The American Pathology of Inequitable Access to Medical Care

What most defines access to health care in the United States may be its stark inequity. Daily headlines in top newspapers paint the highs and lows. Articles entitled: “We Mapped the Uninsured. You’ll notice a Pattern: They tend to live in the South, and they tend to be poor” and op-eds with titles like “Do Poor People Have a Right to Health Care?” and “What it’s Like to Be Black and Pregnant when you Know How Dangerous That Can Be” run side-by-side with headlines touting “The Operating Room of the Future,” and advances in gene therapy that promise cures to everything form vision loss to cancer, accompanied by high six-figure price tags. Americans’ claims that they have access to the best medical care in the world are correct. Equally true are the claims that the system is broken. This chapter maps out the complex picture of access to medical care in the United States and reflects on how variable access illustrates, among other things, an American ambivalence about health solidarity. This Chapter first considers health care financing as one critical element that defines access to medical care and describes the multifaceted U.S. health care financing structure, predominated by public insurance programs for select populations and regulated private insurance for others. Second, this Chapter describes how access is equally shaped by legal requirements that create treatment obligations for doctors or hospitals, regardless of how someone pays for care. There is no constitutional right to health in the U.S., but various layers of statutory and common law have created some guarantees. That said, despite efforts to increase access over the past decades, the United States is still extraordinary, as compared to peer nations, on the unevenness of access to medical care among its population