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Healthcare InequalityINTRODUCTIONThe United States spends $3.2 trillion on healthcare every year, about fifty percent more than any other industrialized nation in the world. The United States is also one of the only industrialized nation to not guarantee healthcare for all of its citizens (Wiley, 2014). The issues surrounding the inequality in America’s healthcare system have been in the national spotlight after the passing of The Affordable Care Act (ACA) in 2010. The issues have sparked an ideological and social controversy, as some see access to affordable/universal healthcare as a human right, and some see it as a government overstep. Health inequities are defined as systematic different opportunities that one or several have to access health care and to achieve health. These different opportunities that some have and some do not are not the only problem, the problem is the opportunities as well. Not only can a large portion of Americans not access health care, if they can access it, it is not the same quality and the cost is extremely high (Chandler, 2006). This cost deters some groups from accessing health care when they need it, consequently making the poor in our country the least healthy. Therefore, the rich have access to better quality health care, while those who cannot afford it have little to no access to health care at all. According to the CDC, 56 million Americans struggled to pay health care related costs in 2013, which is one out of every five adults in this country (Wiley, 2014).  Not only do the poor struggle with health care inequalities, but the middle class is also struggling with the cost of insurance and accessing proper medical care. Out of pocket medical costs for a family with private insurance had a bill of $17,749 per family on average. Due to out of pocket costs, 78 percent of adults with insurance failed to cover all of the costs of their health care visits (Wiley, 2014). CAUSES The causes of inequality in healthcare are complex in nature because of the interdependence on multiple factors that shape the structure of the United States. These causes are directly shaped by historical, institutional and societal structures that have subsequently allowed for all inequity and social injustices in our modern system (Daniels, 2001). Taking this notion of the overarching systematic and structural factors shaping social injustices, inequality in health care is deeply rooted in the societal and economic structure that we have created. Among those overarching structural factors causing health care inequality, more specific causes include poor health in itself and income. The United States, compared to 35 other developed countries, ranks 27th among them in life expectancy, has the fourth highest infant mortality rate, and the ninth highest likelihood of dying young from cardiovascular disease and cancer (Chandler, 2006). The United States also has an obesity rate of 37.9% of adults over 20. Although the causal roots of these statistics cannot be pinpointed to one specific reason or cause, the fact is that with having such an unhealthy population, the need for health care is higher. Thus, when there is inequality in health care with more and more people needing it, the inequality only grows more. Income inequality, in this context, refers to the gap between the rich and the poor die to an uneven distribution of income among the population. America’s top 1% averages over 40 times more income than the bottom 90 percent.LIBERAL EGALITARIANISM & DISTRIBUTIVE JUSTICE Egalitarianism is a protean philosophical school of thought, in which there are many different types of equality. These types of equality, in terms of justice, are ways that people may be treated the same or be treated equally as deemed advantageous to society from an ‘original’ position. This ‘original position’ is a hypothetical thought experiment developed by philosopher John Rawls, in which the principles of justice are determined behind a ‘veil of ignorance’ by a rational and self-interested person (Sypnowich, 2017). The ‘veil of ignorance’ means that one’s personal social status, ability, talent, race or other personal attributes/positions are not used when evaluating what the principles of justice should be in a well-ordered society. John Rawls’s liberal egalitarian theories of justice recognize that social justice is a feature of that ‘well-ordered society’, in which free and equal people are able to pursue their interests in harmony because of institutions that assign rights and duties and distribute the benefits and burdens of mutual cooperation.  Rawl’s aim is not to develop the institutions of a well-ordered society but to determine the principles that would be used to evaluate the possibilities.  The liberal egalitarian theory of justice is one type of way to look at equality, encompassing the values of equality, personal freedom, and personal responsibility. The foundations of the liberal egalitarian school of thought focuses on the balance of social and economic equality/inequalities, dependent on differences of personal choice. In terms of applying this theory to modern day society, the liberal egalitarian theory of justice argues that the policies of our society/government should provide equal opportunities for all, to a degree. While acknowledging inequalities, the system should also ensure the equal opportunity to someone with the same level of talent/skill regardless of their position within the economic/social system. Another important element is the belief in eliminating the effect of all factors outside of an individual’s control in terms of equal opportunity for all. In short, the liberal egalitarian theory of justice states that everyone in society should be inherently equal, have equal opportunities, and possess a level of equality of social status in respect to their personal capabilities dependent on their personal responsibility of choices.LIBERAL EGALITARIANISM & HEALTH CARE INEQUALITY Liberal egalitarianism is a useful theoretical approach to analyzing the implications of health care inequality in America because social justice is seen as a principle of a well-ordered society. Within the realm of liberal egalitarian thinking, health care inequality is a social justice issue because the unequal distribution of wealth due to unequal opportunity is not the responsibility of those who are at a disadvantage because of it. Those who are poor or disadvantaged and are unable to access health care are not the same people who structured the system which they all coexist in. Therefore, the notion of holding individuals accountable for their choices in the context of health care is obsolete, because they have nothing to be responsible for. The health care system was structured the opposite way that Rawls’ would describe a ‘well-ordered society’. The veil of ignorance was not used when envisioning the current system we have, because our health care system is not beneficial to all. The health care system is based solely off profits, and was designed to care for only those who can afford to pay for it. The poor and disadvantaged now are being affected most by these disparities and have no way to fix the system that is built against them. This is an injustice because those with the ability to change the system to make it beneficial for all are benefitting from the way that it is now, and are self-interested by nature.

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