By Samuel Metz, M.D.
Portland Business Journal, August 12, 2020
Racism is embedded in American medicine because it is embedded in American culture. Reversing 400 years of racism requires action, and reversing racism in medicine requires single payer health care.
Single payer radically changes health care access. By providing everyone with a comprehensive medical plan using a single network that includes all providers, single payer provides better care to more people for less money than we do now. And it addresses both subtle and obvious racism in medicine.
Although the practice of medicine is not intrinsically racist, the American method of dispensing it is. Our public health statistics confirm this: Compared to white populations, Black Americans and other communities of color are more likely to be uninsured, to have unaffordable deductibles and co-pays, die when they receive treatment, suffer lower life expectancy and die during childbirth.
Our Covid-19 pandemic exacerbates the excess deaths of Black, Hispanic and Native Americans.
Racism in medicine goes beyond personal bias. It runs through the institutions providing health care. Racism influences who controls access, who becomes a provider, who sets payments, where hospitals and clinics are built and who serves on their boards.
Those of us in health care who doubt the presence of racism in medicine should have a private talk with our Black colleagues. If we have no Black colleagues, that’s an important insight.
Alan Weil, in his editorial The Social Determinants of Death, said, “Racism has long been a central tool in the toolbox of those who wish to hold onto power. Medicine has been complicit over the years. … (Racism) is baked into our institutions, our thinking, and our policies.” All institutions invest deeply to resist change, especially massive institutions like our health care industry.
This health care industry will not reform itself. Change depends upon us, and upon single payer health care.
Single payer offers five corrections to institutionalized racism that are simply not possible within our current health care industry:
- Single payer allows access to health care regardless of employer. This dependence upon employment for access intensifies the consequences when a pandemic simultaneously eliminates our job, income, insurance and health. Communities of color suffer the most from these consequences.
- Single payer allows timely access to health care, regardless of socio-economic status. That means poor people get timely care. Our current private insurance model cannot offer this guarantee.
- Single payer ensures every patient is a paying patient. Race and brand of insurance no longer affect reimbursement. Perhaps white providers, like me, will not unconsciously assume that a white patient pays more or a Black patient pays less.
- Single payer health care allows higher provider reimbursement in underserved communities, like Black sections of Portland, rural areas of Oregon, immigrant neighborhoods and Native American reservations. Providers currently practicing in wealthy communities might find it financially attractive to practice in communities with greatest need.
- Single payer means all of us, not just those with money, have access to vaccines, antibiotics, and preventative measures to contain contagious diseases. Our current system failed to stop Covid-19 before it became a pandemic.
Reversing 400 years of oppression and institutionalized racism requires massive changes in medicine. Single payer opponents may claim its contribution is small, but without it, nothing changes. Our health care industry remains an obstacle, not a solution, to institutionalized racism.
Gil Scott-Heron, the late black poet and musician, said, “Nobody can do everything, but everybody can do something.” Single payer advocacy is something everyone can do to combat racism in medicine. Demand that your elected representatives in our Legislature and Congress become single payer champions.