140428_cartoon_054_a18174_p465According to new research by Emmanuel Saez of the University of California at Berkeley and Gabriel Zucman of the London School of Economics, the richest one-hundredth of one percent of Americans now hold over 11 percent of the nation’s total wealth. That’s a higher share than the top .01 percent held in 1929, before the Great Crash.

We’re talking about 16,000 people, each worth at least $110 million. Robert Reich

None of my patients, that I am aware of, has $110,000,000. No one I know has a private jet.

My patients are more likely to have cars that are unreliable. They get rides from strangers to get to their appointments. They catch a bus  that is so unreliable they ride all morning for a 2:30 appointment and then spend the rest of the evening getting back home. I saw a patient last week who had kept her child home from school for a week with asthma in part because she couldn’t get a ride from her house and there is no bus that goes out that far. Perhaps a jet would have helped but I doubt it.

What does help my patients is Medicaid. About half of the folks that we see have Medicaid. In Alabama, as I have said before, one needs to be VERY poor to qualify for Medicaid, so these are folks that have a lot of other problems associated with poverty as well. My residents and I spend a lot of effort working around transportation issues, dysfunctional family issues, and other “social” issues. At times, the task seems overwhelming.

Referred to as the social determinants of health, this term describe “the array of complex forces that shape and influence the public’s health, often out of clinician sight. These include poverty, income inequality, lack of access to affordable and nutritious food, lack of educational and employment opportunities, violence and racism.” In a recently completed well designed study, investigators showed that access for poor people via Medicaid leads to higher wages, fewer arrests, and a greater likelihood of college graduation. These things in turn lead to better health. Other studies are showing that permanent supportive housing for folks suffering from mental illness goes a long way to reducing the cost to the public of these individuals. People who live in food deserts are more likely to be poor, obese, pay more for healthy food, and make unhealthy choices.

We do as much as we can in our exam room but me, my residents, and my patients
need your help. First, Medicaid is increasingly shown not to be a “broken system”  but life saving to those in need. Support expansion, especially here in Alabama where many are one illness away from bankruptcy. Secondly, while many things contribute to poverty, substandard housing and expensive, unreliable transportation contribute the most. Support policies that mitigate the effect of these such as housing subsidies and transportation alternatives. Third, obesity and related diseases (heart disease, diabetes, arthritis) are clearly related to food policies that benefit agri-business. Buy local and support those who do as well as supporting policies that increase access to healthy food. Lastly, educational attainment predicts economic success with college graduates earning double that of non-college graduates. Support policies that lead to better access to education.

Also, if you are in the top 0.01%, you could give up your private jet and give the money to our residency. Please contact me off-line for this one.