Being poor is expensive. If you've ever been in poverty, you've learned this firsthand. The old shoes you buy on the cheap break down faster, not to mention they have less support. This leads to you 1) having to buy shoes more often and 2) having to go to a doctor more frequently. This economic concept is handily explained as the "Boots theory".1 This trend hardly stops at shoes. People are forced to buy food that's less nutritious, they're forced to live in conditions less built for humans to thrive, and they're less likely to have access to medical intervention. In America, even if you do reach the doctor, it's likely you can't afford it anyways.
This health and poverty relationship isn't new. But, the intensity of this inequality is only growing. A 2021 report done by the CDC's National Center for Health Statistics found that over the counter medicine cost increased by 4.8% in that year alone.2 In fact, that same report found that 9% of women and 7.1% of men didn't take medication as prescribed due to cost. This is a large population, when you consider that 60% of all adults take at least one prescription pill. That would mean about 15.8 million Americans who are prescribed a pill aren't taking it explicitly due to cost. Even more troubling, this report indicates the problem is getting worse, as corporations continually push the price of their pills for profit. The price of medicine is getting higher, not lower. We could soon be looking down the barrel of 1 out of 10 Americans refusing to take medication solely due to price. This is an abject failure of our society.
This valid fear became a powerful source of conspiratorial thinking in the far right of the modern day. Conspiracists passed on multiple theories surrounding Covid-19 regarding for-profit medicine: hospitals being death camps, COVID-19 vaccinations being useless for monetary purposes, or the use of masks as a form of control. All of these conspiracies tied into a very real fear of medical control - a hierarchy of health. None of them exemplify this stronger than the "Medbed" conspiracy of QAnon and adjacent groups. In these circles, online posters spread rumors of hidden, magical devices capable of curing any ailment. QAnon'ers posted gleefully in forums on the coming appearance of these magic beds. Meanwhile, TikTok was flooded with stories about the origin of these magical devices. Aliens, secret government technology - it was clear that the era of disease was over. Of course, these medical miracles would be forever locked away. Reportedly, greedy agents secretly in control of our government would never give such technology to the people.
While the reality of the situation is far from that dire, there is a kernel of legitimacy to these fears. Magic devices capable of fixing any disease are far outside the capabilities of mankind. This is because the damages of living life are more sinister and long lasting than any quick fix could hope to soothe. Long term poor nutrition and stress would require a restructuring of the human body, far beyond the capabilities of any one procedure. Cancer risks skyrocket based on lifestyle choice, with heart disease affected just as well. These small wounds to us are just that - small. With enough capital and intense focus, they can be consistently avoided.
Of course, it's not impossible to live healthy and long on a budget, but it's definitely hard. Especially living in a demanding capitalist country, not having money can be literally deleterious to one's health. Not to mention, systemic discrimination leads to poorer health returns. For example, even with modern medicine, black women in the United States are 3 times more likely to die during childbirth than white women.3 Furthermore, women of color (except for Asian Americans) are significantly more likely to have pre-term births (which lead to more birth defects).4 The health system is significantly influenced by race and socioeconomic status.
This creates a tiered list of citizens, those at the top (white, straight, male) are more likely to receive consistently good care. This isn't news to a lot of people. What might be news is how that stratification is likely to change. While diversity and equity in health movements are trying to increase healthcare in minority groups, there is nothing being done to stop the class disparity of healthcare. The USA is a for profit medical system only. In America, if you don't have money, you don't deserve to live. More so, if you don't have enough money, you don't deserve to live long.
Longevity, the length of life, is a billion dollar business. The IMARC research firm evaluates anti-aging science to be worth 98.6 billion dollars by 2028 (it reached 67.2 billion dollars in 2022).5 Billionaires around the world throw money at research teams dedicated to finding the answer to immortality. A lot of this research goes into regenerative medicine and tissue engineering, which, granted, do benefit other fields. But, the money incentive is only in one direction - finding the cure to aging. While we will never stop aging, this research serves to create small treatments that can give patients a few more years. Combine those with the lifetime of better nutrition and more access to medical care, and soon we'll see a stark difference in lifespan between the have's and have-not's.
Yet, while these new treatments would serve to make the richest live longer, health disparities in the lowest class will only grow. As these technologies become less accessible, the upper class will see this as a sign of prestige. Research and technology focusing on the benefit of the uppermost class will always have a monetary skew - billionaires are more interested in saving themselves than the masses. Money that could have been used on other projects more applicable to the majority of Americans.
The rich are getting richer and using that money to improve their own lives while forgetting about everyone else (what else is new?). This stark difference in our lives with the rich comes into focus here, as new medications have become so expensive they are downright inaccessible to everyone except the richest. CAR-T cell therapy, one of the newest anti-cancer treatments on the market, is one million dollars per treatment.6 That doesn't include hospital costs, other procedures, or the cost of medicine administration. Just to order the drug is a million dollars! This treatment, which has already started to save lives, will never be accessible to 98% of the American population. This medicine is already on the market, the next iteration likely more complex and costly.
Obviously, there needs to be a different approach to medicine in America. Our healthcare is stratified. We have an elite class with access to near mystical treatments, not to mention a life that avoids the constant stresses of poverty. On the other hand, we have a massive swell of Americans who type fantasies online about healthcare. They write longingly for science fiction devices capable of saving their daughters, their fathers, their nephews, themselves. Correctly damning big pharmaceutical companies without the means to do anything, instead the masses of America can only fantasize. As a result, this gap will only widen. The pockets of Big Pharma grow deeper, the elite live longer, and the poor will continue to get poorer.
For-profit medicine cannot work. It propagates a "Capital Health Hierarchy" - money gives you life. Capitalism inherently benefits those with the most wealth, which reinforces oppressive hierarchies. It's true there are scientific organizations attempting to combat racial disparities in medicine. However, there will never be a private organization who seeks to stop disparities based on class. It's antithetical to their existence. In fact, private organizations are more likely to widen these disparities than to fix them. Cutting edge research requires millions of dollars of funding to turn billions of dollars of profit - these numbers continually grow decade by decade. When will we face a 10 million dollar cancer vaccine? A 30 million dollar treatment to extend life by 20 years? What will it cost to cure Ehlers-Danlos syndrome, or Lou Gehrig's disease? What happens if you can't afford the cure?
I guess I write this because I hope that America will change. One thing almost every American knows is the fear of the medical bill - a catastrophe that can destroy your life savings in a moment. We call Ubers instead of ambulances, or just hope "that pain" will go away eventually. Some of us choose to fight for a change - to make medicine free for everyone. Others, convinced it's outside of their means to change, turn to the fantastical. Hidden medbeds capable of curing disease are around the corner, they'd say. But all of them - the disheartened medbed seeker and the angry left wing protestor, have the same pain. All of them see the health hierarchy we live in. The average American will soon be edged out of the average healthcare treatment.
I just hope we can realize a fix before it's too late.
https://en.wikipedia.org/wiki/Boots_theory
https://www.cdc.gov/nchs/data/databriefs/db470.pdf
ibid.
https://www.imarcgroup.com/anti-aging-market
https://www.nature.com/articles/d41586-023-01389-z