by Dr. Jessica Schorr Saxe
|Medicare for All would close gaps in racial inequality in American healthcare.|
The American healthcare system is expensive, inefficient, and plagued by racial inequities.
The COVID-19 pandemic shines a harsh spotlight on those deficiencies, particularly for Blacks and other minorities. George Floyd’s murder has forced the country to give long overdue attention to finally establishing racial justice. Now is the moment for us to definitively address healthcare, along with other critical issues of racial justice.
The United States has performed dismally compared to other developed countries. With 4% of the world’s population, we have had 25% of COVID-19 cases. Cases and deaths rise at alarming rates, while many other countries have controlled the spread. In the U.S., Black and Hispanic communities have borne the brunt of the impact with three times the rate of infection and twice the rate of death. In Mecklenburg County, Black people accounted for 40% of the deaths not connected to long-term care facilities.
The main difference between the U.S. and the more successful countries is our lack of a national health program with universal coverage and coordinated health planning. Several of our failures point out how improving and extending Medicare to everyone might have helped with Covid-19, especially for Black people.
Before the pandemic, millions of Americans were already uninsured or underinsured (insured but unable to afford medical care), with Blacks disproportionately affected. Many people deferred testing or treatment for fear of expense. The is the precise opposite of the response needed to protect us all. People who have been exposed or are feeling sick need to be tested so they can be treated and isolated. Their contacts must be traced and quarantined as needed to prevent spread. Instead, many people are dying and suffering severe illness after delaying care. Many who tried to do the right thing and sought testing and care were stuck with large bills.
The pandemic has worsened our pre-existing condition of insurance inadequacy. The surge in unemployment has predictably resulted in millions losing employer-based coverage. Many will remain uninsured, especially in North Carolina and other states that didn’t expand Medicaid. Even those eventually able to secure other insurance will suffer major disruption as they navigate a new bureaucracy to acquire it and may be forced to change providers and medications.
This is the poison pill of our system: just when individuals most need health insurance and our country most needs them to have it, it’s vanishes into the ether.
Why have Black Americans suffered disproportionately from the COVID-19 pandemic? Multiple reasons include inadequate insurance prior to the pandemic, loss of access due to loss of employment, being essential workers, and having less ability to work from home. Black Americans are also more likely to have underlying conditions that put them at higher risk for complications or and death. These conditions are not due to genetics, but to racism, indirectly through its effects on education, economic security, housing, and exposure to air pollution; and directly through the stress of racism itself.
Medicare is the most popular health insurance in the country. Black Americans should take particular pride in it, as Dr. Montague Cobb, president of the National Medical Association, led Black doctors in supporting Medicare, while the almost entirely white American Medical Association opposed it. Because of the hard work of the NMA and the NAACP, hospitals had to integrate to accept Medicare money.
Just as Medicare led to hospital integration in 1966, Medicare for All can be a major step toward eliminating racism and racial inequities. With everyone in the same system, everyone would be eligible for high-quality care. By cutting the connection with employment, no one would lose their coverage if they lost their job. Everyone could get care during a pandemic, protecting their health and that of the public. People with high-risk conditions wouldn’t feel forced to work just to keep their insurance. And everyone could get their necessary preventive or chronic illness care, pandemic or not.
It’s now more obvious than ever that our employer-based health system has failed us. As the pandemic has so harshly proved, it’s time for Medicare for All.
Dr. Jessica Schorr Saxe is a retired family physician in Charlotte who is chair of Health Care Justice—NC. Write her at HCJusticeNC@gmail.com.