Until recently, healthcare had always been a privilege of the wealthy. Beside food, housing and education, medical treatments are one of the most essential costs of living in the 21st century, without which countless would succumb to common ailments. Access to medicine has also been outlined as a basic human right under the United Nations Universal Declaration of Human Rights. Hence it is paramount that healthcare is a widely affordable and accessible service, and naturally its affordability is a pressing issue in today’s society. While technological advancements, improvements to government policy and efforts on the part of non-governmental organisations(NGOs) have greatly lowered financial and social barriers in some countries, others argue that the yawning income gap between the uber-wealthy and the middle class continues to aggravate the problem. While I acknowledge the manifold complexities of solving inequity in healthcare, I am of the opinion that the issue of accessibility can be solve through the multilateral cooperation of the private sector, the government, independent NGOs, and the general public.

The rich possess an undeniable advantage in accessing healthcare over the average consumer in terms of personal finances. Granted, the cost of healthcare varies widely depending on the country, severity of illness and government policy, yet across the board, the cost of treatment for grave illness such as cancer or organ failure, or long-term illness such as cerebral palsy and diabetes (whose costs run insidiously far and deep) are astronomical, sometimes even with insurance pay-outs and government subsidy. In the US, a country notorious for its exorbitant medical services, medical bills are reported to be the leading cause of bankruptcies. Unlike the rich, the average consumer does not have deep pockets to help cushion the damage a large medical bill can do, which could cause their finances to dip into the red. The income they earn is used to pay off monthly expenses as well as loans for essential purchases such as the house, the car, and student loans, leaving precious little excess income for rainy days.

Poorer households have it even worse. They live pay check to pay check, and are constrained by their working hours as they cannot afford the fall in income when they take leave for treatment. A four-hour, triweekly kidney dialysis treatment can be devastating to the breadwinner as he may not be able to accommodate normal 9 to 5 jobs, especially since not all employers allow for flexible hours. Taking sick leave and working odd jobs due to illness may mean the difference between their dependents having a meal and having to go without. On the other hand, more affluent households can afford to dip into their savings or even live off asset income while the breadwinner recuperates.

In the longer term, even if a rich man were to lose a limb to disease, his earning ability would generally remain unharmed. For example, the stock broker or lawyer does not diminish in ability with one less arm, as his mental faculties remain intact. In contrast, the blue-collar worker who depends on his body for heavy lifting and manual tasks suffers significantly in terms of productivity. His prospects are far bleaker given that the construction firm may lay him off and his future employment (assuming he cannot easily transition to other lines of work) is uncertain. Hence, both the average consumer and the poor are clearly worse off than the rich as they can ill afford to fall ill on the basis of lack of savings, and the potential loss of income in both the short and long run.

 

The rich can also better afford to fall ill as they are less dependent on the government. With their higher level of financial resources, they are able to tap into foreign healthcare systems for treatment. Singapore enjoys a substantial number of medical tourists, and despite the economic downturn the past few years, well-heeled foreigners have continued to seek medical treatment in Singapore’s private healthcare sector. Wealthy individuals with an appetite for risk might even venture into the black market to search for organ replacements in countries like Thailand and China where corrupt officials turn a blind eye and enterprising health professionals ply their (organ) trade. Conversely, the average person lacks the resources to seek foreign treatment, instead relying on the government to provide healthcare, resulting in snaking wait lists for consultations, and long periods of waiting in the region of 10 to 12 months for a surgery where the individuals condition may have deteriorated further, possibly into a critical state. This is a worse problem than merely not being able to afford healthcare, since the entire healthcare system in question is failing the people. Put simply, the healthcare system lacks the necessary resources to render healthcare within the vital period of time for patients to recover without issue. This would be symptomatic of fundamental problems at the policy level, an obvious sign of patent incompetence of the relevant authorities to uphold a basic human right.

The final nail in the coffin is that the authorities may not be working in the interests of the public. A polemic topic of debate is that less than scrupulous public officials in smaller jurisdictions may implicitly agree with insurance providers to legislate mandatory state medical insurance that benefit the authorities. The poor may not be able to afford the higher premiums and unfair co-payment and deductible schemes (where claimants have to pay a high deductible before being able to unlock the claim), effectively gouging the less-fortunate of money through higher-tiered insurance policies; money that could have gone towards better food and a healthier lifestyle rather than financing an unnecessary and unreasonable insurance policy. Hence, the poor get the short end of the stick as they cannot seek treatment overseas in better equipped healthcare systems, and are squeezed financially by inefficient and corrupt officials.

It may not always be the case that only the rich can afford to fall ill. The above argument that the disparity between the rich and the poor in terms of personal finances leads to a similar disparity in access to healthcare does not quite hold true. For starters, not every illness is going to break the bank. The common cold or an ordinary bout of fever is generally not a huge expense given the availability of over the counter medication and free medical advice on the internet from reputable websites such as WebMD.  Generic drugs are produced for cheap (since most of the cost of medicine is in research and development, so after the patent expires the actual production cost is low), and consultation fees are removed from the equation for all but severe sicknesses. Beyond that, a new phenomenon has surfaced in the form of crowdfunding. The heavy cost of treatment is no longer borne by a single income earner, and instead the community helps to finance treatment on websites such as GoFundMe, where magnanimous individuals can offer their generosity in small denominations of a dollar, five dollars or more. Hence, buffered by cheaper medicine and community support, the common man can afford to fall ill.

The less affluent may not be greatly disadvantaged considering the extent of government aid available. The argument that the national healthcare system is ill-equipped is based on the erroneous assumption that the governments operating them are ineffectual, which amounts to fearmongering. It is plain to see that governments are generally doing its job in providing a basic standard of living to their citizens, otherwise countries across the globe would be experiencing frequent epidemics, perpetual health crises and extreme poverty, which is not the case. Aggressive subsidies and means testing are helping the tail-end to afford healthcare while multi-prong approaches help them reskill to increase productivity and earn higher wages. These subsidies are financed through progressive taxation, where the rich are placed in higher tax brackets to redistribute income to the poor. This allows the poor to afford healthcare through the dollars of their richer countrymen. These same tax dollars allow the government to conduct R&D into generic drugs, as in the case of Thailand’s policy towards AIDs medication, which is to deny patents and produce the drugs for cheap. Despite the contention over the effectiveness of a universal insurance plan, risk pooling is, at least on paper, a viable strategy to solving inequity in healthcare. The rich, with arguably better diets, exercise and rest, are at lower risk of contracting weight related diseases such as diabetes and obesity. By pooling the rich with the poor who are at higher risk, the overall risk balances out and insurance premiums are more affordable for the poor (since worse health leads to insurance companies underwriting higher risk) In any case, sustained government efforts to improve the welfare of the common man have yielded indisputable results.

The commendable efforts of NGOs have also helped to fight inequity in healthcare. In less developed countries, the low income of village people often translates into a lack of public education on healthcare. Rural villages tend to be self-contained with limited contact with the outside world, hence deep-seated belief in the occult and traditional medicine has persisted in these societies. This corollary of their isolation was that at the inception of the Ebola pandemic, transmission of deadly disease was rampant due to the bodily contact between infected persons and the populace during religious practices. It was only due to the efforts of smaller independent NGOs that educated the populace about unsafe practices and the availability of Western medicine that the propagation of Ebola was curtailed. Armed with knowledge on how to mitigate disease, the lower income groups can afford to fall ill as they are better able to access healthcare.

In a minority of cases, it is not a case of want of money, but that there is simply no known cure for the disease. Multiple sclerosis does not discriminate in its choice of victims between the rich and the poor, and neither do its autoimmune cousins or evolutionary superbugs. Admittedly, wealth can buy better palliative care, but as long as modern medicine continues to lag behind the progression of disease, no amount of wealth or riches can truly restore the body. Asclepius is powerless to protect against the ravage of disease, and the rich and poor alike can only count on a miracle.

In conclusion, in the absence of a benevolent government, personal finances are a significant discriminating factor in healthcare access. It is only with astute government policy, and public education enabled by technology and NGOs that healthcare is not a privilege but a right afforded to people from all walks of life.

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