More than a half century after Dr. Martin Luther King Jr. famously said “of all the forms of inequality, injustice in health care is the most shocking and inhumane” racial disparities in health care remain a pervasive, systemic problem.
Some of the disparities are a direct product of thinly disguised corporate practices in a system premised on profit margins. Others are evident in social and economic inequities, such as employment and housing that are directly associated with the huge racial wealth and income gap that are a legacy of 400 years of racial discrimination.
"Medicare for All would eliminate the cost barrier that disproportionately affects communities of color with higher rates of no insurance or underinsurance. It would abolish premiums, deductibles, and co-pays for such basics as emergency and hospital care, doctor’s offices, and health needs not covered by traditional insurance, including dental, vision, hearing, mental health, and home and community based long-term care."
A recent study by the Journal of the American Medical Association, for instance, found that Black majority areas in New York, Los Angeles, and Chicago were more likely to be farther from trauma centers.
That reflects an ongoing trend of corporate hospital systems closing hospitals in medically underserved communities while shifting services to higher income, predominantly white communities.
The growing crisis of medical debt is another example. Since 2009, prestigious Johns Hopkins Hospital has filed more than 2,400 medical debt lawsuits in Maryland courts. The impact is especially severe in Baltimore where 32 percent of people of color endure medical debt, compared to just 19 percent of white residents. The largest zip code targeted by Hopkins medical debt lawsuits is 90 percent African American.
Transformation of our health care system to a more humane model based on health care as a human right, not profits and ability to pay would sharply reduce systemic and institutional racial disparities, while we must concurrently address individual practitioner biases that are reinforced by the multiple ways our society perpetuates racism.
Medicare for All would eliminate the cost barrier that disproportionately affects communities of color with higher rates of no insurance or underinsurance. It would abolish premiums, deductibles, and co-pays for such basics as emergency and hospital care, doctor’s offices, and health needs not covered by traditional insurance, including dental, vision, hearing, mental health, and home and community based long-term care.
In a hearing December 11 in the Energy and Commerce Health Subcommittee, National Nurses United President Jean Ross, RN explained how the House Medicare for All bill, HR would specifically provide funding for services in underfunded low income urban and rural areas with medically underserved patients, including many people affected by racial disparities in health.
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That could be a huge boon in the predominantly African American east District of Columbia community where the only remaining hospital is about to close.
"With Medicare for all, and continuing the fight for racial justice, we can make real progress and a major impact on health care injustice."
And in Chicago’s largely African American South Side neighborhoods, home to only two of 12 Chicago hospitals that meet the American College of Surgeons guidelines on cancer care, as noted by a New England Journal of Medicine report. Not coincidentally, Black women in Chicago were almost 40 percent less likely than white women to have the recommended breast cancer screening, and more likely to have their cancer diagnosis missed.
Even allegedly neutral technology can reinforce racism. Another study documented that algorithms used by health systems, insurers, and practitioners to allocate extra medical care for patients with complex medical needs under-estimate health needs of the sickest Black patients.
The algorithm calls for extra care based on what people spend for medical care. But it too fails to account for lack of insurance, where people live, access to transportation, childcare costs, and other socio-economic factors that disproportionately affect Black patients and what they can spend to get needed care.
Some racial disparities are clearly life threatening, such as the lack of trauma centers and best breast cancer screening facilities, and the well documented pregnancy-related mortality rates that are three to four times greater for African American women.
Under Canada’s health care system, similar to Medicare for all, overall treatment and survival rates for acute and chronic health conditions are 13 percent higher, and 36 percent higher in high poverty neighborhoods than in the U.S. Breast cancer survival rates for low income Canadians under age 65 are 14 percent higher than their U.S. counterparts.
With Medicare for all, and continuing the fight for racial justice, we can make real progress and a major impact on health care injustice. Dr. King’s vision of a beloved community based on justice, equality, dignity and good will for all requires no less.