TWO prevailing assumptions underlie most contemporary discussions of medical services for the poor in America. One is that the poor population receives less medical care because they are poor--a systemic discrimination. The other is that because the poor lack medical knowledge and have less education than other social classes, they have impaired health--a class condition. The current debate over national health insurance bills introduced in the Ninety-fifth Congress, which propose to remedy the needs of the poor for improved care and to aid those who have no medical assistance, focuses on these two assumptions.
Lefkowitz ( 1970 and 1973) has undertaken a careful analysis of data relating to questions of poverty and health. He has found that the correlation between poverty and poor health usually disappears when education is taken into account. The correlation can also be considered less than significant because both income and medical deprivation appear to be consequences, at least in part, of education. The claimed assumptions of poverty and ill health have corollaries. One is that the poor receive less medical care and lower quality care than others. Lefkowitz's examination of the data indicates that there is little correlation between the average number of physician visits per person per year and family income. In terms of quality of care, Lefkowitz has found that education rather than income is related to medical care utilization. Leveson has also found that when other factors are held constant education is the key factor in medical care utilization. Lefkowitz's study, however, omits the distinction between perceived poor health and poor health as verified by objective clinical findings.
In terms of clinic care versus private physician care, Lefkowitz ( 1970 and 1973) also found that the proportion of one to the other is the same among the poor and other populations. He says that the image that the poor are at the mercy of public clinics is overdrawn.
There are other questions about the health of the poor. If the poor are less healthy than others but utilize medical care facilities in much the