The data will be presented by Don DeMoro, director of CNA/NNOC’s research arm, the Institute for Health and Socio-Economic Policy, at CNA/NNOC’s biennial convention next Tuesday, Sept. 8 in San Francisco. The convention will also feature a panel presentation from nurse leaders in Canada, Great Britain, and Australia exploding the myths about their national healthcare systems. “With all the dishonest claims made by some politicians about alleged ‘death panels’ in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation’s biggest and wealthiest insurance companies simply because they don’t want to pay for it,” said Deborah Burger, RN, CNA/NNOC co-president.

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

PacifiCare denied 40 percent of all California claims in the first six months of 2009. Cigna, which gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life, was still rejecting one-third of all claims for the first half of 2009. “Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences,” said Burger. PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.

California Blues rejected 28 percent of claims in the first half of 2009. In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as “investigational” even though the lumbar artificial disc she was to receive had FDA approval. At the time of denial, which she calls “insurance hell,” Kutcher notes she had “already gone through pre-op testing, donated a unit of blood, had appointments with four physicians.” Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.

Kaiser Permanente, which denied 28 percent of all claims in the first half of 2009, was one of two systems to reject options for radiation and chemotherapy for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor in 2005. The reason cited was his age, says wife Cheryl Scott, RN. “He had been in perfect health all of his life. This was his first problem other than a sprained ankle. He died six months later.” Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year. “The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about,” Burger said. “Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice.” “The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation,” she said. CNA/NNOC supports an alternative approach, expanding Medicare to cover all Americans, which would give the U.S. a national system similar to what exists in other nations.

Data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, found that among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women. CNA/NNOC represents 86,000 registered nurses in all 50 states, and is working toward unification with the Massachusetts Nurses Association and United American Nurses to build a new 150,000 member national nurses organization.

Bookmark It

Hide Sites

Again, we suffer more than we should even after we pay.

The National Coalition on Health Care offers the following facts:

• 50% of all bankruptcies occur in part because of health care expenses.
• The US spends 4.3 times more on health care than on national defense.
• While industrialized nations with single-payer programs spend at most 11% of their GDP on health care–with everyone covered, the US spends 17%, a figure that will reach 20% in just a few years.
• According to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 1999.

More here.

Now where is race in this debate? Melissa Harris-Lacewell asks this question, pointing to disparities in care (black and brown individuals and communities receive poorer care than our white breathren), in health outcomes (black and brown individuals and communities suffer more from a variety of illnesses and maladies). It’s important to note here that these differences cannot solely be reduced to class, although class is an important component. Even controlled for income and education, black life expectancy is lower, black stress levels are higher. Even controlled for class and education, black and Latinos are less likely to get quality care from doctors. But there are actually a number of frontline organizations from the Joint Center, to the Praxis Project, to the Opportunity Agenda, bringing these disparities to light and ensuring that legislation ameliorates them.

Given this, the question for me isn’t so much whether race is being ignored or not. The question is twofold. Will the discussion about race and the upcoming reform effort led by pundits and intellectuals be given attention beyond “blacks suffer more and get less care”? Will blacks can be mobilized to move against black elites when their interests don’t intersect here?

I ask the first question because while talking about racial disparities in outcomes and in care is important and necessary it is far from sufficient. What we should do is identify the SPECIFIC ways that race works and will work in the upcoming effort.

One of the challenges we face is one of framing–how will the upcoming battle be defined? I note how much money we spend on health care. Are we going to be talking about health care COSTS or health care INVESTMENTS? Spending $1 million on google stock could be viewed as costly….or it could be viewed as an investment (particularly if you’re buying the stock at $10/share as opposed to $438.77/share). What critics of left-leaning reform are going to point to are costs, and how much the American taxpayer is going to pay. Hopefully proponents of left-leaning reform will point instead to INVESTMENTS….but the critical question is how will black and brown bodies be deployed in the framing effort?

It isn’t that hard to imagine conservative pundits using images of non-whites both explicitly in pictures, and implicitly in rhetoric.

“Why should we pay for the health care of some illegal immigrant/welfare mother who doesn’t know how to take care of herself? Why should my hard-earned money go to her?”

“Detroit is the fattest city in the country. Why should the rest of us have to pay for lazy Detroit autoworkers?”

Using black and brown bodies to tilt the health care debate to costs rather than investments will tilt public opinion towards conservative and moderate solutions. We need to be vigilant about identifying this when it occurs because the research clearly indicates that when this type of race-baiting is revealed, it loses its power. We need upwards of 30,000 health care professionals to deal with both the aging baby boomers and the growing non-white majority (40% of Americans under 17 are now non-white). Before we even get to the costs of changing health care from one system to another we’re going to have to create incentives in the form of college grants (as opposed to loans). If whites view this as nothing more than racial set-asides because the cost argument has been racialized, then this effort will die.

Another challenge we face–and I’ll try to deal with more over the upcoming weeks–is structural in nature. States differ not only in the number of residents covered by employer sponsored insurance, they differ in what they require employer-sponsored insurance to actually cover. States like Mississippi required employers to cover very little compared to states like Maryland. How does race come into play here? States with smaller populations of folks who aren’t covered by employer-sponsored insurance are more likely to have the resources needed to take care of them. Black and brown populations are more likely to be uninsured, hence state insurance burdens differ based on the size of their black and brown populations. Southern states with “peculiar” racial histories are much less likely to regulate employers, hence race shapes the quality of coverage required by states.

Now in creating some type of national standard, these state level differences are going to have to be managed. And the question is going to be do we have a high standard that requires states like Mississippi to step their game up, or does Mississippi in effect BECOME the standard? In hashing this out, some states are going to come out as “winners” not having to spend as much to change their systems/come up with more resources.

These dynamics complicate the “blacks/browns get poorer care” argument, but I think, in ways that are helpful for citizens who both want to be informed and want to do something about it. It isn’t just that we get poorer levels of care, but rather that there are discrete rules, regulations, and norms, that make these conditions more likely–rules, regulations, and norms that likely will not be changed if we relegate our discussion to “we get sick while they don’t.”

Now so far I’ve dealt with what I call the racial politics angle. With the way that race shapes how resources are allocated, shapes who gets what.

But also important, particularly given Obama’s presence in the White House is the black politics angle. I recently published a paper on black attitudes about HIV/AIDS, finding that blacks exposed to media stories blaming “down low” black men for HIV/AIDS were more willing to mobilize politically, but were also more interested in quarantining HIV/AIDS victims. NOT the political outcome we would want. This is an example to me of black politics–of how blacks allocate/withhold resources from other blacks within a general context of white supremacy. This is also an example of how health becomes a contested resource within black communities.

During this upcoming battle we’re going to have to pay careful attention to the Congressional Black Caucus. The CBC should have “black interests” in mind…and in as much as they tend to be the most liberal voters in the House they are more attuned to black interests than their white counterparts. However the reality is that a significant number of black representatives live in districts where the largest employers are in the health care industry. What does this mean? Take Elijah Cummings, Maryland Democrat. The health industry is Cummings’ third largest industry donor. These industries employ black executives and managers, as well as black service workers. How might Cummings vote on this matter be influenced by the fiscal needs of his employers and constituents, vs. the health needs of his constituents and black people in general? If race is given the silent treatment in the discussion on health care even though groups are fighting and HAVE been fighting to keep it on the agenda, how might we categorize the discussion about black elites?

I noted in an earlier post that we needed more social scientists to put their two cents in these public conversations. Hopefully after reading this you can understand why I might take this position. I’ve heard Dyson, and West at this point dozens of times, and have never heard them come anywhere close to dealing with these issues in depth. On the other hand just a few days ago I heard Dr. Brian Smedley of the Joint Center and Aranthan Jones of the Podesta Group speak about this issue WITHOUT NOTES for well over an hour.

And I hope this also makes it clear why a strong “race-based” critique of Obama is still needed, but one that does not fall into the simple “is he down/is he ain’t” dichotomy. We are not at the point where we can reduce black suffering to class suffering. Even within the working class, blacks and browns still suffer more. But the trick is figuring out precisely where we need change, and tossing the “he didn’t say King’s name” overboard, along with our desire to protect him from racist attacks. I’m toying iwth the idea of a “black standard” for Obama and what it would look like. I’ll use my next post to talk about this.

Bookmark It

Hide Sites

Nevin’s finding implies a double tragedy for America’s inner cities: Thousands of children in these neighborhoods were poisoned by lead in the first three quarters of the last century. Large numbers of them then became the targets, in the last quarter, of Giuliani-style law enforcement policies.

Bookmark It

Hide Sites

Gee and his team found that Filipinos reported the highest level of discrimination, followed by Chinese-Americans and those of Vietnamese descent. And everyday discrimination was found to be associated with a variety of health problems, including chronic cardiovascular, respiratory, and pain-related health trouble.

Discrimination against those of Chinese descent was not linked to either pain or respiratory problems, but was associated with heart disease. In contrast, discrimination against those of Vietnamese descent was linked to cardiovascular illness, respiratory disease, and pain issues. Filipinos appeared subject to respiratory and pain difficulties, the study said.

The study authors theorized that the differences among the three Asian groups might be explained, in part, by their differing historical and cultural backgrounds.

But in all cases, the association between discrimination and health did not seem to be influenced by age, education level, income level, job status, language ability, or a desire to view one’s life in a positive light, the researchers said.

In view of the findings, the study authors suggested that efforts to bolster civil rights in the United States might not only strengthen the nation’s democracy but also improve its health.

More here.

Bookmark It

Hide Sites

Trying to wrap my head around this I dug up a paper. I knew that blacks committed suicide at far lesser rates than their white counterparts–a sign for me that blacks have far more resiliency because of our history. But the rate of change for blacks is increasing significantly, particularly among black male youth.
The primary reason I am where I am in life is because of group cooperation, group initiative, and group loyalty. My parents, family friends, people at Michigan, my fraternity brothers all looked out for me at one point or another. And now my wife and children help keep me rooted. We’ve got to do a better job of reaching out, of building sustainable relationships that have meaning. We can’t be safe, we can’t be healthy, we can’t be sane, we cannot organize without them.

Bookmark It

Hide Sites