Wednesday, August 12, 2009

An Urban Conservative Perspective on Health Care by Akindele Akinyemi

There is a raging debate over the need for health care reform here in the United States. We have town hall meetings where people have been disruptive. Other meetings not so disruptive. Personally, I do not want to be lied to by any Congressman or woman. So I watch the action on television.

Of course, as urban conservatives, our voices have been silent in this debate. While one group is whining about the rising cost of health care the other side is saying it is needed to ensure all Americans.

At the epicenter of this health care debate is the urban community. Blacks and Hispanics are hit the hardest with health and medical disparities more than any other group in the United States. Blacks and Hispanics make up nearly half of the estimated 50 million Americans who have no health care insurance. 7 million blacks alone in this country do not have any form of health insurance.

But let's tell the truth here. If this reform effort goes through that means the real fear of private insurers, pharmaceuticals and major medical practitioners is that they’ll have to treat millions of uninsured, unprofitable, largely unhealthy blacks and Hispanics.

Of course, some of us do not want this to happen.

Harry Truman proposed the first national health care plan in the late 1940s. Ever since then the number of blacks and Hispanics without a prayer of obtaining health care at any price has always been wildly disproportionate to that of whites – even poor whites. It has steadily gotten worse over the years.

Studies show how blacks and Hispanics are far more likely than whites to suffer higher rates of catastrophic illness and disease, and are much less likely to obtain basic drugs, tests, preventive screenings and surgeries. They are more likely to recover slower from illness, and they die much younger.

Blacks' health problems are further complicated by its struggles with incarceration, drug use and the HIV/AIDS virus, the leading cause of death among young Black women between the ages of 25 and 34. Early detection and life-saving medication are really critical in prolonging life with HIV. This cannot happen without quality health care.

Studies have also found that when blacks and Hispanics do receive treatment, the care they receive is more likely to be substandard than that of whites. This is even after blacks and Hispanics are enrolled in high quality health plans. The other thing that no one is saying is how private insurers routinely cherry pick the healthiest and most financially secure patients in order to bloat profits and hold down costs. Patients pay more in higher insurance premiums, co-payments, fees and other hidden health costs.

When we don't have access to health care, that means we routinely delay care. The lack of routine medical care in itself is a cause of serious ill health.

So with all of this foolishness going on and the media as usual blowing stuff out of proportion we need to look at a different approach to health care reform in our community.

(1) Engaging Non-Profits through Social Entrepreneurship. The first thing we need to take a look at is empowering community based non-profits health care organizations staffed with nurse practitioners that can provide the same care as a doctor at half or a third of the cost. The development of innovative non-profit groups that sponsors a health co-operative working for all the non profits, little companies and employees.

Part of this is creating a social entrepreneur network of low-cost health providers for insure families. This is critical because our community should be engaged in a market-mediated system, where the system of entrepreneurialism and innovation is protected and incentivized. Some social entrepreneur networks who support low-cost insurance for families can engage in a personalized health system. This is a system that is built around each person’s individual health needs and status, which allows every individual to have access to the treatments and solutions that are best for their personal profile and make-up.

For example, if you see somebody black and over 40, they've probably affected in some way by at least one of the following -hypertension, diabetes, obesity and heart disease. Our community cannot embrace a plan that's going to have exclusions, where people cannot be treated for pre-existing conditions. Everybody walking has got a pre-existing condition even young people. We must fix this in our efforts for health care reform.

Other social entrepreneur networks could integrate an intelligent system, meaning that the system is electronic versus paper-based, is IT-rich and functions as an inter-connected, interoperable system.

(2) Allow association health plans. Owners of small businesses in urban areas should be able to band together across state lines to increase their purchasing power to buy less expensive insurance or to self-insure. Large multi-state corporations like General Motors already have this purchasing leverage.

(3) Permit individual membership associations (IMAs) to affinity groups as a college alumni association, the National Pan-Hellenic Council, the National Bar Association, or the Southern Baptist Convention, which have members in many different states, should be able to offer their members health coverage. IMAs would enable people to band together in large pools across state lines. A particular advantage of IMAs is that the individuals in them often remain lifetime members. Obtaining policies through an IMA would provide them with continuity of coverage no matter how many times they changed jobs in addition to passing on all of the benefits of continuous coverage, such as familiarity with provider networks.

(4) Tort Reform. The U.S. civil justice system is the most expensive in the world, about double the average cost of virtually any other industrialized nation. But for all of the money spent, our civil justice system neither effectively compensates injured parties nor encourages the elimination of medical errors.

(5) Engaging our Historically Black Colleges and Universities. Schools like Howard, Meharry and Morehouse have been leading the way in the field of medicine. However, part of the critical issue here are the barriers to us getting the type of care and being able to find a physician that understands the community. We must step up to the plate, develop satellite (out-of-state) HBCU campuses and online courses in the field of public health and medicine to equip our graduates to practice medicine in areas where low-wealth people exist. WE CAN NO LONGER IGNORE OUR HBCU's for they are extremely critical to assisting urban communites to advance in medical technology and medicine. Social entrepreneurs, not government, who are enegaged in health care reform should have a list of providers to assist with families.

Meharry Medical College, Howard University College of Medicine and the Morehouse School of Medicine would embrace a plan that insures more people because these schools are “safety net facilities” providing health care to the nation’s neediest and most ill.

(6) Personal responsibility. I cannot believe the number of people that will not do these 5 things:

1. Know your health insurance plan's rules and follow them.

2. Buy a "lite" health insurance policy.

3. Plan ahead for emergencies.

4. Cut your pharmacy costs.

5. Quit smoking, exercise and take care of yourself.

6. Get your annual check up (especially black men). The doctors and nurses are NOT our enemy, rising health costs are. So please get your teeth fixed as well. It's not cute to showcase tooth rot in the front of your mouth.

The problem with black people in America is the fact that we think Obama's health care reform is going to benefit us. Have we forgotten what the United States Government has done to our people during the Tuskegee Experiment that lasted from 1932-1972 where they tested and injected black men with syphilis to see the effects? I'm not saying that Obama is trying to do weird experiments on our race because that is not the case here nor I believe that is in his character. The point I am simply making is let's not jump in the bed with a government that has a history of hostility towards minorities when it comes to health care.

Let's think for ourselves on this one. The only health reform that we need is the one that will benefit our community. This includes reducing homicide, increasing healthy marriages, obtaining a quality education, expanding urban agriculture projects, opening health food stores and co-ops that promote healthy living and creating an execution plan for our both our occupational therapy and mental health community.

No one is going to take care us but us. This is why I urge urban conservatives to take the lead on this issue. Health care reform is an issue that urban conservatives should be silent on. We have our work cut out for us. Our community is counting on us to come up with alternatives to the health care crisis other than what we are seeing from President Obama and others who are caught up in partisan bickering instead of dealing with the issues at hand. Fear tactics and paranoia should also be left at the door as well.


maidintheus said...

This is such an important topic. Thanks for tackling it.
Your common sense solutions are spot on.

Constructive Feedback said...

You are one of the first Black commentators to discuss the issue of Black people as medical service providers.

As I view all of the arguments posted by our people I hear mostly the notion that "Black people need health care. If you don't support this bill then you are against Black interests". From this they assume that centralized control and financing of health care is in our best interests.

Such a plan does nothing to improve the ability for our people to help ourselves to care for ourselves.

I haven't heard a call for more Black doctors and registered nurses.

I struggle to understand how a people can consider themselves as "progressives" and not consider the increased capabilities that they must shoulder as a means of allowing our people to live at a higher standard.