America has always been a nation divided. The country fought over its divisions in a gruesome war, one side lost, and the nation stitched itself together again. But the stitches never healed and America never adopted a unified identity. This lack of identity led to smaller wars, culture wars, including conservative values versus liberal values, and the role of government versus the responsibility of the individual.

And with the election of Donald Trump, America's culture wars has reached fever pitch. So much so that some people believe America is headed for a second Civil War; but if not war, towards defining a new national identity. But don't underestimate America's ability to make minor adjustments and put off making tough decisions. A second American civil war is unlikely, but so is adopting a national identity acceptable to all. More than likely, America will move in the direction of greater universality in some areas because political and social forces at the time pushed us there.

We are currently experiencing a grudging push by some toward universal health care because, despite Trump supporters' hatred of their cultural opposites, many of them need assistance paying for health care. Even conservative columnist, George Will, thinks single payer health care in America is inevitable. This is good news for single payer advocates like me because single payer would improve access to health care. On the other hand, single payer health care will not reduce the cost of health care because America is not ready or willing to address the issues that make American health care so expensive, especially the issue of poverty.

In his new book, Poverty and the Myths of Health Care Reform, the late Richard (Buz) Cooper, MD, claims that poverty "explains all the differences in the price of health care among different regions of the country." Not everyone agrees with Dr. Cooper's assertion that poverty explains all medical care price differences by locality, including me. High hospital, pharmaceutical, doctor and other vendor charges, as well as waste, including over-treatment play a role in high health care costs. But, I do agree that poverty also plays a significant role in sky-high American health care expenses.

Health care utilization among the poor is higher than among the less poor and wealthy, and it is becoming increasingly so. As Dr. Cooper points out in his book, this was not always the case, but it has been for decades now. The entire premise of the book is that if America does not address its poverty issue, health care costs will continue to rise. There is no government plan or program that will significantly decrease health care costs if all Americans do not have a basic standard of living. And this is where American culture enters the stage. Poverty in itself should be a source of national shame. The richest country in the world is willing to ignore the suffering of tens of millions of its citizens because part of the country views poverty as a personal failing, unworthy of help.

Conclusion

So, America may get a different health care system—it may even be universal, but we won't get an affordable health care system unless we address the greatest ills of our society. And with conservatives in power at the federal and most state government levels, there's little hope in addressing issues they view as personal, not societal. Meanwhile, countless people suffer needlessly, including dying before they should.


Note: I don't get any money for saying this, but Dr. Cooper's book deserves a read by anyone interested in health care reform. As I stated, there are many things I disagree with in the book. I think he gives American physicians and hospitals a pass on the high prices they charge for their services. But I think he is dead on in saying that unless we help the poor, through policy, with basics like decent housing, food, education and job opportunities that provide a living wage, our health care system will have to deal with the effects of their want.

Tags: obamacare, Poverty, health care reform, American culture