The Color of Health Care

Root contributor and American Prospect writing fellow Adam Serwer wants to know: Why aren't people talking about the racial inequities in the current health care system?

Given the harrowing public-health crisis facing people of color, it’s easy to understand why thousands of people would line up in Inglewood looking for quality care. The House version of the health-care reform bill, America’s Affordable Health Choices Act, would help reduce barriers to health insurance access by expanding Medicaid, prohibiting discrimination against people with pre-existing conditions, capping out-of-pocket expenses, and subsidizing the purchase of health insurance below 400 percent of the poverty level. But while both the Senate and the House bills expand community health centers, when it comes to addressing issues like geographic barriers to quality health care stemming from ongoing de-facto segregation, the bills are less aggressive than some health-care policy advocates would like.

Some health care experts argue that in addition to expanding coverage, the key to reducing racial health disparities lies in prevention measures. “They’re putting more focus on prevention and quality services, wellness care as opposed to sick care,” says Dr. Willarda V. Edwards of the National Medical Association. “That’s what we need to be focused on.”

Both the House’s and the Senate’s proposals offer funds for community-based programs that focus on prevention by addressing issues like obesity and smoking — things that contribute to the onset of such chronic diseases as diabetes and cancer later in life. “Ensuring that the final legislation includes prevention could actually be one of the most important steps [in] decreasing if not eliminating some of these disparities,” says Judith Bell, president of Policylink, an advocacy organization focused on social and economic equality. But prevention has so much to do with living conditions — like living in a polluted area or one without access to fresh food — that health-care reform can only do so much.

During the presidential campaign, President Barack Obama avoided making the case for health reform in racial terms. This has continued, with the administration reluctant to point out racial disparities in access to or quality of care for people of color, preferring to make the case for health-care reform in race-neutral terms. An argument for how health-care reform would benefit the poor has also been absent. Opponents of reform haven’t been as shy about invoking race, particularly when it comes to whether the bill covers undocumented immigrants. An Investor’s Business Daily editorial called health-care reform “affirmative-action on steroids” and argued that it was a form of reparations for slavery, a description echoed by Fox News personality Glenn Beck. Much of the rage at town hall meetings across the country has been fueled by the misperception that the reform proposals would extend health coverage to undocumented immigrants. None of the current versions do — a politically convenient decision that ignores the cost incurred by not covering everyone.

Melissa Harris-Lacewell, a professor of politics and African American studies at Princeton University, believes the administration’s decision to avoid race may not have been a wise one. “Obama really does believe that the best way to pass good social policy that has a beneficial effect for people of color is by never mentioning race,” she says. “They were trying to do what they did in the campaign, which is focus on similarities rather than differences. … It’s not like the opposition isn’t capable of bringing this up anyway.”

“I think they fumbled the ball on this one,” she adds.