We have a storied history in this country of not talking about issues of race and ethnicity. The health care reform debate is proceeding no differently. In the midst of the broadest and weightiest debate that the nation has had on health care in many years, there is little attention being paid to racial inequality.
History tells us that ignoring inequality tends to further entrench its insidious causes. It's imperative that we begin an honest debate about the fundamental reality that health care access and outcomes in America are radically unequal.
Consider these facts:
• Hispanics are twice as likely to die from diabetes. Tuberculosis strikes Asian Americans at 16 times the rate of whites. Cancer kills 35 percent more African-Americans than whites.
• If two patients have similar heart disease, a black patient is one-third less likely to undergo life saving bypass surgery than a white patient.
• Among preschool children hospitalized for asthma, only 7 percent of black and 2 percent of Hispanic children, compared with 21 percent of white children, are prescribed routine medications to prevent future asthma-related hospitalizations.
• One of the most dramatic predictors of health is access to insurance and while 11 percent of whites are uninsured, about 32 percent of Latinos, 20 percent of blacks and 17 percent of Asian Americans have no health coverage.
Coming to grips with these complex problems will require a diversity of responses that address socio-economic and cultural realities that extend far beyond the dominant cost and coverage discussions we have seen so far. It's simply untrue that getting people "coverage" and controlling costs automatically solves America's health equity problems. Equity can only begin to be addressed if the plan is affordable and comprehensive, only if all immigrants are eligible, only if primary care is available in low-income communities and only if providers are culturally competent.
My suggested solutions should not be considered exhaustive - rather these are meant to initiate a reasoned examination of the racial and ethnic disparities experienced in health care by so many Americans:
A Public Health Insurance Option: The public and the health insurance industry desperately need a benchmark for quality and efficiency. Giving people the choice of a public plan raises the bar for all plans and allows plans to compete on quality and service. A public plan option would help boost the quality of insurance across the board for all Americans.
Strengthen and Expand Medicaid: Medicaid is a cornerstone of our current system and it needs to be maintained in national health reform as it was in Massachusetts' reform plan. It provides unique coverage for people with low incomes and in poor health. At the same time, it needs to be strengthened to assure the financing is stable, that enrollment is simple, and that all low income people can qualify and have access to covered services.
Immigrant Inclusion: Almost half of all immigrants are uninsured, a level that is about three times higher than for native-born citizens. Lack of coverage for this population has severe and ongoing deleterious effects on the health of the nation. Our goal needs to be high quality coverage and health outcomes for everyone without regard to people's status.
Health Empowerment Zones: Much of the inequality in our system is traceable to specific geographic communities that disproportionately experience depravation. Designating such communities as health empowerment zones would allow the creation of incentives in underserved areas to attract culturally competent health care professionals, create disease management programs for the critically ill and improve data collection to better document minority health care trends.
Community Health Centers: Community health centers provide excellent-quality health care, with outcomes comparable or exceeding those in private settings. With a proven record of removing barriers to care, improving health outcomes while reducing health disparities and generating substantial cost savings, CHCs should be candidates for substantial increases in resources.
The inequality in our system has complicated causes. The only possible silver bullet in addressing the moral outrage of racial disparity is honesty. We can't be afraid to talk about the reality of differential treatment and to work diligently as a nation for comprehensive solutions which hold us to our ideals of equality.