United States: Race and class -- African Americans in a sick system

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By Malik Miah

August 2009 -- The critical lack of quality and affordable health care is devastating for African Americans. Twice as likely as whites to go without health insurance, African Americans suffer chronic illnesses such as high blood pressure and diabetes at an escalating rate. The root of the problem is not inferior Black — or better white — health care. It is first and foremost a class issue, exacerbated for Blacks and Latinos because of the institutional racism that still permeates society.

Only the wealthy can afford “the best medical care in the world”. Everyone else’s care is rationed by the employer or private plans that each can afford to buy, or if uninsured, by the use of “free” clinics and emergency rooms. The debate over the broken US health-care system and what to do about it is one of life and death.

Stubborn facts

The facts don’t lie. The United States is the only industrialised country that refuses to provide health care for all its citizens on principle. Health care is considered a privilege, not a right. The words “preventive care” and “cradle to grave” are demonised as “socialistic” and anti-capitalist — against the American way of life.

Unlike hundreds of billions spent on US wars of occupation in Iraq and Afghanistan, the cost to provide quality health coverage for all Americans is considered “too expensive”. The “right” of the insurance monopoly, the drug industry and organised doctors’ partnerships to make profits off the backs of sick people is a foundation principle of the free market health-care system.

The false charge that US President Barack Obama is a “socialist” is a cheap appeal to the “market fundamentalism” with which US society is permeated. Further, the persistent appeal to the right wing’s white, racist base about Obama not being “one of us” exposes the deep racial undercurrents in the country. The target today is health care; tomorrow another issue.

Obama’s stance, articulated during the presidential debates where he said he considered health care “a right not a privilege”, put him on a collision course with the insurance industry and their hired hands in Congress. The conservatives reject the French, British and other European models where health care is provided by the government directly or the insurance industry is highly regulated like a public utility. Hatred for government programs that actually help the common citizen is fundamental to their free-market philosophy.

Sixty years and still waiting

It’s not new. In the 1940s the same forces fought US President Harry Truman’s call for national health care. In the 1960s President Ronald Reagan, the hero of the conservative movement, led the charge against “socialised medicine”. In a series of recordings, Reagan attacked a government-run health-care system for the elderly (Medicare) as being the sure-fired road to socialism.

Reagan and the Republican Party aggressively opposed the establishment of Medicare. Every Republican voted against the bill that established the program.

The result? Thanks to Medicare most retirees have better health care than younger citizens who can’t afford high insurance premiums. In fact, fewer than 10% of Americans with Medicare coverage say they don’t like it. Not surprisingly, the right refuses to openly call for its elimination even as they attack universal health care.

The Veterans Administration (VA) is another successful government-run health program. It provides a program that is superior to most private for-profit plans. Yet it came under attack by President George W. Bush, who sought to gut the VA and shut hospitals. This was only stopped by scandal when the public learned how veterans were not getting the treatment they expected.

The problems with Medicare and veterans' care are mainly about money, as privatisation hawks seek to starve the programs to get the private sector back. Both Medicare and the VA programs provide better health care than the private sector — and, significantly, equal care to all racial and social groups.

With the profit motive taken away by the government, the service is more “socialised”. The limitations of these programs are primarily due to Congressional attempts to underfund them, not administrative inefficiencies that are comparable to the private sector and much cheaper to taxpayers.

These two government programs could be the basis to build fair medical coverage and provide universal care. Most importantly, they show how a government solution could begin to close the racial gap in the type of care provided to Blacks and Latinos.

Racial and class gap

A myth of the health-care system is that it may be broken, but treats African Americans and whites equally. In reality Blacks and Latinos are nearly 50% of the 48 million uninsured, and the least likely to be insured. This racial gap is rooted in the history of institutional discrimination that the rise of the talented African-American middle class does not negate.

The problems of health care for African Americans are interlocked with race and class. In a 2005 article entitled, “The Consequences of Being Uninsured for African Americans”, Gail C. Christopher, the former vice-president of the Joint Center for Political and Economic Studies Office of Health, Women and Families and current vice-president for health at the W.K. Kellogg Foundation, wrote:

National surveys have consistently confirmed the simple and primary reason why people are uninsured — they cannot afford to purchase health insurance if their employers don’t offer and pay for health insurance. Compared to white Americans, studies show that African Americans are less likely to work in jobs that make health insurance available, they are less likely to be offered health insurance, and they are less likely to take it when offered. Just 53% of African Americans get insurance through work as compared to 72% of white Americans....

African Americans constitute 12% of the overall population but 16% of the uninsured. 53% of African Americans earn less than 200% FPL [Federal Poverty Level] as compared with 25% of white Americans. 20% of African Americans are uninsured compared to 12% of white Americans; [and] 24% of African Americans are covered by public insurance (Medicaid) as compared with 16% of white Americans.

The situation is even more pronounced today in the deepest recession since the 1930s. African-American official unemployment rate is twice that of whites.

“Of the estimated 48 million American adults who spent any time uninsured in the past year, 67 percent were families where at least one person was working full time”, according to the Commonwealth Fund Biennial Health Insurance Survey in its 2006 report. Further, “Two of five (41.1%) working age Americans with incomes between $20,000 and $40,000 a year were uninsured for at least part of the past year.”

“African Americans”, adds Christopher, “have higher incidence of chronic disease such as diabetes, high blood pressure, and obesity; health status outcomes will reflect constrained access to healthcare services. For example, heart disease mortality rates for nonelderly adults are twice as high for African Americans as for white Americans. The infant mortality rate for African Americans — 15% in high school and 14% post-high school — is almost one-third higher than the next ethnic group and more than twice as high as for white Americans.”

Even when they can pay for medical coverage and the high insurance premiums, African Americans and Latinos can be excluded if afflicted with diabetes, high blood pressure and other diseases because of the “pre-existing condition” clause in all health insurance polices.

There is no such thing as a safe job or career with paid health insurance for life, as auto workers have recently learned. An aging unemployed worker with a pre-existing condition simply can’t purchase affordable health care.

How to win

The fight to win health care for all against the big insurers, pharmaceuticals and the American Medical Association lobbyists requires mass public pressure. What's missing are street mobilisations in Washington DC and across the country to take on the anti-reform right. Reliance on friendly politicians has never worked.

Tweaks to the health insurance industry may help a few, but will not provide millions of uninsured and under insured Americans the urgent and preventive health care they need. African Americans and Latinos — already worse off — will continue to receive inferior care with the resultant premature deaths from preventable diseases and treatable illnesses.

While President Obama’s moderate “public option” plan may be better than what exists, the status quo alliance will oppose any changes to the system that takes away control from the private insurance companies. The disagreement between Obama and the conservatives, including the self-named “Blue Dog” Democrats, is a diversion from the real debate the country needs: how to solve the discriminatory treatment of Blacks and Latinos and achieve universal health care for all Americans.

A key lesson of history is that universal health care will not be won by waiting for Obama or Congress. Lyndon B. Johnson didn’t create Medicare in the 1960s; it came as a by-product of the social upheavals led by the civil rights movement, which also won historic civil rights and voting rights legislation.

Unless a new mass movement is built to win universal health care, true reform is impossible. Extra-parliamentary action is what’s needed to break the status quo and impose change on the system.

[For more articles, analysis and studies on the health care in general and its impact on Blacks, Latinos and the uninsured go to The Henry J. Kaiser Foundation website at www.kff.org and the Joint Center for Political and Economic Studies website at www.jointcenter.org. This article first appeared in the September-October 2009 issue of Against the Current, the magazine sponsored by the US socialist organisation Solidarity. It has been posted at Links International Journal of Socialist Renewal with permission. Malik Miah is a San Francisco trade union activist at United Airlines, an editor of Against the Current and a supporter of Solidarity.]

Submitted by Terry Townsend on Tue, 10/27/2009 - 12:45


An Interview with an Emergency Room Doctor and the "Inalienable

Right" to Health Care vs the Heath Insurance Industry Tyranny 

by A H Goldberg*

Paul Hochfeld, MD who is an  emergency room doctor in Corvallis 

OR and one of the Mad as Hell Doctors spoke with me earlier this year in 

an interview about the need for single payer, as it provides quality health care for 

all at less expense and provides for "someone" to run such a system, and

we now have no system, but a complete mess insuring a shortage

of primary care doctors. Dr Hochfeld has made a documetary on

the health care crisis in this country and what should be the solution

with single payer. I have to add with some person or persons in 

charge of such a system in the federal government, we could have

accountability which is now completely and absolutely lacking. 

The Mad as Hell Doctors was a group which advocates a single

payer health system and set out from Oregon a while back to cross

the country and to make a stop in Washington in the US Capital to

speak out there in the seat of the US Government on this matter,

crossing the USA speaking out as they went on the advantages of

a single payer system of health care. They crossed the country in

what they referred to as a Care A Van. 

Now the Wall Street Journal, the voice of big business in this country,

no less says we have a shortage of surgeons so severe that people

are now getting surgeons who are temporaries going from one town

to another. The American College of Surgeons condemns this practice

This mouthpiece for big business says this shortage of surgeons has

been going on for 25 years and is most pronounced in rural area. This

has literally then become a matter of life or death, and especially in

these rural areas. 

Most doctors, most health economist, and most of the American people

back single payer, Dr Hochfeld has said in an article which came out 

December 30th last year in the Corporate Crime Reporter.  

Why hasn't this country adopted single payer which would, as it

should, establish health care for all as an "inalienable right" as Thomas

Jefferson would so aptly put it?  

Start with what ought to be clearly and absolutely obvious to everybody.

The health insurance and pharmaceutical industries having it so

good riding a gravy train and making piles of money, and thus aren't

the least bit interested in single payer, which is so predictable. They

just want to keep their gravy train going. 

It's greed trumping need as I would hasten to add. 

AARP is right in there with the health insurance and pharmaceutical 

industries fighting single payer, while putting on act of being a good

guy as Dr Hochfeld says. They makes a pile of money from the profit

side of the organization and talk as if their non profit and profit side

are completely separate, but AARP is in this fight, not for anybody's health

but for the money.  Thus the American Association of Republicans for

Privatization (AARP) has shown its true colors.

Furthermore, AARP's influence is pervasive as it is successful at passing

itself off as the good guys as Dr Hochfeld points out. Dr Hochfeld also said

that AARP has even threatened legislators in Oregon who vote for single

payer that AARP will make sure they're defeated. This organization, Dr 

Hochfeld says, has been spending piles of money lobbying to stop single

payer for years. Dr Hochfeld tells how AARP seeks to demonize single

payer with the "socialized medicine" label.

This is the health insurance and pharmaceutical industries' line as well

along with all the talk about people losing their choices, which health

care as the health insurance now runs it, means no choice. The health insurance

industry decides who can see which health care provider, what health care that

person can get, how much, the amount to pay, the amount of coverage

by the health insurance industry, and this includes pharmacies to go to

get prescriptions, which ones are allowed, which amount of coverage,

the payment, and right on through-- no choice. With Single payer, all

the people can see any damn health care provider they want to see, when 

they want to see that provider as long as that provider is available and it's

for needed health care, and nobody goes without health care. Add to

that a good estimate is that it would save a third of a trillion dollars. But

that would take money away from the bean counting, parasitic health

insurance industry and its welfare program for itself.

Meanwhile showing just how "humanitarian" the US health insurance industry

is, in the blue state of New York, the Guardian health insurance company

has dropped a whole line of coverage to drop such "dogs" as one top executive

at that company said in an email of 37 year Ian Pearl, who has muscular 

distrophy even though this is the coverage Pearl relies on to keep him alive.

But not to be outdone in this competition for rank hypocrisy are those in congress

who while themselves using a form of a single payer system vote against it for

their constituents, and this includes that infamous senator from Montana and for

the health insurance industry who needs no introduction, but surely "deserves

and comment on, which he will get here.

Therefore, let's not fail to "thank" Max Baucus for his mandatory, fine those who don't 

purchase health insurance they don't really choose or which they can't even afford, 

and selling himself as the prostitute for hire for the health insurance industry pimps. 

AARP along with the health insurance and pharmaceutical industries want

the kind of "change" they can believe in, change in their pockets which they

line with our money. They just want to have funds. 

Having joined this outfit just as I retired years ago when I thought it was

an advocate for retired people, I just continued my membership, but the

things AARP says in its magazine show what it's all about, and that's good

to know to insure we know how phony it is and how this outfit puts its greed first.

Then it's "divided we fail" if the hierarchy in AARP doesn't get what it wants. 

As a member of AARP, I happen to know first hand how this organization, 

these "good guys" pressed for a "compromise" resulting in cuts in Medicare

coverage of prescriptions, and after that happened AARP was right there

to tap into this new involuntary market to make lots of money. This shows

how much of an axe those running AARP have to grind to make sure single

payer doesn't pass. It would substantially, if not overwhelmingly cut down on

their revenue. Thus we have AARP alligned with those who put greed over

need. AARP has been able to play this role of being an advocate by the US

mainstream media playing right along and passing this off as the gospel truth. 

Thomas Jefferson, for all his faults put it so well when he said, "Greed degrades."

Meanwhile the country's mainstream media also fails to or virtually fails to cover

Dr Hochfeld and the majority of doctors favoring single payer. The same is true

of other health care providers who favor single payer. The same media if it does

cover single payer, always comes up with BS put down that could easily be 

knocked down by Dr Hochfeld or many other health care providers, but lack

of coverage insures that never happens-- more on this and reasons for same


As someone who has experienced this country's health care first hand, I have

personally had to wait at least an hour and a half to see a doctor in an emergency

facility in metropolitan Minneapolis/St Paul. That's long enough that I or anyone

else could easily have died. It's worse in other major metropolitan areas, and the

Nation even had an article showing that at times people would be moved from

one emergency room to another due to the shortage of doctors. Do believe some

have surely died as result of this health care mess. Others have done without care

they need due to the shortage of primary care doctors and often to not having any

health insurance coverage at all. This was years ago, and things are definitely worse


This country thus has endured as Jefferson would say, "a long train of abuses"

It has health care of, by, and for the health insurance industry with the drug industry

and AARP getting a piece of the action and big time money at our expense. The

health insurance industry, though, is the primary ruler here, with other two simply

being along for the ride. But tyranny it surely is, for none of these institutions with

all their power recognizes they should "derive their just powers from the consent

of the governed."  With that in mind, as Jefferson said "governments (institutions

in this case) are instituted to secure "the inalienable rights" of "life, liberty and

pursuit of happiness."  With Jefferson also referring at one point to health as being

"essential" for happiness, thus it should be an inalienable right, and when "governments

(again in this case institutions) "become destructive" of such rights, then the people have 

"a right to alter or abolish" them, and replace them with "new governments" (in this

case a new institution, single payer) providing proper "safeguards" for the people. 

This single payer would definitely do, providing health care "of, by, and for the 

people" as Abraham Lincoln would say, and thus end the current health insurance

industry tyranny over the people's health care with that industry's arbitrary authority

and abuse of such power in determining who gets to see which health care provider,

get what health care, what coverage, charging as it so chooses with no accountability

nor consideration of those it rules over and consideration of "deriving its just powers

from the consent of the governed," treating these "subscibers" as lowly subjects, making

victims of them, victims of this same tyranny. It' time to stop this nonsense of letting the 

health insurance industry rule while the people pay the price.

The US health insurance industry controls health care and maintains its tyranny by

divide and rule strategy of playing off heath care providers against patients. When

talking to health care providers, the industry blames the patient for abusing the "system"

which really isn't a system, by using it when they don't need it, thus causing high costs.

When dealing with patients, the industry will blame the health care providers for charging

too much. AARP takes the line that the health care providers are at fault with its members,

overwhelmingly patients, but never gets at the real cause of the problem, the health insurance

industry, as AARP is gettting piles of money off this "system," which puts the quid pro quo

back in the status quo, stressing as it does the buying of politicians to get what they want


With the pharmaceutical industry, the key to their piles of 

money lies in the fact that with full private control, the industry

can charge what it likes, as long the federal government, once the

people's government, isn't negotiating prices for prescriptions. 

This is the conclusion I'm forced to on this. 

We need a system Dr Hochfeld is saying. Currently it's clear we don't 

have a system, but a hodgepodge and complete mess, and this I'm

forced to conclude.

With Rash Windbag and his tea baggers many of whom surely are a claque

financed by far right/loony right super rich types putting out so many lies, it's

hard for the people of the USA to get to the truth about health care in this country

unless they or someone they know experience that the people of the USA have

first hand experience with the harsh reality of same. But as Rash and his tea

bag crowd neo constipated crowd often like to mix the Christian religion in

this, the Bible passage that says "Ye shall know the truth and it will set you free"

really right on the mark and entirely fair to use.

Now why is the media not covering those health care providers including

doctors who favor single payer.? Why would that be?  Hey, how about

the huge amount of MONEY these media types get from big business

especially the health insurance and pharmaceutical industry, which they

might lose if they covered such topics as single payer? This one professor

of mine in a University of Oregon journalism program referred to as thematic bias-- 

certain topics are just off limits, and this tends to be due to advertising the media

get from certain sources. These media types know which side their bread is

buttered on.  Combine this with the fact that the media generally is a big

business itself and it's easy to see why the media cover this issue the way

it does, leaving out all that might not fit its own big business bias, greed and

self righteous selfishness. 

A H Goldberg* is the name on this writer's blog which can be accessed at ahgoldberg.radiioleft.com.