Health-insurance reform, a subset of health-care reform, has dominated the national agenda in recent months. Many constituencies have united in their criticism of the insurance industry, and for good reasons. The Obama administration knows it can only take on so many powerful interest groups at once. But there is an unfortunate by-product of this narrow focus on insurance reform: many important issues are being neglected. The discussion of health-care finance reform, as important as it is, diverts attention from other important issues that should be driving the dialogue.
For example, there is virtually no discussion of the disparities in health care along racial and ethnic lines. The great inequalities in health outcomes between minorities and non-minorities are undeniable and highly problematic. These disparities are usually due to language differences, socioeconomic barriers and bias among health-care providers.
Studies dating at least as far back as the early 1990s show that whites are more likely than blacks to receive highly technical and invasive cardiovascular operations — transplants, cardiac catheterization and implantation of devices like pacemakers — even given absence of financial incentives. Additionally, primary care physicians who treat black patients usually have fewer resources and are less well-trained clinically than physicians who treat white patients.
The difference in care between black and white patients is especially stark in cardiac health. Black patients are less likely than whites to receive more effective medical treatment after heart attacks, strokes or heart failure. And after these episodes, blacks’ long-term survival and functional health are worse than whites.
This differing treatment is not only unjust; health professionals also consider it a medical error. Sadly, the inferior health-care system used to treat blacks, poor people and other minorities does not receive nearly as much attention as insurance reform.
To address the issue of disparity in health care, hospitals should implement quality-assurance systems to study their treatment of patients of different racial and socioeconomic backgrounds. This relatively simple reform would benefit our health-care system enormously by uncovering instances of bias, which will facilitate a resolution to this serious problem.
Medical malpractice reform is also being overshadowed and should be moved to the forefront of the national discussion. Doctors spend countless hours and health-care providers spend millions of dollars performing arguably unnecessary tests and procedures simply to avoid lawsuits. Meanwhile, hundreds of thousands of patients suffer injuries at the hands of health care providers, but the vast majority do not receive compensation. These cases often drag out in court, racking up huge amounts in legal fees — a huge boon for trial lawyers.
The public debate should include a robust discussion of topics such as no-fault malpractice insurance. Under this system, hospitals, doctors, nurses and other health care providers would be quick to admit mistakes and correct their errors. After being reviewed by a panel, patients would be compensated for their injuries. And doctors would be free to practice without the fear of medical malpractice lawsuits. In addition, health care providers can then study why malpractice occurs and how they can prevent it.
In June President Obama arranged a deal with the pharmaceutical industry’s lobbying group; they agreed to contribute $80 billion to help defray the cost of health-care reform and to fund advertising intended to generate support for parts of Obama’s legislation. Obama agreed not to ask for more savings over the 10-year span. Surprisingly little attention has been paid to this arrangement, and many Democrats believe that this deal basically eliminates the government’s power to negotiate lower drug prices under Medicare.
Disparities in treatment, malpractice reform and some of President Obama’s troubling deals do not represent a comprehensive list of all the issues the public has been ignoring. But they are some of the crucial issues still being neglected in favor of a focus on insurance reform. This is unfortunate because it is imperative to get health care right this time.
Our country will not be inclined to revisit these issues piecemeal over the next five or 10 years. It is highly unlikely that the American public will have the energy, incentive or interest to create more effective change in the future. The best way to get it right this time is to make sure that all issues related to health care receive the same attention as health-insurance reform.
Jennifer Parker is a junior in Silliman College.