The power of Tony Judt’s new book, “Ill Fares the Land,” is in his assertive exposition of the corrosive effects of income inequality – a problem that is greater in the US than in any other Western democracy. “Poverty,” he says, “is an abstraction, even for the poor. But the symptoms of collective impoverishment are all about us.” Not only in crimes committed, which are actually decreasing, but in gated communities and the incarceration of young black males, both of which erode our social fabric.
Nowhere are the effects of income inequality more evident than in health. Judt cites Wilkinson and Pickett’s recent book, “The Spirit Level,” which chronicles the relationships between poverty and ill health. And ill health begets health care spending, so it should not be surprising that the added health care costs associated with poverty account for as much as one-third of health care spending in dense urban centers. Indeed, more than any other factor, poverty explains the geographic variation in health care that was so widely discussed but never properly diagnosed during health care reform. Judt has made the diagnosis for the US, as Sir Michael Marmot did recently for England, where the problem is similar but half as great.
Here, there and everywhere, the solution will require more than just health insurance. It will require the kind of social reorientation that Judt calls for.
The writer is a professor of medicine at the University of Pennsylvania