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Last Thursday, the American Medical Association issued an official apology for its past racism toward African American patients and physicians.  Along with the apology were the findings of a study conducted by the Commission to End Health Care Disparities, a group that the AMA and the National Medical Association (an organization representing black physicians) co-chair.  The study has found that between 1846 and the 1960s, the AMA's past transgressions included:

substandard care for black patients or segregated them to black hospitals; a lack of support for black physicians and for the Civil Rights Act; and exclusion of blacks from medical schools, hospital staffs and residency programs.

The apology can be found here, and the study is available in the online version of the Journal of the American Medical Association. To learn more about the work of the Commission to End Health Care Disparities, go to the AMA website.

It is also worth noting that a number of doctors were opposed to the AMA's discriminatory policies in the 1960s.  A group of physicians picketed the AMA convention in Atlantic City in 1963 in order to call attention to the AMA's racist acts.  Among these physicians was Dr. Robert Smith, a leader of the Medical Committee for Human Rights in Mississippi (MCHR).  The MCHR grew out of the Medical Committee for Civil Rights, and organized a number of volunteers to come down to Mississippi to provide care to black patients who were not being treated in their communities:

Though MCHR volunteers were not licensed to practice professionally in Mississippi, they could offer emergency first-aid anywhere and anytime to civil rights workers, community activists, and summer volunteers. Working without pay, they cared for wounded protesters and victims of police and Klan violence, assisted the ill, visited jailed demonstrators, and provided a medical presence in Black communities, some of which had never seen a doctor. They established and staffed health information and pre-natal programs in many Black communities. Appalled at the separate and unequal care provided to Blacks by Mississippi's segregated system, they soon involved themselves in political struggles to open up and improve Mississippi's health care system for all.

The Health Care Blog has a posting that discusses My Health Direct, the web-based solution to overcrowding in emergency departments.  The idea of My Health Direct is for hospitals to use an online appointment system to re-route their Medicaid and uninsured patients to community and safety-net clinics.  According to the blog posting, the program has been successful in increasing patients' access to primary care and improving the quality of care and treatment outcomes for those patients:

More than 12,000 health appointments have been made with the vast majority of these appointments for patients who are uninsured or enrolled in a Medicaid managed care plan. These appointments were made for patients who either presented for care with a non-emergent condition, or needed follow-up care in a primary care setting.

A utilization review of My Health Directs impact demonstrated that more than 92% of patients who received an appointment did not present to the ED again. Patients who obtained appointments were more than 4 times more likely to actually attend their appointment compared to previous referral efforts from the ED. Lastly, there was a 25% reduction in repeat non-emergent visits of those patients assisted by My Health Direct.

A recent Health Beat blog posting titled "The Realities of Rural Medicine" discusses the unequal access to health care for people who live in rural areas.  The study on rural health care, conducted by the Center for Studying Health System Change, found that both patients and doctors feel significant strain in living in communities that do not have enough primary care options.

The Washington Post is reporting that Los Angeles City Councilwoman Jan Perry is trying to limit the prevalence of fast food restaurants in South Central Los Angeles by placing a moratorium on new fast food locations in the area.  Perry is a representative for District 9, an overwhelmingly African American and Latino constituency that has significant health disparities in comparison to the wealthier West L.A. area:

Perry quoted research showing that although 16 percent of restaurants in prosperous West L.A. serve fast food, they account for 45 percent in South L.A. Experts see an obvious link to a health department study that found that 29 percent of South-Central children are obese, compared with 23 percent county-wide.

Originally posted to The Opportunity Agenda on Tue Jul 15, 2008 at 11:36 AM PDT.

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Comment Preferences

  •  Common thread (5+ / 0-)

    The commonality in all of the stories cited above is inequality of access to health care.  And even though some of the inequalities mentioned above - racial and geographic - are not specific to the uninsured, every one of those problems is made worse by a system that ties your access to health care to your economic status.  And every one of them will be better and more easily addressed under a single payer system.
    Single payer now!

    •  A good reminder (0+ / 0-)

      That it is economic disparities more than racial disparities driving social disparities right now.

      To bring this back to Obama (lol) he also talks about changing affirmative action from racial to economic standards.

      (And, oh yeah, single payer now!)

      "It was involuntary. They sank my boat." John F. Kennedy, on being a war hero.

      by smileycreek on Tue Jul 15, 2008 at 09:23:43 PM PDT

      [ Parent ]

  •  We will not be able to completely level the field (1+ / 0-)
    Recommended by:
    ludlow

    I think that the rich and powerful will always have preferred access to the best facilities, but with single payer we can at least reduce the gross disparities.

    Numbers are like people . . . Torture them enough and they'll tell you anything.

    by Actuary4Change on Tue Jul 15, 2008 at 12:07:07 PM PDT

  •  After Katrina I was one of the RNs CNA/NNOC sent (1+ / 0-)
    Recommended by:
    Mdfog10

    to the Gulf Coast to help. I took care of many people who were getting medical care for the 1st time in years. They had hypertension, diabetes, were in need of dental care. Some of those folks were getting care through the Charity Hospital that had to close down. I thought then and your diary makes me think again that none of this discrimination and disparity would exist had we a National Health Care plan.

    In a Single Payer system everybody is covered. You chose your own doctor and hospital. Because providers would be paid for every patient seen and every needed service rendered rural areas would have more health care providers.

    Health Care for All/Improved and Expanded Medicare for All HR 676 would go a long way to bringing us Health Care Justice and Equity.

    http://web.mac.com/...

    Only power used to empower is everlasting. Prof. Scott Bartchy www.nurseconscience.blogspot.com

    by ludlow on Tue Jul 15, 2008 at 12:12:40 PM PDT

  •  Food outlets should not be banned simply (0+ / 0-)

    because they prepare food faster.

    More rational is restricting the amount of fats solid at 80 degrees in the product per wholesale food cost.

    More rational is restricting the amount of oil& fat in the product per wholesale food cost.

    More rational is restricting the amount and percentage of calories from fat, white flour, pasta, potatoes, and sugar per wholesale food cost.

  •  HR 1200, the American Health Security Act (0+ / 0-)

    SEC. 201. COMPREHENSIVE BENEFITS
    (a) if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

    (1) HOSPITAL SERVICES- Inpatient and outpatient hospital care, including 24-hour-a-day emergency services.

    (2) PROFESSIONAL SERVICES- Professional services of health care practitioners authorized to provide health care services under State law, including patient education and training in self-management techniques.

    (3) COMMUNITY-BASED PRIMARY HEALTH SERVICES- Community-based primary health services (as defined in section 202(a)).

    (4) PREVENTIVE SERVICES- Preventive services (as defined in section 202(b)).

    (5) LONG-TERM, ACUTE, AND CHRONIC CARE SERVICES-

    (A) Nursing facility services.

    (B) Home health services.

    (C) Home and community-based long-term care services (as defined in section 202(c)) for individuals described in section 203(a).

    (D) Hospice care.

    (E) Services in intermediate care facilities for individuals with mental retardation.

    (6) PRESCRIPTION DRUGS, BIOLOGICALS, INSULIN, MEDICAL FOODS-

    (A) Outpatient prescription drugs and biologics, as specified by the Board consistent with section 615.

    (B) Insulin.

    (C) Medical foods (as defined in section 202(e)).

    (7) DENTAL SERVICES- Dental services (as defined in section 202(h)).

    (8) MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT SERVICES- Mental health and substance abuse treatment services (as defined in section 202(f)).

    (9) DIAGNOSTIC TESTS- Diagnostic tests.

    (10) OTHER ITEMS AND SERVICES-

    (A) OUTPATIENT THERAPY- Outpatient physical therapy services, outpatient speech pathology services, and outpatient occupational therapy services in all settings.

    (B) DURABLE MEDICAL EQUIPMENT- Durable medical equipment.

    (C) HOME DIALYSIS- Home dialysis supplies and equipment.

    (D) AMBULANCE- Emergency ambulance service.

    (E) PROSTHETIC DEVICES- Prosthetic devices, including replacements of such devices.

    (F) ADDITIONAL ITEMS AND SERVICES- Such other medical or health care items or services as the Board may specify.

    (b) Cost-Sharing-

    (1) IN GENERAL- Except as provided in this subsection, there are no deductibles, coinsurance, or copayments applicable to acute care and preventive benefits provided under this title.

    (2) COST-SHARING FOR LONG-TERM CARE SERVICES-
    ...

    (i) payments for home and community-based long-term care services are subject to coinsurance of 20 percent; and

    (ii) payments for nursing facility services are subject to coinsurance of 35 percent.

    ...
    (i) such coinsurance shall not apply to an individual with income (as defined by the Secretary) of not more than 100 percent of the income official poverty line applicable to a family of the size involved; and

    (ii) in the case of an individual with such income that exceeds 100 percent, but is less than 200 percent, of such applicable poverty line, the coinsurance shall be reduced in the same proportion as the proportion of such income is less than 200 percent of such applicable poverty line.
    ....
    (e) State Program May Provide Additional Benefits...at the expense of the State.

    (f) Employers May Provide Additional Benefits...to employees or their dependents, or to former employees or their dependents.

    SPECIFIED PREVENTIVE SERVICES
    (A) Basic immunizations.

    (B) Prenatal and well-baby care (for infants under 1 year of age).

    (C) Well-child care (including periodic physical examinations, hearing and vision screening, and developmental screening and examinations) for individuals under 18 years of age.

    (D) Periodic screening mammography, Pap smears, and colorectal examinations and examinations for prostate cancer.

    (E) Physical examinations.

    (F) Family planning services.

    (G) Routine eye examinations, eyeglasses, and contact lenses.

    (H) Hearing aids ...[ by prescription]

    Dental Services
    (1) IN GENERAL- In this title, subject to subsection (b), the term `dental services' means the following:

    (A) Emergency dental treatment, including extractions, for bleeding, pain, acute infections, and injuries to the maxillofacial region.

    (B) Prevention and diagnosis of dental disease, including examinations of the hard and soft tissues of the oral cavity and related structures, radiographs, dental sealants, fluorides, and dental prophylaxis.

    (C) Treatment of dental disease, including non-cast fillings, periodontal maintenance services, and endodontic services.

    (D) Space maintenance procedures to prevent orthodontic complications.

    (E) Orthodontic treatment to prevent severe malocclusions.

    (F) Full dentures.

    (G) Medically necessary oral health care.
    ....

    Mental Health
    and Substance Abuse Treatment Services-
    ...
    (A) INPATIENT HOSPITAL SERVICES
    (B) INTENSIVE RESIDENTIAL SERVICES- ... up to 120 days during any calendar year...
    (C) OUTPATIENT SERVICES- Outpatient treatment services of mental illness or substance abuse
    ....

    SEC. 631. MANDATORY ASSIGNMENT
    (a) No Balance Billing- Payments for benefits under this Act shall constitute payment in full for such benefits and the entity furnishing an item or service for which payment is made under this Act shall accept such payment as payment in full for the item or service and may not accept any payment or impose any charge for any such item or service other than accepting payment from the State health security program in accordance with this Act.

    (b) Enforcement- If an entity knowingly and willfully bills for an item or service or accepts payment in violation of subsection (a), the Board may apply sanctions against the entity in the same manner as sanctions could have been imposed under section 1842(j)(2) of the Social Security Act for a violation of section 1842(j)(1) of such Act. Such sanctions are in addition to any sanctions that a State may impose under its State health security program.

    SEC. 615. PAYMENTS FOR PRESCRIPTION DRUGS
    ...
    (1) IN GENERAL- The Board shall establish a list of approved prescription drugs and biologicals that the Board determines are necessary...

    (2) EXCLUSIONS- ...ineffective, unsafe, or over-priced products where better alternatives are determined to be available.

    (b) Prices- ...the Board shall from time to time determine a product price or prices which shall constitute the maximum to be recognized under this Act as the cost of a drug to a provider thereof. The Board may conduct negotiations, on behalf of State health security programs, with product manufacturers and distributors in determining the applicable product price or prices.

    (c) Charges by Independent Pharmacies- ...based on the drug's cost to the pharmacy...plus a dispensing fee...taking into account...differences in the volume of prescription drugs dispensed...

    SEC. 811. PAYROLL TAX ON EMPLOYERS.

    [8.7 percent]

    SEC. 59B. HEALTH CARE INCOME TAX.

    [2.2 percent of the taxable income of the taxpayer for the taxable year]

    SEC. 821. INCREASE IN EXCISE TAXES ON TOBACCO PRODUCTS.

    Every Federal candidate should support HR 1200, the American Health Security Act. HR 1200 with an Oregon style efficacy rating system added is the most likely long-term future health system in my opinion.

    A transition to HR 1200 relying on Medicare will probably be needed. People could pay for a three month period of Medicare coverage by sending in an age-based premium like they do with estimated taxes, but about a month in advance so they can get a three-month Medicare card in time. People needing subsidies could just go to a welfare office or health department and pay whatever their share is with a check, cash, or a postal money order, the agency would make up the difference in a check to the IRS.

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