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Nancy Graham
Brittany Stephenson
ENG 1010
December 2, 2015
Inequality in Healthcare: Income Determines Outcomes
In the United States, wealthy patients have not only better access to healthcare overall but
also have better outcomes and lower mortality rates than low-income patients have. The reasons
for this are complex and are believed to be due in part to behavior differences between highincome versus low-income Americans; however, compared to other countries the United States is
spending more on healthcare and the results do not indicate better results. The system forces
physicians into ethical dilemmas with concierge, Very Important Patient (VIP) or red blanket
patients versus the general population of sick or injured (Clark). Does VIP, concierge or red
blanket patient services (private chef, deluxe rooms, etc.) increase the patients outcome? If so,
what does that mean to the rest of the patients in the hospital?
Minority health care
According to the article The New Inequality: Health Care, higher-income patients have
access to advanced medical breakthroughs because they can pay out of pocket (for instance, The
Cancer Treatment Center or The Laser Spine Institute advertised on television) or have more
comprehensive private insurance willing to cover innovative treatment (Luhby). The Forbes
article, Why Health Care Is Different If You're Black, Latino Or Poor, goes so far as to say that
African Americans and Latinos experience a 30 to 40 percent poorer health outcome than white
Americans (Pearl). The wealthy have opportunities low-income Americans simply do not have.

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From their choice in the grocery store to their experience with health care, every aspect is
affected by money.
Can the increases in mortality and poor health of low-income Americans be dismissed
as behavior, location or access to health care? The Money article points to a study that 27% of
low-income people smoke and 34% are obese compared to 12% of higher income people smoke
and 25% are obese. It is clear that the wealthy have better health care access and take advantage
of it more often (Luhby). Although low-income people have higher incidence of smoking and
obesity is that due to social acceptance within that group or is that due to their inability to obtain
healthy food, gym membership and smoking cessation treatments? Health is a privilege not an
assumption in America.
Income predicts mortality
Does income predict when a person will die in America? Unfortunately, the answer is
yes. Study after study shows that low-income patients have a higher mortality rate and a higher
rate of disease than higher income patients do. The Forbes article points out low-income patients
have a 10-fold increase in limb amputation because of diabetes than patients in affluent areas
(Pearl). The death rate of breast cancer in African American women is 50 percent higher than
white women do (Pearl). The Forbes article quotes a 2014 Robert Wood Johnson Foundation
report Your health care depends on who you are. Pearl declares that Latinos and African
Americans experience a 30 to 40 percent decrease in health outcomes compared to white
Americans. This article does a good job of suggesting solutions and studying relevant cultural
issues.
America spends more on health care; however, our results do not reflect improved
outcomes. Detsky, does a great job of comparing the United States to other countries of similar

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wealth and the causes of the lower health outcomes. From this article, it is clear that although
America spends a fortune on health care we are not getting what we pay for. Medicare and
Medicaid costs tax payers millions each year, yet many Americans are not receiving adequate
care.
Is there inequality in healthcare? If so, why is it important to change? In the Money
article Luhby talks about inequality between rich and poor. These inequalities are not just
financial there are significant health care differences between the classes. Wealthy Americans
have access to more and better skilled doctors, better testing and faster access to diagnostic
medicine. Luhby talks in this article about the difference in care received by low-income versus
wealthy. Many physicians do not accept Medicaid and higher-income patients had access to
medical breakthroughs that the low-income patients could not access (Luhby). This was a well
thought out article looking at several aspects of health care.
Wealth affects health care
Do the wealthy in America receive better health care or just more health care? I believe
the answer is they receive both more and better care. All of the articles I have chosen reflect this
opinion based on research. In the article, How Hospitals Coddle the Rich states A doctor in
Connecticut surveyed the directors of 32 emergency departments around the state on whether
they gave faster treatment to VIPs in their emergency rooms. Most responded, and all but one
supported the practice Anyone that has been to an emergency department knows that regular
patients wait sometimes for hours for care, but if you are rich those annoying wait times are not a
problem.
In the Two-tier hospital care article, research shows that patients in a room with a view
of nature recovered faster from surgery than those facing a brick wall. Another study cited in the

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same article states that even a room with sunlight could decrease stress and pain medication
requirements. Who gets a room with a view or the private chef? Either those that can pay out of
pocket or those with private insurance. That is not the majority of patients.
Physicians point of view
Are physicians being placed in an unethical position choosing care first for a red
blanket patient over a homeless African American patient? In the article Two-tier hospital
care a physician comments instead of focusing on why some people get special treatment,
we should be asking why everybody isnt getting treated as well as everybody deserves to be
treated. In other words, instead of focusing on why some people get more, we should be focusing
on why so many are getting less. These letters give a perspective from hospital staff and
physicians. There is an ethical element to this debate. If a physician is obligated to treat all
patients objectively, can that really be done if the patient is covered with a red blanket in a
$1,000 per night private room with private chef? I believe most physicians take their Hippocratic
Oath seriously but hospital administrators concerned with donations, may override a physicians
ethics.
My opinion
Lower-income Americans, Latinos and African Americans have higher mortality and
lower medical outcomes. Although the reasons for this are multifaceted, there are solutions. The
healthcare system does not operate in a fair and unbiased way. If a person has premium insurance
or money, they have opportunities not provided to the neediest Americans. Routine illnesses,
such as diabetes that are well maintained in wealthy Americans are killing or maiming (limb
amputations) low-income Americans. Race should not determine health outcomes but it does in

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the United States. More money does not mean better health care. The United States spends more
than our peer countries on healthcare and the outcomes are lower for many criteria.

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Works Cited
Clarke, Shoa A. "How Hospitals Coddle the Rich." The New York Times. The New York Times,
25 Oct. 2015. Web. 22 Nov. 2015.
Detsky, Allan. "Why America Is Losing the Health Race - The New Yorker." The New Yorker. 11
June 2014. Web. 22 Nov. 2015. <http://www.newyorker.com/tech/elements/why-americais-losing-the-health-race>.
Fiscella, MD, MPH, Kevin, Peter Franks, MD, Marthe R. Gold, MD, MPH, and Carolyn M.
Clancy, MD. "Inequality in Quality." JAMA Network. 17 May 2000. Web. 22 Nov. 2015.
Hartley, Dori. "Too Poor for Health Care, Too Rich for Medicaid." The Huffington Post.
TheHuffingtonPost.com, 19 Jan. 2014. Web. 22 Nov. 2015.
Luhby, Tami. "The New Inequality: Health Care." CNNMoney. Cable News Network, 18 Dec.
2013. Web. 22 Nov. 2015.
Pearl, MD, Robert. "Why Health Care Is Different If You're Black, Latino Or Poor." Forbes.
Forbes Magazine, 5 Mar. 2015. Web. 22 Nov. 2015.
"Two-Tier Hospital Care." The New York Times. The New York Times, 31 Oct. 2015. Web. 22
Nov. 2015.
Woolf, Steven H. "Shorter Lives." U.S. Health in International Perspective: Shorter Lives,
Poorer Health. Washington D.C.: National Academies, 2003. Print.