Rinku Sen

race is central, not a distraction, to health care reform

The Rand Corporation published a report in the New England Journal of Medicine concluding that health care sucks for everybody regardless of class and race. Surveying only people who had seen a doctor in the last two years, the study finds no racial disparities, and even finds that Blacks and Latinos sometimes get better care than whites. But, as we argued in our report Closing the Gap: Solutions to Race-Based Health Disparities, hundreds of studies show that this bad-for-all system produces life-threatening racial disparities. Those disparities are a warning sign of how broken the system really is; we can't fix the system truly unless we deal with them.

Even with similar insurance, people of color get lower quality care. The Department of Health and Human Services' huge National Health Care Disparities report finds that disparities are mostly getting worse, not better. Even Rand's own study on cardiac care confirms this fact.

So disparities exist, but the new findings give courage to those from right to left who don’t want to deal with race. Sally Satel of the American Enterprise Institute, which pushes tax cuts as the primary way to expand access, said, "The obsession with racial disparities is a distraction from what we really need to do, which is improve health care for everyone." From the other side, a Frameworks Institute memo about how to frame health care reform tells us not to discuss discrimination in California health care because "Black and Latino Californians also react negatively to the disparities message." I guess the conservative drumbeat that discrimination is all in our heads has finally taken hold.

I'm ready to fight for universal, publicly funded health care, but that alone will not resolve disparities, as we can see in Canada and the UK. On the other hand, some of the things that would, such as evidence-based guidelines and public reporting of hospital quality scores by patient race, ethnicity, and primary language, will tell us how we need to improve access and care for everyone.

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Posted at 11:45 AM, Mar 20, 2006 in Health Care
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