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Inequality and the Right to Live

David Callahan

Opponents of income redistribution often argue that taking from the haves and giving to the have-nots is at odds with individual rights. 

But here's a simple fact: There is no surer way to lose all your individual rights than to be dead. And evidence keeps mounting that people with lower incomes die earlier. In effect, one result of inequality is that the all-important right of living is enjoyed more by some members of our society than others. 

This is not a new point, of course. We have long known that people without health insurance are more likely to die when faced with major illnesses or medical emergencies. One study estimated that 26,000 Americans died in 2010 because they lacked health insurance. As a society, we had plenty enough wealth in 2010 to make sure that all those uninsured people had coverage, and most of them might be alive today if we had done so. But that would have meant higher taxes for an expanded Medicaid system. And basically we made the choice to allow some people to die -- thousands -- so that others could keep more of their money.

Meanwhile, new evidence is emerging about how income correlates with life expectancy. The Washington Post has an article today comparing two Florida counties: an affluent one where men live to 78 on average and women to 83; and a poorer, adjacent county where men live to 71 and women to 78. The Post notes:

The widening gap in life expectancy between these two adjacent Florida counties reflects perhaps the starkest outcome of the nation’s growing economic inequality: Even as the nation’s life expectancy has marched steadily upward, reaching 78.5 years in 2009, a growing body of research shows that those gains are going mostly to those at the upper end of the income ladder.

There are half as many physicians in the poor county as the wealthy county, but the problem goes beyond access. According to a wide range of studies, poorer people are more likely to smoke, be obese, lead sedentary lives, and less likely seek out medical information or follow doctor's orders.

Now, you can say the earlier deaths of the poor are thus mainlyabout individual choices, but come on: If huge swaths of people in similar circumstances make the same choices, the problem clearly has a large structural dimension.

One recent study, which found that mortality rates among women were actually increasing in many poor counties, had this to say:

These findings suggest that improving health outcomes across the United States will require increased public and private investment in the social and environmental determinants of health—beyond an exclusive focus on access to care or individual health behavior.

It's often noted that freedom requires a careful balancing of rights. I'd say the evidence is overwelming that we don't have this balance right today. By leaving some Americans free to accumulate bigger bank accounts, and allowing the highest levels of inequality since the Gilded Age, we are depriving others of the freedom to be alive at all.

Obamacare is a step in the right direction, and a new payroll surcharge on the affluent just went into effect January 1 that will help subsidize a huge expansion of Medicaid. But plenty of work will remain to get the balance right even after the ACA is fully implemented.