The Death Gap: How Inequality Kills

Ansell argues that the fundamental perception of healthcare in the United States—whether it is treated as a human right or a commodity—significantly influences health outcomes and perpetuates systemic inequities. Ansell’s exploration of this theme reveals both ethical and practical implications, stressing the need for a paradigm shift in how healthcare is conceptualized and delivered.

Ansell argues that treating healthcare as a commodity inherently prioritizes profit over patient well-being, leading to significant disparities in access and quality of care. This market-driven approach creates a healthcare system where those with financial resources can secure high-quality care, while marginalized and low-income populations face barriers to basic medical services. Ansell illustrates this with stark examples from his experience as a physician in Chicago, where hospitals in affluent areas offer advanced treatments and state-of-the-art facilities, while those in impoverished neighborhoods struggle with underfunding and limited resources. This discrepancy reflects deeper systemic issues where financial incentives overshadow the ethical imperative to provide equitable care.

Ansell juxtaposes the market-driven understanding of the healthcare system as a commodity with a more fundamental, humanistic attitude, which is at the foundation of his book. He argues that “health is a fundamental human right and not a commodity to be traded and sold in a marketplace” (13). This humanistic approach underscores the moral responsibility to assist those suffering without discrimination. Ansell also draws on the principles of social justice to argue that access to healthcare is a fundamental human right that should not be contingent on one’s socioeconomic status. This perspective aligns with the views of Friedrich Engels and Rudolf Virchow (See: Background), whom Ansell references (XXII) to emphasize that health disparities are a consequence of social conditions and require political solutions. By framing healthcare as a right, Ansell advocates for a system that prioritizes human dignity and equality, ensuring that all individuals receive the care they need regardless of their financial situation.

Ansell asserts that commodification of healthcare results in significant inefficiencies and poorer health outcomes. Ansell points out that a market-driven healthcare system leads to fragmented care, where patients often experience disruptions in treatment due to insurance changes or cost barriers. This fragmentation can result in delayed diagnoses, inadequate treatment, and ultimately, higher mortality rates. The example of Windora Bradley, a long-time patient of Ansell, illustrates the devastating consequences of such a system. Despite her best efforts to manage her health, Bradley’s experience with rising insurance costs and changing plans left her without consistent access to the care she needed.

Ansell critiques the Affordable Care Act (ACA) for addressing some aspects of healthcare access while perpetuating the underlying commodification of health services. Although the ACA expanded insurance coverage to millions of Americans, it did not fundamentally alter the market-based nature of the system. Ansell’s analysis suggests that true health justice requires a more radical approach, such as adopting a single-payer system that treats healthcare as a public good rather than a market commodity.