Unfinished business: let’s have an honest discussion about health care

By Rogette Harris

Many people in the United States are not getting the health care services they need and / or deserve, even though they have insurance.

The debate over health care in the United States is incomplete. If access to care is essential, so is the quality of care. Many Americans have health insurance, but still don’t get the care they deserve. How many people know that doctors have the legal right to refuse to treat patients? Only emergencies cannot refuse treatment and often it is then too late.

Racial and ethnic disparities in health care present considerable moral and ethical dilemmas for the American health care system. As a nation, we have an abundance of healthcare facilities, innovative technologies and access to medicines. Unfortunately, these are not accessible to everyone. Health care can also be linked to social justice issues, opportunities and quality of life for patients, communities and the country as a whole. Inadequate, inaccessible and / or poor medical care further exacerbates rising health care costs which have far-reaching consequences for the overall quality of care received by all Americans.

Data compiled over the past 40 years undeniably shows racial disparities in the health care system. The COVID-19 pandemic blew up these loopholes for the world to see. For example, infant mortality for black babies remains nearly 2.5 times that of white babies; the life expectancy of black adults remains about a decade shorter than that of whites.

Diabetes rates are over 30 percent higher among Native Americans and Latinos than among whites. Death rates from heart disease, stroke, and prostate and breast cancer remain much higher in black populations, and people of color remain significantly under-represented in the professional workforce of health.

Again, this is a moral and ethical question. Race must be taken out of the equation.

Racial disparities in kidney disease, for example, are glaring and well documented. Black Americans are more than three times more likely than whites to have kidney failure and require dialysis or a kidney transplant, but receive poor care.

Although black Americans make up about 13% of the American population, we represent at least 35% of Americans with kidney disease. Almost 100,000 Americans are on a kidney waiting list. Of these, about a third are black, about as many as those who are white. This number does not include those who are still trying to make a list of kidneys.

According to a New York Times article, people of color and low-income Americans are less likely to receive quality care when warning signs first appear, and chronic kidney disease could be prevented. Black Americans are more likely to develop kidney failure and require dialysis, and less likely to be treated by a kidney specialist before they get to this stage, according to a report from the Centers for Medicare and Medicaid Services. Black Americans also wait longer for an organ and are more likely to be rejected from waiting lists.

Last month, a scientific task force suggested that doctors remove a common measure of kidney function that adjusts results by race, providing different ratings for black patients than for others. Instead, the task force advises doctors to rely on a breed-neutral method of diagnosing and managing kidney disease. The task force put this recommendation and others in a report from the National Kidney Foundation and the American Society of Nephrology. The goal of this new report is to exclude racial bias in clinical care, so that people are no longer judged on the basis of their race and the color of their skin dictates the kidney care they receive.

Unfortunately, health care decisions that consider race and ethnicity are not uncommon or even unique to kidney disease. The algorithms and calculators that doctors rely on to make diagnostic and treatment decisions for many serious and less serious conditions use race as a variable, as reported in an article published last year in the New England Journal. of Medicine.

Poor quality health services hold back progress. While these disparities have always existed, the COVID-19 pandemic has exposed these disparities more openly for all to see. The report, Delivering Quality Health Services – a Global Imperative for Universal Health Coverage – shows that disease associated with poor quality health care places additional emotional and financial stress on families and health systems.

It is time to speak the truth and have an honest debate about health care. Regardless of your stance on Medicare for All, there can be no universal health coverage without quality care. Let’s stop rolling the dice with people’s lives. Doctors must take the Hippocratic Oath seriously. Only with improved, high-quality, people-centered services can we restore confidence in health systems.

Rogette Harris is a Democratic political analyst and member of the PennLive Editorial Board.

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