Race and the Coming Health Care Reform War
We all agree that our health care system is broken. We get too little care for what we pay, suffer more than we should even after we pay. When Grant Hill first signed with the Detroit Pistons several years ago now he was on "sky's the limit" trajectory. The summer he left the Pistons for the Orlando Magic, he injured his ankle. He was never the same afterwards, and had several surgeries to repair it, attempting comeback after comeback. I bring Hill up because in March 2003 a simple heel realignment surgery led to a staph infection that almost killed him.
The National Coalition on Health Care offers the following facts:
- 50% of all bankruptcies occur in part because of health care expenses.
- The US spends 4.3 times more on health care than on national defense.
- While industrialized nations with single-payer programs spend at most 11% of their GDP on health care--with everyone covered, the US spends 17%, a figure that will reach 20% in just a few years.
- According to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 1999.
More here.
Now where is race in this debate? Melissa Harris-Lacewell asks this question, pointing to disparities in care (black and brown individuals and communities receive poorer care than our white breathren), in health outcomes (black and brown individuals and communities suffer more from a variety of illnesses and maladies). It's important to note here that these differences cannot solely be reduced to class, although class is an important component. Even controlled for income and education, black life expectancy is lower, black stress levels are higher. Even controlled for class and education, black and Latinos are less likely to get quality care from doctors. But there are actually a number of frontline organizations from the Joint Center, to the Praxis Project, to the Opportunity Agenda, bringing these disparities to light and ensuring that legislation ameliorates them.
Given this, the question for me isn't so much whether race is being ignored or not. The question is twofold. Will the discussion about race and the upcoming reform effort led by pundits and intellectuals be given attention beyond "blacks suffer more and get less care"? Will blacks can be mobilized to move against black elites when their interests don't intersect here?
I ask the first question because while talking about racial disparities in outcomes and in care is important and necessary it is far from sufficient. What we should do is identify the SPECIFIC ways that race works and will work in the upcoming effort.
One of the challenges we face is one of framing--how will the upcoming battle be defined? I note how much money we spend on health care. Are we going to be talking about health care COSTS or health care INVESTMENTS? Spending $1 million on google stock could be viewed as costly....or it could be viewed as an investment (particularly if you're buying the stock at $10/share as opposed to $438.77/share. What critics of left-leaning reform are going to point to are costs, and how much the American taxpayer is going to pay. Hopefully proponents of left-leaning reform will point instead to INVESTMENTS....but the critical question is how will black and brown bodies be deployed in the framing effort?
It isn't that hard to imagine conservative pundits using images of non-whites both explicitly in pictures, and implicitly in rhetoric.
"Why should we pay for the health care of some illegal immigrant/welfare mother who doesn't know how to take care of herself? Why should my hard-earned money go to her?"
"Detroit is the fattest city in the country. Why should the rest of us have to pay for lazy Detroit autoworkers?"
Using black and brown bodies to tilt the health care debate to costs rather than investments will tilt public opinion towards conservative and moderate solutions. We need to be vigilant about identifying this when it occurs because the research clearly indicates that when this type of race-baiting is revealed, it loses its power. We need upwards of 30,000 health care professionals to deal with both the aging baby boomers and the growing non-white majority (40% of Americans under 17 are now non-white). Before we even get to the costs of changing health care from one system to another we're going to have to create incentives in the form of college grants (as opposed to loans). If whites view this as nothing more than racial set-asides because the cost argument has been racialized, then this effort will die.
Another challenge we face--and I'll try to deal with more over the upcoming weeks--is structural in nature. States differ not only in the number of residents covered by employer sponsored insurance, they differ in what they require employer-sponsored insurance to actually cover. States like Mississippi required employers to cover very little compared to states like Maryland. How does race come into play here? States with smaller populations of folks who aren't covered by employer-sponsored insurance are more likely to have the resources needed to take care of them. Black and brown populations are more likely to be uninsured, hence state insurance burdens differ based on the size of their black and brown populations. Southern states with "peculiar" racial histories are much less likely to regulate employers, hence race shapes the quality of coverage required by states.
Now in creating some type of national standard, these state level differences are going to have to be managed. And the question is going to be do we have a high standard that requires states like Mississippi to step their game up, or does Mississippi in effect BECOME the standard? In hashing this out, some states are going to come out as "winners" not having to spend as much to change their systems/come up with more resources.
These dynamics complicate the "blacks/browns get poorer care" argument, but I think, in ways that are helpful for citizens who both want to be informed and want to do something about it. It isn't just that we get poorer levels of care, but rather that there are discrete rules, regulations, and norms, that make these conditions more likely--rules, regulations, and norms that likely will not be changed if we relegate our discussion to "we get sick while they don't."
Now so far I've dealt with what I call the racial politics angle. With the way that race shapes how resources are allocated, shapes who gets what.
But also important, particularly given Obama's presence in the White House is the black politics angle. I recently published a paper on black attitudes about HIV/AIDS, finding that blacks exposed to media stories blaming "down low" black men for HIV/AIDS were more willing to mobilize politically, but were also more interested in quarantining HIV/AIDS victims. NOT the political outcome we would want. This is an example to me of black politics--of how blacks allocate/withhold resources from other blacks within a general context of white supremacy. This is also an example of how health becomes a contested resource within black communities.
During this upcoming battle we're going to have to pay careful attention to the Congressional Black Caucus. The CBC should have "black interests" in mind...and in as much as they tend to be the most liberal voters in the House they are more attuned to black interests than their white counterparts. However the reality is that a significant number of black representatives live in districts where the largest employers are in the health care industry. What does this mean? Take Elijah Cummings, Maryland Democrat. The health industry is Cummings' third largest industry donor. These industries employ black executives and managers, as well as black service workers. How might Cummings vote on this matter be influenced by the fiscal needs of his employers and constituents, vs. the health needs of his constituents and black people in general? If race is given the silent treatment in the discussion on health care even though groups are fighting and HAVE been fighting to keep it on the agenda, how might we categorize the discussion about black elites?
I noted in an earlier post that we needed more social scientists to put their two cents in these public conversations. Hopefully after reading this you can understand why I might take this position. I've heard Dyson, and West at this point dozens of times, and have never heard them come anywhere close to dealing with these issues in depth. On the other hand just a few days ago I heard Dr. Brian Smedley of the Joint Center and Aranthan Jones of the Podesta Group speak about this issue WITHOUT NOTES for well over an hour.
And I hope this also makes it clear why a strong "race-based" critique of Obama is still needed, but one that does not fall into the simple "is he down/is he ain't" dichotomy. We are not at the point where we can reduce black suffering to class suffering. Even within the working class, blacks and browns still suffer more. But the trick is figuring out precisely where we need change, and tossing the "he didn't say King's name" overboard, along with our desire to protect him from racist attacks. I'm toying iwth the idea of a "black standard" for Obama and what it would look like. I'll use my next post to talk about this.
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