The way Dr. David A. Ansell sees it, universal healthcare is not only needed in the U.S., it is part of ensuring a human right embedded in the Constitution and international law.
“This is really not a matter of left or right, but right and wrong,” Ansell said earlier this month during a community presentation and discussion at WMed’s W.E. Upjohn M.D. Campus in downtown Kalamazoo. “The reason I say it is there are 30 countries in the world of all different ilks, all of them capitalist countries, that have decided that universal healthcare is the right thing to do.”
Dr. Ansell’s contention comes at a time when life expectancy in the U.S. is falling, especially among those living in poverty. At the same time, other developed countries like Canada, which has universal healthcare, are seeing life expectancy rates increase.
Dr. Ansell, who is senior vice president and associate provost for Community Health Equity at Rush University Medical Center in Chicago, is an author and advocate who has amassed 40 years of experience serving patients on Chicago’s South Side. He has written two books – “County: Life, Death, and Politics at Chicago’s Public Hospital” and, more recently, “The Death Gap: How Inequality Kills.”
Dr. Ansell visited WMed on June 6 to discuss what he called the human consequences of structural violence that stems from racial and class inequities, and what must be done to make things right. More than 250 people filled the auditorium at the Upjohn Campus to listen to Dr. Ansell and take part in a question-and-answer session after Dr. Ansell’s presentation.
Dr. Ansell’s visit was co-sponsored by WMed, the Western Michigan University Lewis Walker Institute for the Study of Race and Ethnic Relations, ISAAC, YWCA Kalamazoo and Organize West Michigan.
Dr. Ansell told the crowd at WMed that he decided to be a doctor “because that was clearly going to be good” but discovered quickly during medical school in Syracuse, New York, there were “huge inequities, things that are wrong.”
Dr. Ansell said he later decided to quit medical school to become a forest ranger, but during that time met a group of other medical students and began studying the U.S. healthcare system.
“At that moment, I knew what I wanted to do was be a doctor, but I figured out in that moment … why I wanted to be a doctor and that was that healthcare was a human right. I decided in that moment in time that I was not only going to become a doctor, but I was going to become a human rights activist and that that was really my core job and I’ve carried that with me everywhere I’ve gone.”
Dr. Ansell completed his residency at Cook County Hospital in Chicago, a facility he described as “run down” and “decrepit” at the time. He contended that the condition of the hospital was allowed because of the patients it served – black and brown people who were poor.
During his time at Cook County Hospital, Dr. Ansell said the phenomenon of “patient dumping” – transferring patients from one hospital to another because they’re uninsured – was rampant at the time. Many of those patients made their way to Cook County and as patient dumping grew, Dr. Ansell said he and other residents at the hospital decided to conduct a study that turned into “an experience in speaking up.”
What the study revealed, he said, was that many of the patients who were “dumped” at Cook County Hospital were told that the facility they were transferred from had no beds while doctors at Cook County were told the patients were transferred because they had no health insurance.
The phenomenon of patient dumping had a disparate impact on black and brown patients, Dr. Ansell said, and presented a clear example of structural racism in which systems set up in the U.S. replicate social injustices “that have white on top and black and brown on the bottom.”
The study by Dr. Ansell and the other residents at Cook County Hospital was published in the New England Journal of Medicine in the 1980s and led to the passage of the Emergency Medical Treatment and Labor Act, which requires hospitals to treat patients with an emergency condition regardless of their ability to pay or if they have insurance.
“It’s the only form of universal health care we have in this country because people spoke up,” Dr. Ansell said. “The point is it’s not enough in life just to show up and smile. You have to do something and we learned that at County.”
In addition to discussing his experiences at Cook County Hospital, Dr. Ansell also addressed what he said is an ever-widening inequality and death gap in the U.S.
He presented statistics about the issue with numbers drawn from neighborhoods in Chicago. For example, he said the life expectancy of residents who live in The Loop in Chicago is 85 years old while those living in Chicago’s Garfield Park have a life expectancy of just 69 years.
That gap – 16 years – is larger than the life expectancy gap between the entire U.S. population and Haiti. In some cities in the U.S., Dr. Ansell said, the gap in life expectancy is as much as 15 or even 35 years.
“It’s one street and two worlds in very place in this country,” Dr. Ansell said. “Even in Kalamazoo.”
He said neighborhoods with low life expectancy rates are marked by poverty and high economic hardship. That poverty, he contends, is caused by structural violence, which he said stems from the passage of laws, and procedures and practices in the U.S. that systematically disadvantage some more than others.
“When you think of these neighborhoods of concentrated disadvantage, you have to think of them as valleys and the mountains are like The Loop and those mountains couldn’t exist without the wealth in these neighborhoods being expropriated through legal means, laws, business practices, jobs leaving the area,” he said. “We have more concentrated wealth than we’ve ever had in this country.”
Dr. Ansell said the good news, though, is that once a problem has been recognized “there are things you can do about it.”
Moving forward, Dr. Ansell said a move toward universal healthcare in the U.S. is needed. He told the crowd at WMed that recent surveys show that more than 80 percent of Americans agree that healthcare is a moral issue and the U.S. should follow the lead of other developed countries on universal healthcare.
Dr. Ansell said Americans worry regularly about healthcare and healthcare costs and often skip care as deductibles are continuing to rise in a system that he said is not sustainable.
“We’re so privileged to do this work and I never get down or despair,” Dr. Ansell said. “I know that the arc of the universe bends toward justice but it requires us to bend it.”