Disparities in Healthcare for Younger and Older Americans: An Examination of Access, Quality, and Policy Solutions

July2024 by WovenCare Advocacy Services

Healthcare disparities in the United States are well-documented, affecting people of different ages, socioeconomic statuses, and racial backgrounds. While much attention is often given to the challenges faced by the elderly, younger Americans also face significant obstacles in accessing quality healthcare. This article explores these disparities, considers whether older Americans should seek healthcare abroad, and discusses policy solutions to improve access and quality for all.

Introduction

Healthcare in the United States is a contentious topic, marked by significant disparities in access and quality. These disparities are particularly stark when comparing younger and older populations. Younger Americans often struggle with affordability and access, while older adults face challenges related to prescription costs and the availability of comprehensive care. This article aims to explore these disparities and propose actionable solutions.

Disparities in Healthcare Access and Quality

Younger Americans

Younger Americans, particularly those under 40, often face difficulties in accessing affordable healthcare. Several factors contribute to these challenges:

• Insurance Coverage: While the Affordable Care Act (ACA) has increased coverage, many young adults still find themselves uninsured or underinsured. According to the U.S. Census Bureau, in 2021, approximately 10.5% of adults aged 18-34 were uninsured.
• High Out-of-Pocket Costs: Even with insurance, high deductibles and copays can deter young adults from seeking necessary medical care. The Commonwealth Fund reported that in 2020, 44% of adults aged 19-34 skipped or delayed care due to costs.
• Mental Health: Younger people often face mental health challenges but encounter barriers to accessing care, such as stigma, lack of mental health providers, and insufficient insurance coverage for mental health services.

Older Americans

Older Americans, particularly those aged 65 and over, face their own set of healthcare challenges:

• Prescription Drug Costs: Despite Medicare Part D, many older adults struggle with the high cost of prescription medications. The Kaiser Family Foundation found that in 2019, 23% of older adults reported not filling a prescription due to cost.
• Long-Term Care: As people age, the need for long-term care services increases, but these services are often not covered by Medicare, leading to significant out-of-pocket expenses.
• Access to Specialists: Older adults may also face difficulties accessing specialist care, particularly in rural areas where healthcare providers are scarce.

Should Older Americans Seek Healthcare Abroad?

The high cost of prescription medications and healthcare services in the United States has led some older Americans to consider seeking care abroad. Medical tourism is a growing trend, with countries like Mexico, Canada, and India offering more affordable healthcare options. However, this solution is not without risks:

• Quality of Care: While many countries offer high-quality healthcare, standards can vary widely. Patients must thoroughly research providers and facilities.
• Follow-Up Care: Post-treatment care can be challenging when it involves international travel.
• Legal and Regulatory Issues: Patients may have limited legal recourse if complications arise from treatment received abroad.

Despite these risks, medical tourism can be a viable option for those facing prohibitive costs in the U.S. However, it is not a long-term solution to the systemic issues within the American healthcare system.

Policy Solutions for Improving Healthcare Access and Quality

Ensuring Access to Medical Doctors

One significant issue in the American healthcare system is the reliance on physician assistants (PAs) and nurse practitioners (NPs) instead of medical doctors (MDs). While PAs and NPs play crucial roles in healthcare delivery, some patients feel they receive better care from MDs. To address this:

• Increase Medical School Funding: Expanding funding for medical schools and residency programs can help produce more MDs, particularly in underserved areas.
• Loan Forgiveness Programs: Offering loan forgiveness for doctors who work in rural or underserved urban areas can incentivize more MDs to practice in these regions.
• Telemedicine Expansion: Telemedicine can bridge the gap in areas with a shortage of MDs, providing patients with access to specialists and primary care doctors remotely.

Expanding Medicare Eligibility

Currently, Medicare is primarily available to those aged 65 and over, but expanding eligibility could help address the healthcare needs of younger populations with health issues:

• Lower the Age of Eligibility: Reducing the Medicare eligibility age to 60 or even 55 could provide millions of Americans with affordable healthcare coverage.
• Expand Disability Coverage: Making it easier for individuals with disabilities to qualify for Medicare, regardless of age, can ensure that more people receive necessary care.
• Public Option: Introducing a public option that mirrors Medicare could provide an affordable alternative for those not yet eligible for Medicare.

Health-Related Issues Before Retirement

Many Americans experience significant health issues before reaching retirement age. Chronic conditions such as diabetes, hypertension, and heart disease often manifest in middle age. According to the Centers for Disease Control and Prevention (CDC), nearly 50% of adults have at least one chronic condition, and these conditions often begin developing well before age 65.

Statistics on Health Issues Pre-Retirement

• Diabetes: The CDC reports that approximately 34.2 million Americans have diabetes, with the majority diagnosed in middle age.
• Hypertension: Nearly half of adults in the U.S. have hypertension, a major risk factor for heart disease and stroke.
• Obesity: Over 40% of adults are classified as obese, leading to increased risk for numerous health conditions.

Conclusion

Healthcare disparities in the United States are complex and multifaceted, affecting both younger and older populations. Younger Americans struggle with affordability and access, while older adults face challenges related to prescription costs and comprehensive care. While seeking healthcare abroad may be a short-term solution for some, systemic changes are necessary to address these disparities.

Increasing access to medical doctors, expanding Medicare eligibility, and addressing the health issues that arise before retirement age are crucial steps in creating a more equitable healthcare system. By implementing these policy solutions, the United States can ensure that all its citizens, regardless of age, have access to the quality healthcare they deserve.

References

U.S. Census Bureau. (2021). Health Insurance Coverage in the United States: 2021. Retrieved from https://www.census.gov/library/publications/2022/demo/p60-276.html
The Commonwealth Fund. (2020). How High Is America’s Health Care Cost Burden? Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2020/jun/how-high-americas-health-care-cost-burden
Kaiser Family Foundation. (2019). Health Care Costs for Older Adults. Retrieved from https://www.kff.org/health-costs/report/health-care-costs-for-older-adults/
Centers for Disease Control and Prevention. (2021). Chronic Diseases in America. Retrieved from https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm