In
theory, the Medicare program - which provides health coverage to people over 65
and those with disabilities - gives the same benefits to everyone
enrolled. But in practice, not everyone
receives the same outcomes. Communities
of color consistently have more difficulty getting care and tend to receive
lower quality care.
Earlier
this year, Congress took a few baby steps in addressing those disparities. In a new law that chiefly dealt with how doctors
are paid for treating Medicare patients, Congress included language to help
reduce the disparities in Medicare for people of color.
The
new law, the Medicare Improvements for Patients and Providers Act of 2008
(MIPPA), includes three key changes to address these differences.
Improved data collection (which helps identify what
disparities exist so the best solutions can be designed to address them);
Outreach to the previously uninsured (since
those who do not have insurance are often the sickest and tend to experience
barriers to enrolling in public programs); and
Care
that is culturally and linguistically appropriate (since providers
and patients have to be able to effectively communicate with one
another in order for good health care to be delivered and received).
As we move ahead to tackle broader health care reform, it's
important to remember that the entire population will continue to grow and
become more diverse.
MIPPA provides a good example of how health disparities can be woven into the
broader health care reform discussion. Although this
legislation wasn't specifically created to eliminate health disparities, it
recognizes that making the system work for everyone requires us to understand
why difference exist and allows us to seek appropriate solutions to address and
eliminate them.
In a sign that President-Elect Obama means business, former
Senate Minority Leader Tom Daschle (D-SD) was selected to fill the top spot at
the Department of Health and Human Services. This is good news. Very good news.
"The appointment of Senator Daschle as Secretary of the Health and Human
Services Department is the best news possible for those who want to achieve
meaningful health care reform," said Families USA's Ron Pollack.
In addition to leading HHS, Daschle will also serve as the health
"czar" - or White House point person who will report directly to the
President.
This is a
perfect role for Daschle. Although he was always been interested in health
care, in the last few years he's become a true wonk on the subject, publishing
a book called Critical: What We Can Do About the Health-Care Crisis. It
urges precisely the sorts of reforms President-Elect Obama and his
congressional allies are promoting right now.
Daschle's track-record as Senate Minority leader turned
health wonk gives him incisive knowledge of both the political environment and
the policy required to push legislation through Congress.
Speaking at Families USA's Health Action conference last
year, Daschle
said:
One of the biggest tactical
mistakes we've made, the opponents of health reform have defined the debate. As
a result, we've lived under a number of myths. Perhaps the biggest myth of all
is that the US
has the best health system in the world. So before the debate can begin, we
need to all understand the same basic facts. We need to understand how we got
here and where we need to go.
Incremental change in our
system is no longer a viable option. Instead we need comprehensive reform. In
growing numbers the American people are demanding that we do something. Our
goal should be to build what current and retired members of Congress have
today, and make that available for all Americans.
Daschle's commitment to health care, combined with his astute
understanding of the political climate, gives us reason to believe that health
care reform is not simply a campaign promise, but a likely reality in an Obama
administration.
Today, Senator Max Baucus, chair of the Senate Finance
Committee, revealed his long awaited white paper on
health care reform. According to the Senator,
...the
Call to Action has three equally important legs: (1) a policy that ensures
meaningful coverage and care to all Americans; (2) an insistence that any such
expansion be coupled with an emphasis on higher quality, greater value, and -
over time - less costly care; and (3) an absolute commitment to weed out waste,
eliminate overpayments, and design a sustainable financing system that works
for taxpayers as well as for the nation's recipients and providers of health
care.
Creating ahealth insurance "exchange," where individuals and small businesses
could compare and purchase plans - which would include a range of private
plans and a public plan option.
An expansion of Medicaid and SCHIP.
The plan would allow people between 55 and 64 to
"buy-in" to Medicare as a temporary transition provision until quality,
affordable insurance options are available through the exchange.
Support for the employer based model where
employers would be required to offer coverage to their employees, and
small businesses would receive a tax credit if they comply.
Senator Baucus, along with
Senator Kennedy, is expected to play a very important role, as Ezra Klein explains
here, in the road
to reform. Baucus chairs the Senate Finance Committee, which has broad
jurisdiction, overseeing health care reform, Social Security, unemployment
benefits, and taxes and trade. As chairman, it is up to Baucus to schedule
markups, hearings, and votes - and ultimately serves as the gatekeeper for
legislative action on, say, health care reform.
Having Baucus on board with such a comprehensive plan is
certainly encouraging. To quote Families USA's own Ron Pollack:
"The white paper
released today achieves a sound balance between public- and private-sector
approaches, and it blends good policy with a sound view of what is achievable.
"There has never
been a more auspicious opportunity to secure meaningful health care reform: The
President-Elect has made it a top priority; key congressional committee chairs
have made it their top priority; and the large and diverse health care interest
groups are working cooperatively to find common ground.
"As a result, we
have a unique opportunity to succeed this time in securing much-needed health care
reform."
We heard encouraging words from Michael Myers, staff director for the Senate
Health, Education, Labor, and Pensions (HELP) committee, chaired by Senator Ted
Kennedy, at Families USA's post-election health care briefing:
"With the Obama victory, the
question is no longer whether we'll pursue comprehensive healthcare reform, but
when and in what form."
Determined to see health care reform come to fruition, Senator
Kennedy has wasted no time in convening regular meetings with key stakeholders in
the hopes of introducing comprehensive legislation in early January. In an
op-ed in Sunday's Washington Post., Kennedy reiterated
the urgency for reform:
"...despite the current economic downturn, we must forge
ahead with this urgent priority. The system is broken. And it's no longer just
patients demanding change. Businesses, doctors and even many insurance
companies are demanding it as well."
The specifics of his reform proposal remain under wraps,
according to Kennedy's office, but Myers
suggested that it will look much like Obama's plan and the Senator will
pursue a "single bill" strategy.
Senator
Obama's proposal builds on our current system of health coverage, preserving
what works and strengthening aspects of the system that need improvement. Under
his plan, workers who are satisfied with their employer-based coverage would
keep it. A new National Health Insurance Exchange would enable individuals and
businesses to purchase health coverage that's as good as the coverage for
members of Congress and other federal employees. His proposal requires that all
children have insurance. It would also cap out-of-pocket expenses and regulate
insurance companies so that they can no longer cherry-pick the young and
healthy and deny coverage to people with pre-existing conditions.
Many observers are poised
to see reform finally happen. Having learned a thing or two from the last
reform efforts in 1993 led by President Clinton, and understanding that reform
is not inevitable, many stakeholders (who don't always see eye-to-eye) are
searching for common ground. In Congress, staff from three jurisdictional
committees -- Finance, Budget, and Health, Education, Labor and Pensions (HELP)
-- have met to form working groups to discuss coverage expansion, systems
reform, and financing. In addition, Senator Baucus, chair of the Finance
Committee, which must approve any legislation before it goes to the Senate
floor, is also committed
to reform:
"I made sure the finance committee
spent this year learning and preparing for action on a comprehensive overhaul
of the healthcare system, and I intend for us to move swiftly and decisively with
legislation in early 2009."
We'll hear more from Baucus this week when he releases his
white paper on health reform.
Posted by: Ron Pollack, Executive Director, Families USA on Nov 05, 2008
The election we witnessed yesterday was not simply historic - it was truly transformative.
Just 43 years ago, Congress passed, and President Lyndon Johnson signed, the Voting Rights Act. For decades, since the end of Reconstruction, voting for many in the states of the old Confederacy was an act of unmatched heroism. To vote was to lose a job - even the laborious job of chopping and picking cotton for a meager $3 a day. To vote was to have your house shot into in the dark of night. To vote was to risk, and for too many to lose, one's life.
The Voting Rights Act was borne out of the heroism of many. Most visibly, it was catapulted onto the national agenda by the hundreds of brave souls, led by John Lewis in March of 1965, who crossed the Edmund Pettus Bridge leaving Selma, Alabama east on Route 80 to march towards Montgomery. As they crossed the bridge, they were brutally assaulted by police and highway patrolmen on horseback. They were beaten but not defeated.
Dr. Martin Luther King re-started the march soon thereafter. Thousands marched with him, sleeping in the fields at night. Singing their defiance of then-Governor George Wallace, they chanted:
Wallace, you never can jail us all,
Wallace, segregation's going to fall!
And they made it triumphantly to Montgomery. At night, after the final speeches were over near the State Capitol, Viola Liuzzo - a then-unknown civil rights activist who participated in the march - was murdered.
In the first election in Mississippi after the Voting Rights Act, a number of brave heroes decided to run for local office: sheriff, county board of education, mayor, county supervisor. They knew they wouldn't win, but they were undaunted.
I remember in the all-black town of Mound Bayou, Mississippi - in the heart of the Mississippi Delta, in the poorest part of our nation - black leaders assembled in houses before the elections, not knowing what violence they would face. Some had guns and other weapons to protect themselves and their families; others, more schooled and adherent to Dr. King's admonitions of non-violence, simply brought their bodies and heroic determination to vote for the first time.
Now, only four-plus decades later, we have witnessed an election that no one could realistically have dreamed about during those dark and difficult days. President-Elect Barack Obama's triumph - more profoundly, the triumph of our nation - is, in no small part, the victory of so many people who risked all they had to work for a better day.
For those of us fortunate to see, and participate in, this transformative election, our work must continue and start anew. This election is an opportunity - an opportunity to bring fairness and decency and dignity for those who have yet to share our nation's bounty. It is only the achievement of such justice that will enable us to realize Dr. King's dream: "Free at last, free at last, thank God almighty, we're free at last."
There's no question that there are social determinants to
health -- meaning that a person's position in society (determined by income,
education, type of job, wealth, housing conditions, social environment, etc.)
largely predicts one's health outcomes. The higher up in society, the greater
the privileges. For example, a high-paying job likely means access to
employer-based health insurance - affording the chance to seek medical care
whenever necessary for that individual and his/her kids.
More recently, there has been increasing evidence that
childhood poverty has a clear association with adult health problems. The Campaign
to End Child Poverty and the World
Health Organization (WHO) recently published reports outlining this huge
health inequality. What both studies show is that growing up in poor socioeconomic
conditions puts a child at greater risk of coronary heart disease, stroke
mortality, disability, and poor mental health as an adult. According to the
Center for American Progress's analysis
of the reports,
Differences in health are no
accident; they stem directly from social inequalities and the policies that
create them. WHO explains, "the high burden of illness responsible for
appalling premature loss of life arises in large part because of the conditions
in which people are born, grow, live, work, and age. In their turn, poor and
unequal living conditions are the consequence of poor social policies and
programmes, unfair economic arrangements, and bad politics."
A disadvantaged childhood directly affects health in later
life. Nonetheless, the WHO said that tackling this problem lies outside the
realm of health policy, placing a high priority on areas such as such as early
education. Perhaps its time to focus
more attention and resources on childhood education programs and national
health care reform-two areas that are proven to be inextricably linked.
Last
week I had the opportunity to meet Kenyon McGriff. Well, not in person. I read
his story and saw his picture.
Kenyon is a teenager from Philadelphia who decided
to not let where he lives, how much money he doesn't have, or the fact that he
doesn't cook much, continue making him unhealthy. You see, when Kenyon was 15,
he weighed 270 pounds. After a visit to the Children's Hospital of Philadelphia
two years ago, he decided to lose weight. He joined a running club at his
high school and gave up sugary and fried foods.
Since then he's lost 30
pounds.
It hasn't been easy
though. For many like Kenyon, finding fresh fruits and vegetables can be
difficult when you're surrounded by fast food, and exercising can be dangerous
when you're running in the street instead of on a trail. In a neighborhood
where he can buy a lot of chips and soda with his last $5, he now makes a conscious decision to buy snacks like sushi because it's
healthier.
Living conditions can have a
powerful influence on health--positively or
negatively. Where Kenyon lives in Philadelphia, the average life expectancy is
72.3 years; however, people who live just 8.5 miles away, can expect to live
almost 7 years longer.
Today, nearly 20 percent of all Americans--about 52 million people--live in poor neighborhoods. The Robert Wood Johnson Foundation's Commission
to Build a Healthier America,
recently held a public hearing to discuss how the conditions where we live,
work, and play influence health. Over the course of this year, the Commission
has examined factors outside the traditional health care system that promote
health--like quality public education, a good job, and
convenient transportation options--as well as those
that can make you sick -- like, poor air and water quality, violence, and
substandard housing.
What they've found is that
many social and environmental factors beyond an individual's control contribute
to health disparities--potentially as much as medical care or genetics. The
Commission hopes that creating innovative ways to address disparities will
encourage children and young adults (like Kenyon) to make healthy behavioral
choices-and put the structures in place that allow them to do so.
In the search for new solutions to reform the health care system,
some policy makers are touting high-deductible health plans as a way to expand
coverage. These plans are often attractive at first because of their relatively
low monthly premiums, but a closer look shows they're not all they're cracked
up to be. That's because medical costs are not covered until the deductible is
paid-an average of $4,000 to $5,000 per family.
What seems like a good deal at first can be a nightmare once
someone actually needs health care. This is especially troubling for certain
populations. Because little is known about how these plans will affect racial
and ethnic health disparities Families USA released Unequal
Burden: The True Cost of High-Deductible Health Plans for Communities of Color,
which describes the full costs of these plans and why they're simply
unaffordable for many communities of color.
In particular, it discusses three serious concerns that make
high-deductible health plans less helpful-or even potentially harmful-for
communities of color.
High out-of-pocket costs;
Incentives to delay or avoid
necessary care; and
Barriers that will widen the
health disparities gap.
As the debate around health care reform continues, let's work on
finding real solutions for the uninsured.
Can discrimination make you sick? Apparently, it can.
There are troubling differences in cancer survival rates
between groups based on their race or ethnicity. Part of the solution, of
course, is to make sure all groups have equal access to care. Eliminating
barriers to care would help to close the cancer survival and mortality gaps, but
that won't completely solve the problem. The quality of care received
also plays a significant part in health outcomes-how a doctor interacts with a
patient, not just the treatment offered to a patient-can affect that patient's
life expectancy.
So what happens when a patient is, or feels, discriminated
against? According to a recent Stanford
University study, perceived discrimination influences health outcomes. In
other words, if you feel you've been discriminated against, it affects you.
Women who perceived some form of discrimination from their
health care providers were a third less likely to have a mammogram and half as
likely to be screened for colorectal cancer. Men who perceived discrimination were
70 percent less likely to be screened for colorectal cancer, despite having a
regular source of care. The longer cancer screening is delayed, the worse the
potential outcome-making this literally a matter of life and death.
Despite advances in cancer detection, treatment, and
research, people of color are still more likely to be diagnosed with cancer at
later stages and more likely to die from the disease. For communities of color,
breast and colorectal cancer are two of the top three cancers that are
diagnosed and cause death.
As we find new ways to detect and treat cancer, we must make
sure that everyone benefits from those advances. And that means finding new
ways to detect and treat another deadly disease: discrimination.
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