Health Care Reform: A Minority Report

Medical professionals sound off on how Obama's health care plan will impact poor and black Americans.

Let’s cut to the chase regarding President Barack Obama’s health care plan, or, as it’s formally called, the Affordable Health Choices Act of 2009. At least three versions exist at the moment: the administration’s and those of the House and the Senate. In the days remaining until the congressional recess begins this week, they will squabble over what the final bill looks, and who will pay for it.

What is not uncertain is, however, that whatever becomes law will have a great impact on poor and minority patients, the hospitals that treat them and those hospitals’ doctors, nurses and staff. An estimated 16 percent of the black population is uninsured, as is 32 percent of Hispanics. So what are the best ways to address that problem and the many others that afflict a health care system everyone agrees is complex, expensive and economically discriminatory?

Most people who have health insurance get it through an employer. In a nutshell, Obama’s plan offers a less expensive government-run option, with nearly universal coverage of all Americans. This public plan would function alongside the private and other health care options that now exist. The advantage of a public plan is that it may force private insurers to compete for customers when it comes to treatment, service and price.

Linda Loubert, a research associate at the Institute for Urban Research, favors a single-payer, government-administered, health care system but believes that neither the president nor Congress wants to create such a public system, which would eliminate the need for private insurer coverage. Loubert, a Morgan State University economist, says that the best she could hope for was that whatever law emerges will “take the competition for money [in health care provision] out and make it a competition for good health.”

To Dr. Carolyn Barley Britton, former president of the National Medical Association, which represents more than 30,000 black physicians, the current state of American health care reminds her of New Orleans before Hurricane Katrina struck in 2005. “For years people were warned that levees had problems but not enough steps were taken [to correct them]. We have also been warned for more than 20 years that the health care system is in trouble and have not taken steps [to prevent disaster],” she said.

Some critics say the Obama plan costs too much. Britton points out, though, that bringing people who are currently uninsured into a new system would lower costs, since they now arrive in emergency rooms with serious illnesses that could have been prevented or slowed under universal coverage. Instead, she says, “they get health care at the high [cost] end of the spectrum.”

Darrell Gaskin, an associate professor of health economics at the University of Maryland, College Park, sees many advantages to Obama’s proposal, including that it would permit employees to take their health benefits from one job to another without loss of coverage—in effect, a insurance coverage rollover, much like the way people move their 401(k) or 403(b) retirement savings plans.

Plus, he says, a small business may see a decrease in insurance expenses as it becomes easier for employees to obtain health insurance from a pooled marketplace of private and federal insurers. These factors will encourage ambitious private insurers to compete by lowering costs for customers.

Those are sweet ideas to Vita Ozoude, president of the Nevada Black Chamber of Commerce. “If the Obama plan is a cheaper alternative, [business] owners will look at it because it boosts the bottom line,” said the Reno-based CPA, who has a private tax practice.

The tricky part may be getting the word out. Azizza Davis Goines, president of the Sacramento Black Chamber of Commerce, says a lot of business owners hear the clamor over health care costs and think it’s not for them. They have to be educated, she says: “It will be a wonderful thing to have options.”

For medical schools at historically black colleges—among them, Meharry Medical College, Howard University College of Medicine and the Morehouse School of Medicine—a plan that insures more people could only help. These are “safety net facilities” providing health care to the nation’s neediest and most ill, says Osei Mevs, an official at Meharry.

As institutions of last resort, these hospitals see many of the sickest patients, many of whom have no health insurance. If the health care reform becomes law, says Mevs, the financial condition of these black teaching hospitals may improve because the patients they are treating would suddenly be insured.

Dr. Charles Mouton, chairman of family medicine at Howard’s College of Medicine, agrees. He says a health care plan that helps increase hospital reimbursement is a major step forward. Otherwise, he said, frontline hospitals cannot afford the staff to provide the basic care that communities need.

The alternative to fixing the health care system, all agree, is crisis. Britton, of the NMA, says, “There is no question that if the health care system is not altered, it is going to break. And when that storm hits, there is no doubt that the levee is going to collapse.”

Frank McCoy is a journalist living in Maryland.