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The 2016 Election and Income Inequality

For years, we have read periodic articles and studies on growing income inequality in the United States and across the globe. Every year, a greater percentage of global wealth is concentrated in the hands of a small percentage of the ultra-rich, and the gap between CEOs and hourly wage earners in their corporations is now measured in multiples of one hundred. In this brief writing, we will explore the connected dots between healthcare, income inequality, and the 2016 election. In fact, the U.S. healthcare system is a microcosm of the broader income inequality issue.

According to the all-knowing Wikipedia, “The top 1 percent of income earners in the U.S. received approximately 20 percent of the pre-tax income in 2013, versus approximately 10 percent from 1950-1980. The top 1 percent is not homogeneous, with the very top income households pulling away from others in the top 1 percent. For example, the top 0.1 percent of households received approximately 10 percent of the pre-tax income in 2013, versus approximately 3-4 percent between 1951-1981. A 2011 study by the CBO found that the top earning 1 percent of households increased their income by about 275 percent after federal taxes and income transfers over a period between 1979 and 2007, compared to a gain of just under 40 percent for the 60 percent in the middle of America’s income distribution.”

The Economic Policy Institute (EPI) says that “CEOs make 276 times more than typical workers.”

I think the poisonous fruits of income inequality may be finally affecting U.S. society in high-profile and tangible ways. Let’s consider the presidential election for a moment. For years, pollsters have segmented the American electorate on dozens of factors – race, gender, education, religion, income, psychographic factors, you name it – and yet this year those tried and true methods were much less reliable than ever before. Some have even called the 2016 presidential election an “unpollable” election given the dynamics of the race.

But what if it’s not the election that was “unpollable?” What if years of income inequality, exacerbated by the Great Recession of 2008 and the painfully slow recovery, have finally upended the shaky social structure of the last 25-30 years? What if the new divide is not race or gender but potential – the potential to be successful, to have a home and a reliable good-paying job, to send your kids to safe schools with the confidence that their life could be better than yours? If you can’t achieve it, your resentment of those who have it will be incredibly intense.

When Peggy Noonan, an amazingly insightful Wall Street Journal columnist, writes about distrust in the elites and a widening gulf between Washington D.C. and real people in the heartland, she speaks about the belief that real people always see themselves on the losing end of a rigged game. In my view, this is a political manifestation of an economic problem called income inequality, and it represents an existential threat to the American Dream. If this isn’t the land of opportunity, where anyone can be successful and rags-to-riches stories are part of the national fabric, what are we?

Rightly, you may be asking, what does this have to do with our healthcare system? The simmering resentment created by income inequality has roots in the healthcare system, where there have long been perceptions of a tiered system that rations care based on ability to pay. Anyone who works in healthcare knows there is some truth to this perceived reality.

Beyond the myriad and deeply complex policy issues, there are quality, access, and price issues that affect everyone in the healthcare system – hospitals, physicians, health plans, patients, and their families. Healthcare providers and health plans can nuance their marketing to account for the side effects of income inequality. We can empathize and connect with people if we understand them, and we can tailor our marketing to address their concerns and fears.

And healthcare organizations can take a hard look at their own organizations and work to shrink income inequality in their own workforce, if that’s an issue. We can “keep our side of the street clean” and set an example for other industries, even if it forces us to make difficult choices and tradeoffs.

February 8, 2018
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