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PT and the Greater Good

Justice and Health Inequalities

Published June 4, 2012 4:27 PM by Dean Metz

I was recently home for a holiday, visiting family and some friends. I had lunch with a woman I hadn't seen since high school graduation. No, I'm not telling you how many years that has been.

We chatted about many things while catching up, but she was very interested in my perceptions of the NHS versus what was available in the USA. She described how she and her husband had to give up on a small business because the insurance premiums became unsustainable. She told me that she funded her own pregnancy because the insurance plan they were on didn't cover uncomplicated pregnancies. She agreed that with the burden of health care costs on employers and small business, it was difficult to find an incentive to take such a risk. The idea of basic health care for all seemed really appealing to her once I described what the NHS was really all about.

Later that evening, I was in a pub in Mystic, CT, and a gentleman sat at the bar next to me. He had just undergone bilateral knee replacements a week ago. His "PT nurse" (his words) came daily to his home and would be coming for another week. He was very happy with his health care. He did not appear to be of Medicare age, but I found it interesting that any third-party payer would still be providing home care to someone able to go to the pub for a pint.

These two people have had remarkably different experiences with the health care system. One got treatment far more tailored than the other. This doesn't happen in the UK. In my work in public health, we strive to reduce health inequalities and provide environments in which all people can be healthy. The British see justice as something beyond a legal meaning. They see it as fairness among all people. To them, their system is just and ours is actually unjust. What do you think? When our very Constitution promises "justice for all," does our health care system deliver?


I think the US system is fundamentally unfair. Ability to get basic health care should be available to all. We have a healthcare system that is unfair and getting more so, like other aspects of our society. The "haves" (like the man you met in CT) are doing just fine, and can get cutting-edge treatments and all the care they want (often more than they "need"), while so many go without basic care (and end up costing the system even more when their treatable or preventable conditions go untreated or unprevented). Fixing this situation requires difficult choices and our government (and we the people) are incapable of making such difficult decisions.  Wow, what a pessimist!

Jeanne Duffy June 7, 2012 10:34 AM
Boston MA

Great article, don't know enough about England's health care system to comment but feel very blessed to have great health insurance provided by my firm with a contribution by me as well which I am happy to pay each month.  I believe there should be a partnership between employer and employee and shouldn't be the burden of one over the other.

I also believe we need to care for all people and not just the gainfully employeed. No one should be denied care anywhere in the world.

Bernie Hoban June 7, 2012 6:24 AM
Brooklyn NY

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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