Letter to the Editor: Can equity be achieved in U.S. health care?

The U.S. health care system is a patchwork of public and private insurance plans and hospitals that remains one of the most expensive systems in the world. Health care represents approximately 20% of our national gross domestic product each year, in real dollars about $5 trillion of spending per year, and this annual line-item expenditure in the federal budget has increased exponentially with the emergence of the COVID-19 pandemic.

COVID-19 has laid bare for all to see – and in many instances experience – the broken, unequal, disjointed and ineffective system of care that exists from inner cities to suburbia to rural areas. Many Americans have found the health care system to be wanting, especially in crises as in the case of the lethal virus. It is especially apparent in treatment for COVID-19, and disparity in access and outcomes among Black, Brown and other historically vulnerable groups is substantial and statistically significant compared to White counterparts.

Efforts have been made to overhaul our health care system, address key issues and improve components. No significant changes to the existing system had been made for half a century, until the passage of the Affordable Care Act (ACA)  in 2010.

Although the ACA expanded insurance coverage to many Americans and held providers to certain improved patient-outcome standards, it did not go far enough to address persistent system problems. As the virus exploited the long-running racial inequities within all systems of this country and exposed our flailing public health infrastructure, the questions have been posed: What will Joe Biden do if elected? How will the Biden plan address these issues?

The Biden plan builds on the ACA by adding a public option to lower costs and enhance coverage. The plan is gradual and projected as being less costly in terms of possible tax increases. The big deal of the plan is that it offers choice to all to purchase a public health insurance option like Medicare. Biden’s plan would negotiate lower prices from hospitals and health care providers, unleashing the same bargaining power as Medicare on behalf of the public. This plan is an “enhanced lifting all boats” strategy, the hope being that it will reduce existing disparities and move our health care system toward more universal access and greater equity for all.

The hope is that the Biden plan, with its bold objectives, will do just that by changing and improving our existing system.

Dr. Denise A. Davis