President Obama has heard all the arguments against universal health care. One he won´t hear from opponents, that is the private insurers and hospitals, is that of their fear of having to cover and treat the millions of black and Hispanic uninsured. According to the Commonwealth Fund, blacks and Hispanics make up nearly half of the estimated 50 million Americans that have no health care insurance. They are far more likely than the one in four uninsured whites to experience problems getting treatment at a hospital or clinic, and to have fewer if any choices in getting health care coverage.
The huge racial disparity in the number of uninsured has been a sticking point for every Democratic president since Harry Truman proposed the first national health care plan in the late 1940s. President Obama will fight the same battle against private insurers and health care providers when he dumps his proposals for universal health care on the Congressional table.
But the disparity in access to and quality of health care for minorities has fueled the crisis and the urgency for reform. A recent study by the Archives of Internal Medicine examined treatment and care for more than 150,000 Medicare patients. It found that hospitals and insurers pay far more to care for African-Americans and Hispanics near death than whites. Researchers tossed out several theories such as cultural differences, spiritual beliefs, patient fears, and even family break down to explain the gap in cost. The explanations are an exercise in victim blaming. The end of life hospital and treatment costs for blacks and Hispanics are higher because of the decades of medical neglect and the grab for profits by private medical providers.
Countless studies have shown that blacks and Hispanics suffer higher rates of catastrophic illnesses and diseases, are much less likely to obtain basic drugs, tests and preventive screening, to be admitted to hospitals and to have surgery. They are more likely to recover slower from illness, and they die much younger.
Studies have found that when blacks and Hispanics do receive treatment, the care they receive is more likely to be substandard to that of whites. Studies have found that even when blacks and Hispanics are enrolled in high quality health plans the gap in the care and quality of medical treatment still remain.
Private insurers routinely cherry pick the best and most well-endowed patients financially to bloat profits and hold down costs. American medical providers spend twice as much per person than providers in countries that provide universal health care, and provide less quality for the inflated bucks. Insurers get a rake off on both ends. Patients pay more in higher insurance premiums, co payments fees and a grab bag of other hidden health costs. At the same time, government medical insured programs also shell out more than public insurers in other countries with universal health care.
The massive public attention and anger over the health crisis has caused insurers, their lobbyists and political flacks to scramble. Americas Health Insurance Plans, the major insurer industry group, recently announced that it will put its considerable muscle behind health care reform. On the surface, the announcement seemed to be a major breakthrough in that the industry has finally seen the light and will work hand in hand with President Obama to make real health care reform a reality. That´s not the case. The group has not softened its resistance one bit to providing coverage to those that it labels "high risk" or less charitably, "undesirables." That´s the millions who suffer chronic and major diseases—cancer, diabetes, asthma and heart disease. Blacks and Latinos have higher incidences of these ailments than whites.
Under the AHIP´s reform plan, insurers will still be free to exclude high risk cases from coverage. The government ostensibly will provide coverage and pay the costs for them. But even that concession is suspect. The issue is cost and the ancient fear, or at least scare tactic, of government control of medical care. Private insurers and their lobbyists have blared that out for decades to torpedo reform. Obama´s mere mention that he´ll impose higher taxes on the wealthy to pay for coverage of the uninsured stirred war hoops from them of deficit busting and socialized medicine. They shouted that to derail Clinton´s reform plan in 1994.
The battle for universal health care will again be a titanic struggle between a health care industry that has had its way for six decades and has gutted every proposal and plan for expanded health care. The arguments will be the same as always, cost, inefficiency, heavy handed government control and interference. Race, of course, will never be mentioned as a reason to water down or shelve completely Obama´s plan. But it, as always, will lurk underneath. President Obama will have his hands full on this one.
Earl Ofari Hutchinson is an author and political analyst. His new book is How Obama Won (Middle Passage Press, January 2009).
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