Universal Health Care as a Health Disparity Intervention

Health disparities have been the focus of intense scholarly interest over the past decade, with about 2000 articles and 150 books devoted to the subject. To help make sense of this burgeoning literature, I find it useful to categorize work in health disparities into 3 sequential phases. First, in the descriptive phase, we identify the presence of a disparity by race, sex, socioeconomic status, type of health insurance, or some other relevant grouping. Second, in the mechanistic phase, we determine the reasons for the disparity. Third, in the interventional phase, we use our descriptive and mechanistic findings to develop and test an intervention to reduce or eliminate the disparity.

Nearly 50 million U.S. residents lack health insurance, and a great deal of the work on health disparities has focused on comparisons between them and insured persons. From a descriptive perspective, we know that uninsured persons have worse health outcomes than insured persons. For example, uninsured patients with breast cancer have 30% to 50% higher mortality and uninsured accident victims have 37% higher mortality than their insured counterparts (1). From a mechanistic perspective, we know that uninsured persons receive less ambulatory care and diagnostic testing, have more difficulty obtaining prescription medications, and often delay seeking care because of cost concerns (2).

Sadly, this descriptive and mechanistic knowledge has not yet led …