The Centers for Medicare and Medicaid Services (CMS) made headlines this month after announcing they would not approve lifetime limits on Medicaid from any state. The ruling came shortly after CMS had also knocked back a request from Kansas state to impose three-year periods on its Medicaid eligibility.
These moves may seem surprising from an administration that has openly declared war on America’s medical system. But in reality, they are mere window-dressing for the abysmal state of healthcare systems in North America, since even Canada’s healthcare – widely regarded as a paragon of how healthcare is “done right” – suffers from the same shortfalls as the US.
Even if the CMS effectively kept overzealous conservative policy-makers in check, this is at best a minor victory. A raft of policies is being discussed at the same time that would turn the 2010 Affordable Care Act and Medicaid, the supposed safety net for the poor, into a vehicle of discrimination.
The primary beneficiaries of the act were minorities, who are traditionally disproportionately affected by a medical coverage gap. In 2013, 53% of those in the coverage gap were from a minority group – a huge rate considering that only 23.1% of the total population are non-white. However, under the Trump administration, that problem is only getting worse. A prime example is a recent billintroduced by Michigan, under which access to Medicaid will be revoked for those who work less than 29 hours per week. People living in counties with high unemployment are exempt – but not those living in cities with the same.
The perfidiousness of this proposal is hard to overstate due to its racially discriminatory effect. Under these conditions, the bill becomes a direct attack on the black community, which is mainly concentrated in cities such as Detroit, Flint and Muskegon. Although unemployment rates here are elevated, the surrounding affluence of the suburbs brings the county average down. As a result, the unemployed black populace may lose their healthcare, while their white counterparts living rurally will not.
The bill has understandably caused an outrage, but it’s not only ethnic minorities that have been given a rough ride under Trump’s tenure. Women have also been under attack, with new threats from the administration to withdraw Title X family planning funding from any facility offering abortion services. As this doesn’t technically regulate the service itself, the idea may well come to fruition at the expense of women’s health across the country.
This assault on women’s reproductive freedoms is especially vexing given that Title X funding is very rarely used to subsidize abortions, except in extreme cases. Instead, it’s devoted to screening for serious conditions such as cancer and HIV, as well as contraception. Ironically, the proliferation of contraceptives over the last few decades have led to a decline in abortions since they were officially made legal, but the GOP’s proposals could undermine this progress by making adequate protection more difficult to obtain.
While the problems of prejudice in the US are well-documented, critics of the US system are readily pointing north of the border, hailing Canada for its supposedly progressive healthcare system. However, not everything that glitters is gold, and a closer look reveals that Canada’s healthcare system suffers from some of the same structural and moral deficiencies as America’s – with the difference that barely anyone talks about them.
A dearth of racial data in Canada makes it difficult to quantify the issue in concrete terms, but from the outset it’s clear that people from African, Arab and First Nation backgrounds aren’t receiving equal treatment. Add to this mountains of anecdotal evidence and a bleak picture emerges of how minorities are subconsciously or overtly discriminated against on a daily basis.
Indeed, just like in the US, minorities are more likely to be left out in the cold than others. Unable to afford the high costs of certain medical treatments – costs any just system should cover for them but doesn’t – they are left to fend for themselves. This is already a deeply disturbing scenario in general terms. However, when rare genetic conditions like Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA) are added into the mix, the outlook of patients turns from bad to catastrophic.
After all, for those who suffer from rare diseases, it doesn’t matter their race, gender, or status – it’s safe to say that they are all equally discriminated against by regulators, which have a shameful history of frequently dragging their feet in approving new treatments that come to market. For instance, Spinraza – the only viable treatment for SMA – is still not covered by standard healthcare plans, leading to petitions in 2017 and protests in 2018 to end the status quo.
Despite activists’ efforts to get the government to fund the drug, there is no guarantee there will be progress. On the contrary, if Canadian provinces accept the recommendations of the Canadian Agency for Drugs and Technologies in Health (CADTH), the most vulnerable may stand to lose access to Spinraza.
Sadly, this is par for the course when it comes to those with genetic conditions. Patients with DMD, too, have been woefully neglected when it comes to getting access to much-needed treatments. Deflazacort, the main treatment for this debilitating condition, has not yet been approved in Canada, which means that patients need to apply to Health Canada’s Special Access Program – an unacceptably long and unwieldy process.
It’s clear that with so many obstacles to overcome, North American healthcare systems have a long road ahead. If things continue as they are, a system intended to stop the most vulnerable members of society from falling through its cracks may actually prize them even further apart. Politicians in the US and Canada have sabotaged healthcare for too long. Eliminating discrimination once and for all means achieving a level of healthcare that truly is as universal as it ought to be.