Health care consolidation may offer some promise, and potentially some peril, but we should determine how it impacts those communities with the poorest health and thereby addresses health inequality. After all, those who have the means can already access the greatest medical services, technology, and expertise in the world. Our global rankings in health outcomes do not match our health expenditures because of the disproportionate health burdens suffered by low socioeconomic communities. They are subjected to poor health services, if they receive any at all.
How, then, does consolidation address barriers these vulnerable citizens face, such as geography, cost, and a lack of profitability in addressing many of their health needs? If we are to accept the proposition that consolidation will lead to integrated health care, those who are already receiving the benefits of our current system will inevitably be rewarded. But is there evidence that these benefits will trickle down to those who suffer most?
Moreover, health disparities do not arise only, or even primarily, from health care disparities; heath disparities instead stem largely from social determinants of health that differentially affect minority and low-income communities. The water issues in Flint are an unfortunate reminder that health can no longer be narrowly addressed through improvements in health care services. What good is increased insurance coverage and improved medical technology for those consuming poisoned water from birth?
And this is not just in Flint. As one article rightly pointed out, “America is Flint!” While 4.9 percent of children in Flint have elevated levels of lead, in the most recent data for Iowa 32 percent of tested children had elevated lead levels. The Centers for Disease Control and Prevention (CDC) estimates that 535,000 children between the ages of 1 and 5 suffer from lead poisoning, which research has associated with impaired cognitive development associated with violent and criminal behavior.