Quality Health Care... But Not for All

By now most of us understand the role that chronic conditions and diseases like diabetes, hypertension, heart disease, cancer, mental illness and HIV/AIDS play in driving up the costs of our bloated health care systems.  We may even understand how good primary and preventative care can help ameliorate these costly conditions, if not prevent them altogether.  And after reflection, we can see how having 50 million uninsured actually makes our health care system far more expensive than it has to be.  But at the end of the train of thought, we’re still missing an important detail – who gets left behind, and what that says about the progress we still need to make in America.

A recent report from the Department of Health and Human Services spells it out for us:  “Low-income Americans and racial and ethnic minorities experience disproportionately higher rates of disease, fewer treatment options, and reduced access to care. With unemployment on the rise, the disparities already apparent among these groups will continue to increase.”  As a reminder, this is regardless of employment status – 80% of uninsured people are in families where at least one person works full time.  So there should be no reason that, “African Americans are more likely to develop and die from cancer than any other racial or ethnic group.”   It shouldn’t make sense that “American Indians suffer from diabetes at more than twice the rate of the White population.”  How could there be a common thread between Hispanic and Vietnamese women such that they each contract cervical cancer at twice the rate of whites?  And what reason could there be for us to accept that Hispanics currently have an infection rate for HIV 2.5 that of whites – and for African Americans its 7 times?

But there is a common thread – these ethnic groups are less likely to receive prevention, primary care, and early detection for some of the most common and expensive medical ailments we deal with as a nation.  Because we’re OK with 50 million uninsured, we’re therefore OK with half of Hispanics and a quarter of African Americans not having a regular doctor (that number is one-fifth for Whites).  If we accept the economic or libertarian necessity of not giving coverage to all, we’re also accepting a lack of cancer screening, mammography and pap smears that leads to a high mortality rate for colorectal cancer for African Americans and cervical cancer for Vietnamese women for the simple fact that when they cancer is eventually caught, it’s likely to already be well-advanced.  Obesity is a spark for diabetes, heart disease, hypertension and many other expensive ailments, but African Americans and Hispanics have a higher incident rate, fueled by decreased access to care and counseling.

And this is the land of equal opportunity for all?

The sad part is the joke is on us.  As the HHS report points out, “About one-third of the uninsured have a chronic disease, and they are six times less likely to receive care for a health problem than the insured.”  So the economic necessity for not reforming health care turns out to be a chimera – uninsured Americans are still receiving care, indeed at a higher volume than the insured.  Instead of receiving it from a doctor they have a relationship with, many are receiving it from a stranger  (and one that they may not be able to communicate well with) only when things are so bad they can no longer be ignored.  They’re also receiving expensive care towards the tail end of a treatable but now advanced illness.  But it doesn’t have to be this bad – we know that these disparities gaps fade once people reach the universal coverage of Medicare.  And the money for that preventable, uncompensated care comes from – you guessed it – taxpayers and the insured.

When are we going to learn?

(Photo credit:  greg.turner on Flickr.)