rights standards. Recent surveys show that the American public is unsatisfied with the system currently in place. Nine out of ten Americans “believe the U.S. health care system needs fundamental changes” while nearly two-thirds “support a government guarantee of health care coverage for all.”³ Our government spends the most per capita of any nation on health care, totaling nearly $2 trillion.⁴ Yet, according to the World Health Organization, the U.S. ranks below every other industrialized nation in life expectancy and infant mortality.⁵ It has become increasingly clear that the current system is fundamentally flawed. 

Availability of Health Care in the U.S.

Many Americans take access to skilled doctors and state of the art medical facilities for granted. However, an estimated 50 million Americans live in areas that have been identified by the federal government as “primary medical care health professional shortage areas,” meaning there are too few doctors to serve the population.⁶ This need persists despite the fact that the number of doctors per 100,000 people has been increasing rapidly.⁷ Shortage areas tend to be either rural communities or predominantly minority neighborhoods in cities. New York has 122.5 primary care physicians per 100,000 people while Idaho has only 56.7 per 100,000.⁸ Furthermore, surveys have found that black and Hispanic communities of all income levels are 4 times as likely as others to have a shortage of doctors.⁹

Accessibility of Health Care in the U.S.

The high cost of health care acts as a serious barrier to treatment for many Americans. Most Americans depend on health insurance companies to cover their medical expenses.  However, approximately 45 million Americans are uninsured.¹⁰ Many of the uninsured would like to have health insurance but do not, because their employer does not provide adequate health insurance benefits and the cost of individual coverage is too high. Medical underwriting which requires those seeking insurance to undergo screening can lead insurance companies to reject applications because of “preexisting conditions.” Individuals with serious conditions such as cancer and heart disease, or minor conditions such as acne, back pain, or being 20 pounds over or underweight could be considered uninsurable.¹¹ This system can prevent individuals with relatively minor and treatable conditions from obtaining health insurance. Lack of health insurance leads to negative health outcomes as the uninsured receive less preventative care, less care for chronic illnesses, and fewer hospital services. They are also more likely to die prematurely.¹² Eighteen thousand people die each year because they are uninsured.¹³

The high cost of health care combined with a lack of health insurance affects some groups more than others. Hispanic children are over 3 times more likely and black children are almost 50% more likely than white children to lack health insurance, leading to poorer health. Black and Hispanic children are almost 2 times as likely to be in less than “excellent or very good health.”¹⁴ Americans with disabilities also face difficulties in accessing care. While people with disabilities are insured at the same rate as people without disabilities, they are four times as likely to have special needs not covered by their health insurance provider.¹⁵ Additionally, one study found that 28% of people with disabilities had postponed needed care because of cost as compared to 12% of people without disabilities.¹⁶

Disparities are also glaring in the area of mental health. The Surgeon General’s report on mental health released in 2001 revealed that while mental illness is at least as prevalent among racial and ethnic minorities as in whites, minorities have less access to and are less likely to use mental health services, and receive poorer quality mental heath care.¹⁷ Subsequent independent reports done in 2003 and 2005 reveal that, since then, not much has changed and minorities continue to face a  myriad of barriers in accessing appropriate mental health treatment.¹⁸ Consequently, minority communities have a higher proportion of individuals with unmet mental health needs.

Acceptability of Health Care in the United States 

Linguistic and cultural differences as well as systemic racism can act as barriers to acceptable health care in the U.S. Historically, racist attitudes resulted in unethical research and experimentation on black Americans.¹⁹ Even today, doctors may harbor unintentional racist attitudes which lead them to provide a lower standard of care for minority patients. Research shows that racial and ethnic minorities receive less care and lower quality care than white patients – a disparity that cannot be attributed to differences in income or insurance level.²⁰ This gap in care may account, in part, for differences in mortality rates from breast cancer. The mortality rate among black women with breast cancer is 68% higher than that of white women.²¹

Effective communication is essential to culturally competent health care,²² and doctor-patient communication becomes an important issue in a country where 24 million people report speaking English less than “very well.”²³ Federal policy requires health care providers to offer translation services, but such services are not always available and there are few observed quality standards for translators.²⁴ This can result in miscommunications which can have serious consequences for patients’ health. For instance, the Hmong language has no concept of cancer. In some cases, inexperienced translators have attempted to explain radiation by saying “we’re going to put a fire in you.”²⁵ Cultural differences can cause confusion and miscommunication as well.  Different cultures may have different understandings of illness and health than doctors trained in Western medicine. For instance, while Western medical practice focuses on the individual, some communities require that the extended family play a central role in managing illness.²⁶

Adequacy of Health Care in the United States

The costs of the U.S. health system are over $2 trillion annually and are expected to reach $4 trillion by 2017.²⁷ Yet, despite paying thousands of dollars per person on health care each year, Americans do not have better health outcomes.  For example, a baby born in El Salvador has a  better chance of survival than a baby born in Detroit.²⁸  The U.S. health care system is inefficient; its fragmented structure consumes 20-24% of spending in administrative costs, far higher than in countries with a government-run system.²⁹ Insurance incentives which encourage overuse of expensive medical services also raise costs. Other costs are directed to advertising expenses or profits rather than medical services.³⁰ Embracing a universal right to health care would not only allow for marginalized groups to access quality services but would also improve the physical, mental, and social well-being of all citizens in the United States.