Separate And Unequal: U.S. Health Care and the Republican Response

The problem of the uninsured, and the ethnic and racial divide in American health care are closely related and both cut to the heart of what it means to be a just society in the 21st century.
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The nation commemorated the 40th anniversary of Martin Luther King's death last week. Here's a quote from him that didn't get much play in the testimonials: "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Two recent studies highlights the lack of progress we've made in four decades, and proposals from John McCain and the Florida State Senate show how little resonance Dr. King's words have in some corners of public life.

Studies by the Robert Wood Johnson Foundation and the Harvard School of Public Health provide more documentation for something many Americans know from personal experience: The United States is a nation living under medical apartheid. The South Florida Times summarized the studies' findings as follows:

"... elderly black and Hispanic patients often received substandard care for common but serious conditions like heart attacks, congestive heart failure and pneumonia. Researchers say their data suggests that the nation's healthcare system is racially and ethnically segregated, not just for the elderly, but across the board."

Lead researcher, Dr. Ashish K. Jha, said:

"When we see ongoing segregation in housing and education [in America,] it may not be surprising that we're seeing very different administration of care in hospitals that serve blacks and Hispanics versus hospitals that mostly serve whites. But we're not talking about [failures of] high tech medicine. This is basic stuff, like failing to administer aspirin or beta blockers to patients suffering a heart attack; treatments that we've known about for 20 years.''

These studies are consistent with earlier findings that, at all levels of incomes, black Americans die years earlier than whites. The infant mortality rate for African American babies is 2.5 times greater than it is for non-Hispanic whites, according to data from the National Center for Health Statistics, giving us the worst infant mortality rate of any industrialized nation on Earth except Latvia. It should be noted that these recent studies demonstrate that Hispanics in this country also experience extreme disparities in medical care.

Are you OK with that? Then how about this? Lack of health insurance results in the deaths of 18,000 Americans each year, according to studies compiled by the National Academies' Institute of Medicine. That equates to 49 or 50 deaths every day.

How are politicians responded to this ongoing health crisis among "the least of us"? The Republican-dominated Florida State Senate is proposing to cut $803 million in health care financing for the low-income residents, the poor, and senior citizens -- a figure the Orlando Sentinel calls "staggering." Disabled Floridians and recent transplant recipients would be among those losing medical coverage. "This is a death sentence for a lot of people," said a bone-marrow transplant patient. He's right.

For his part, according to the Boston Globe, John McCain is still "working out the details" of his health plan. He's already done enough. Some friendly reporters are emphasizing his willingness to offer tax credits rather than just tax deductions, as his GOP predecessors have done. But his plan is the same prescription for disaster that Bush's and Giuliani's were. Like them, he proposes to end tax benefits for employers providing health insurance. That would effectively scrap the current employer-funded system which, however imperfect, provides health coverage to millions of Americans today.

McCain would replace the employer system with a tax benefit that would fall far short of covering the added costs of health insurance for working Americans, especially since the bargaining clout of employers would be scrapped for a free-for-all system of individual buyers without expertise or buying power. The result would be a plan that creates substantially higher out-of-pocket costs for workers currently covered by their employers, without extending insurance to those currently uncovered.

Oh -- and insurance company profits would skyrocket.

McCain attempts to make his plan more politically palatable than his predecessors' by speaking in vague terms about "high risk pools" and subsidies. But, except for the inclusion of tax credits, he has yet to differentiate his proposal from theirs in any concrete way. His refusal to place any requirements on insurance companies, together with his abandonment of the employer-based insurance system, would create enormous financial hardship for many of those who suffer from cancer and other pre-existing conditions.

What about the poor and unemployed? Some of them might benefit from a tax credit in theory, but here's what would happen in real life: The $5,000-per-family figure McCain mentioned wouldn't cover premiums for very many lower-income people, if any. It's unlikely they'd be able to afford the difference between $5,000 and the actual cost of insurance, which would likely be thousands of dollars per year. The net result? An unused tax credit - and continued lack of coverage for the uninsured.

Obama and Clinton supporters are free to continue their blood feud over which has the better health plan. I've argued that Obama's is more politically feasible and, in the end, more progressive. Some colleagues in the policy world disagree. But most of us agree that either Sen. Clinton's plan or Sen. Obama's would be a vast improvement over McCain's. And the actions of the Florida State Senate are nothing more than unconscionable.

To be clear, we're talking about two distinct policy issues here: the problem of the uninsured, and the ethnic and racial divide in American health care. But these two issues are closely related, and both cut to the heart of what it means to be a just society in the 21st century.

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