Addressing Racial Health Inequities
Part XV: Yes, Now is the Perfect Time to Talk Healthcare in America
Note: This post is one part of my series, Yes, Now is the Perfect Time to Talk Healthcare in America, which provides an in-depth look at the current healthcare system so that it can be reformed. Click the link or scroll to the bottom to check out the other posts in the series.
I believe that incentivizing and repositioning young healthcare professionals, like primary physicians, can make an immediate impact on racial health inequities. It can greatly aid minority, working class, and rural communities that need access. However, I would be remiss if I did not underscore the stark and systemic health inequities that exist for the Black and Brown communities in America. I can’t pretend that simply providing health insurance and moving around some young health professionals will solve the problem. It will help, but we must go much further.
The racial health gap in America does not exist in isolation. It manifests as part of interconnected institutional failures: health, housing, education, economic, and justice. With this in mind, perhaps some health-specific strategies can produce tangible improvements and bleed into these other areas as well.
Corporate Community Wellness Strategy
From a health standpoint alone, I believe the best reform we can make will affect generational change. I see preventative health as that mechanism. I think we can use a few different strategies in this direction.
First, I believe that in our urban centers, large corporations have an obligation to better serve their surrounding communities. For under-served, local communities, they should contribute to premiums and out-of-pocket expenses related to well-baby and well-child visits, cancer screenings, and medication costs.
As previously discussed, hospital systems continue to consolidate along with many industry sectors. It would be easy to say that America should simply enforce the antitrust laws already on the books but realities exist. Monopolistic activities litter the healthcare system, and America can remedy this de facto situation. Legislative action can create accountability which, through the legal system, has been sidestepped.
I believe large enterprise has an obligation to aid the lifeblood of their cities and communities. And, I think it should include more than employment and value for shareholders.
I also think this commitment tackles healthcare from an alternative angle. Corporations will possess a greater stake in their local communities and have an incentive to work with their health insurance partners to drive down prices. I don’t hold any animosity toward big business. In many ways, they already help communities and have robust charitable arms. Still, I believe the levers of government can play a role when more is needed and how to guide it. Perhaps, this approach will create avenues for under-served communities to gain access to private care and otherwise inaccessible treatment pathways.
Sister-City Community Ratings
Second, for private insurance, I would build on the community ratings reform legislated in the Affordable Care Act. Under the law, insurers cannot raise premiums based on health status, medical claims, preexisting conditions, gender, race, and most other factors. Instead, the risk must be pooled to create a more even community rating. However, we know that communities themselves can greatly vary and housing, in affect, partitioned.
Community ratings impact many segments of lower-income, Black and Brown communities. It anonymizes risk and creates a burden-sharing apparatus. However, I believe we can do more for those who don’t qualify.
In practice, housing and funding go hand in hand. Often, they are inefficiently siphoned to wealthier communities. Therefore, cycles, where funding does not reach the communities most in need, perpetuate. Unfortunately, this disproportionately impacts minority communities.
This situation often functions as a modern form of redlining. Funding isn’t only re-directed away from lower-income housing. It’s often given to public schools, medical centers, and businesses located in higher-income areas as well. While moving is often highlighted as an option, lower-income individuals are often priced out.
I would require state legislators to design sister-city community ratings. For instance, I would pair community ratings for an upper-middle class with a lower-middle class community. For individuals who receive employer-based insurance in lower-income communities, this would make impactful gains. While based on wealth disparities and on a sliding scale, the racial health inequity gap would winnow.
I imagine some would argue that middle class communities might see their premiums increase and, in the short run, this might be true. I see this as more of an investment into our country than as a tax burden. In the long run, if this measure can be choreographed with more individuals switching to government-based insurance, the impact would be widely offset. Once under a singular program, risk will be flattened through spread.
Like the corporate community wellness strategy, this will give more advantaged communities incentive to improve the health equity of their sister cities and increase lower-income community mobility. I think it would be important to put an independent commission in place to ensure that actual health standards are improving rather than gentrification. This way, wealthier communities must tackle rather than displace the shared risk.
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