June 18, 2012
Whether it is the individual mandate or the expansion of Medicaid, the issues focus on insurance. Individuals do not want to be forced to purchase insurance and nearly half of the states do not want to expand their Medicaid coverage.
However, without insurance, healthcare in this country is generally out of reach for all but the wealthiest few.
As we wait for the Supreme Court to rule on the constitutionality of the ACA, we should consider the healthcare disparities that result from our current system of healthcare. Whether it is near universal insurance coverage under the ACA or some other plan, these disparities are hurting individuals and even holding back the country when compared to other industrialized nations.
In 2011, the Office of Minority Health (OMH) released its National Stakeholder Strategy for Achieving Health Equity. As part of its plan, the OMH discussed the current context for healthcare disparities in the U.S.
From 2005-2007, compared with whites, mortality rates for African Americans ranged from 2.1 times to 8.8 times higher for diabetes mellitus, prostate cancer, and HIV.
In 2009, for African Americans compared with whites, there were:
- 2.0 times more hospital admissions for diabetes-related lower extremity amputations;
- 1.8 times more new AIDS cases; and
- 1.4 times as many women who did not receive prenatal care in the first trimester.
The numbers were not much better for American Indians, Alaskan natives, Asians, native Hawaiian, Pacific Islanders, and Hispanics/Latinos.
The report also notes that in 2006, there were 13.3 maternal deaths per 100,000 live births compared with 6.6 deaths in 1987. And, the rate for non-Hispanic African-American women was more than three times that of non-Hispanic white women.
Last month, the Commonwealth Fund released a study showing that although the U.S. spends more per person on healthcare than 12 other industrialized countries, patients do not necessarily receive “notably superior” care. According to the report, in all of the other countries, “health care affordability is ensured through universal insurance-based or tax-financed systems.”
Of course, just as spending more doesn’t mean superior care, it also doesn’t mean equal care.
Last week, the Thomson Reuters Foundation reported on the results of a global perception poll to rank the countries of the Group of 20 (G20) nations on how well women fared in these countries.
Among the 19 countries with major economies, the U.S. ranked only 6th best for women. Canada, Germany, the United Kingdom, Australia, and France all ranked higher.
Notably, access to health insurance and reproductive rights were two of the primary factors that lowered the U.S. ranking. The report noted that 22.9 million women do not have health insurance and that 92 anti-abortion provisions were enacted at the state level in 2011. One expert noted that women “suffer disproportionately from the lack of affordable healthcare.”
With or without the ACA, the U.S. needs to address the barriers that perpetuate economic, racial, and gender disparities in our healthcare system.