PNHP New York Metro board member Dr. Steve Auerbach addressed a Medicare-for-All rally in New York City on July 24, 2021, alongside members of Students for a National Health Program (SNaHP). He reminded the crowd, “There is no policy debate anymore. There is no economic debate anymore. Single payer is the way to go.”
Video courtesy of Larry Melnicker.
By Michael Cadigan
Spectrum News, July 24, 2021
LOUISVILLE, Ky. — Dozens of people took to the streets of Louisville and marched demanding better access to Medicare. Louisville joined 55 other cities across the country in a march for Medicare for All.
Kay Tillow helped organize Saturday’s rally and said she felt very passionately about the cause.
“All of us know that we are one serious illness away from bankruptcy because we have a system where people pay too much and are not covered and people go without care because of deductibles and copays,” said Tillow, the chair for Kentuckians for Single Payer Healthcare.
Tillow joined others in calling health care a human right and demanding that Congress take action to pass a national single payer improved Medicare for All plan.
Bob Brown said he felt the need to attend the march because he recently turned 65 and understands the benefits a single payer pan can provide.
“The single payer plan has been wonderful. I have been lucky and have had insurance all my life through my occupations. This plan, as a retired man, is as good or better than any insurance I’ve ever had,” he said.
Dr. Garrett Adams, who has worked at the UofL School of Medicine, said there are many Kentuckians who are just a year or two away from hitting the key age of 65, who have limited finances and often put off seeking care until they qualify.
“People that are 63, or 63 and a half, or 64 can’t wait because they are working on hurt knees that they can’t do anything about. They can’t afford their medicine. They need advanced treatment for their congestive heart failure and they can’t wait for their 65th birthday so they can go on Medicare,” Dr. Adams said.
Tillow said the nationwide movement also calls for improvements to cover vision, hearing, dental, and long-term care. Demonstrators also want some barriers removed like copays, deductibles and forms they described as confusing. Tillow will continue to work organizing these events until lawmakers take action.
“It is going to take a few million people in action to persuade Congress that this is the right thing to do. But, we have to make it happen and we won’t stop until we have everyone covered under single payer,” said Tillow.
21 organizations participated in the Louisville Rally and March. They marched a half mile from the Romano L Mazzoli Federal Building to Jefferson Square Park to place flowers at the Breonna Taylor memorial.
PNHP part president Dr. Garrett Adams and PNHP board adviser Kay Tillow spoke with Spectrum News on July 24, 2021. They discussed the urgent need for single-payer reform as part of a segment covering a Louisville, Ky. march for Medicare for All; the Louisville action was part of a series of nationwide marches taking place that same day.
PNHP-IL Co-President (for Southern Illinois) Dr. Pamella Gronemeyer addressed a Medicare-for-All rally in Chicago on July 24, 2021. The rally was part of a series of nationwide marches taking place that same day, and was covered in Chicago by Hard Lens Media, WGN-TV, and others. Dr. Gronemeyer assured the crowd that physicians support, and that patients urgently need, single-payer reform.
UnitedHealth Group Earnings: What They Suggest about Patient Access to Care, American Hospital Association, July 15, 2021, by Rick Pollack, AHA President and CEO
Today UnitedHealth Group announced a jaw-dropping $6 billion in earnings in a single quarter. But not enough has been said about a big contributor to these profits: not paying for health care services. During the same quarter last year the company noted its $9.2 billion in profit was due in part to “broad-based deferral of care.” What that means in real-life: profit was earned off missed childhood vaccinations, reduced access to opioid misuse treatment and avoided emergency care for cardiac arrest. But even this isn’t the full story.
Throughout the course of the pandemic, United pursued a number of changes to its policies to further restrict patients’ coverage. United didn’t just profit from avoided care, it actively sought to scale back what care it would pay for at the same time.
United routinely rolls out these coverage restrictions throughout the year, meaning that enrollees purchase their health plans under one set of rules only to later learn that their providers and cost-sharing responsibilities have changed.
Our top private health insurer is rolling in cash. And it’s reducing coverage, Los Angeles Times, July 20, 2021, by David Lazarus, Business Correspondent
UnitedHealth Group, parent of UnitedHealthcare, the country’s largest private health insurer, earned $15.4 billion in profit last year. It took in more than $9 billion in profit during the first half of this year.
So what does a well-heeled insurer do amid such a windfall? It seeks to reduce people’s coverage, of course. …
The insurer won’t cover nonemergency treatment at non-network facilities outside a policyholder’s service area, which is defined as your state of residence and adjoining states.
This change mainly affects UnitedHealthcare members who want to travel to residential treatment facilities, rehabilitation clinics and other nonhospital healthcare providers.
Which is to say, if you’re a UnitedHealthcare member and you need rehab for any reason, you’d better stay in network and you’d better stick close to home. Otherwise, you’ll be footing the bill yourself. …
Coverage networks might save insurers a few bucks, but they’re not in the best interest of patients, who should be free to seek the best possible care from the best-qualified doctor or hospital.
Nor, for that matter, should people’s coverage be tethered to their jobs. Lose your job, lose your health insurance — what the hell kind of system is that?
We know from the experience of other developed countries that [insurance risk management] is done most effectively by creating a single risk pool comprising the entire population, and then having a single government program handle all claims consistently, fairly and transparently.
Studies have shown that the taxes paid into such a single-payer system — Medicare for all, say — would be less than the premiums, copays and deductibles that now constitute most out-of-pocket medical expenses for Americans.
By Don McCanne, M.D.
UnitedHealth Group has demonstrated that it has mastered its ability to increase profits by not paying for health care services. They are serving their corporate shareholders at a cost to their customers, aka patients.
Contrast this private insurer function to what the role of a publicly financed and publicly administered insurer would be. Passive insurer shareholders and profits would play no role. The goal would be to pay for necessary health care services, not avoid them.
Even David Lazarus – the Business Correspondent for the LA Times – sees what UnitedHealth Group does and in response sings the praises of single payer.
Based on Rick Pollack’s comments, the American Hospital Association should be a valuable team member in our efforts to achieve health care justice for all.
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FOR IMMEDIATE RELEASE: July 21, 2021
Contact: Gregory Lines, M.D., M.P.H., glines@challiance.org
Danny McCormick, M.D., M.P.H., dmccormick@challiance.org
David Cecere, Senior Director of Corporate Communications, Cambridge Health Alliance, dcecere@challiance.org
Gains in health insurance coverage under the Affordable Care Act (ACA) were small for Black, Hispanic and low-income Americans in many states according to a new study from Harvard Medical School. The study, published today in the journal Health Equity found dramatic variation in states’ performance in expanding insurance coverage to these populations that have historically had low coverage rates.
Using state-level survey data from over 500,000 working age Black, Hispanic and low-income adults, the researchers compared insurance coverage rates in each US state prior to and after implementation of the ACA in 2014. The study also examined the size of the remaining uninsured Black, Hispanic and low-income populations in each state following the ACA.
The study found that while the best performing states were able to reduce rates of uninsurance among black, Hispanic and low-income adults by approximately 60%, the worst performing states reduced uninsurance by less than 10%, a six-fold difference. In addition, states’ performance in reducing uninsurance in these populations was strongly correlated with states’ choices about how to implement the ACA. States that did not invest in public education about the ACA, provide assistance to residents to sign up for ACA or participate in the ACA’s optional Medicaid expansion were much more likely to perform poorly.
While previous studies demonstrate that the ACA substantially increased coverage and reduced racial and ethnic disparities in coverage in the United States, the authors say the study data sheds new light on the extreme variation in state level performance in expanding coverage to populations most in need. “Our study shows just how little progress was made for people of color and low-income Americans in some states under the ACA,” said one of the study’s lead authors, Dr. Gregory Lines, an internal medicine physician at Cambridge Health Alliance and instructor in medicine at Harvard Medical School. “And, it is clear that this poor performance stems from political leaders’ decision to undermine full implementation of the ACA. More comprehensive health care reforms that do not rely as heavily on the whims of individual states are clearly needed–it is a matter of racial and economic equity.”
The study also found that, 2 years after ACA implementation, in six states one quarter of Black adults remained without insurance coverage; and in 20 states, one quarter of low-income adults continued to lack coverage. In addition, in 13 states, over 40% of Hispanic adults lacked coverage following ACA implementation. In several states, the results were most dramatic. For example, after the ACA, 28.7% of Black Americans remained uninsured in North Dakota as did 61.8% of Hispanics in North Carolina and 45.3% of low-income adults in Texas.
The study authors believe that the high rates of uninsurance in many states after the ACA are having negative health consequences currently. “The poor performance of many states under the ACA essentially locked in the high levels of uninsurance that those states entered the COVID-19 pandemic with,” said the study’s senior author, Dr. Danny McCormick, an associate professor of medicine at Harvard Medical School and a primary care physician at the Cambridge Health Alliance. “COVID-19 took a large toll on people of color and the poor, and these populations are larger in poor performing states. This has likely translated into greater difficulty accessing COVID-19 care and worse health outcomes for these populations at highest risk.”
“States’ performance in reducing uninsurance among Black, Hispanic and Low-income Americans following implementation of the Affordable Care Act,” Gregory Lines, M.D., M.P.H.; Kira Mengistu, M.D.; Megan Rose Carr LaPorte, M.D., M.P.H.; Deborah Lee, M.D.; Lynn Anderson, M.D.; Daniel Novinson, M.D., M.P.H.; Erica Dwyer, M.D., Ph.D.; Sonja Grigg, M.D.; Hugo Torres, M.D., M.P.H.; Gaurab Basu, M.D., M.P.H.; and Danny McCormick, M.D., M.P.H. Health Equity. Published online first, July 21, 2021, 3PM ET.
By Linda Carroll
Medscape, July 21, 2021
(Reuters Health) – People of color are less likely than white patients to receive care from surgical specialists, medical specialists and pulmonary specialists, a new U.S. study suggests.
Analysis of nationally-representative data on more than 130,000 U.S. adults found that adjusted rate ratios (ARR) of visits to 29 different types of specialist were often lower among Black, Hispanic, Asian/Pacific and Native American patients compared to white individuals, according to the report published in JAMA Internal Medicine.
“If you take a step back, we already know that people of color in the U.S. have a lower life expectancy than white individuals,” said the study’s lead author, Dr. Christopher Cai, a resident physician at Brigham and Women’s Hospital and the Harvard Medical School in Boston.
One factor may be that, despite a greater need among people of color in some areas for specialty care, doctors are granting more appointments to white individuals, Dr. Cai said. “The primary cause appears to be inequities in insurance,” he added. “The bottom line is that we need to remove barriers to accessing health care.”
One statistic that suggests disparities in health insurance may play a big role is the fact that one of the few areas in which people of color get similar access to specialists is nephrology.
“The unique thing about kidney disease,” Dr. Cai said, “is that Medicare offers coverage for end-stage disease. An approach like Medicare for All would go a long way to reducing these disparities.”
To take a closer look at the use of specialty services by race and ethnicity, the researchers turned to data from 2015 to 2018 Medical Expenditure Panel Survey (MEPS), which collects demographic (including self-reported race/ethnicity) and health care utilization data from a nationally representative sample of the noninstitutionalized, civilian U.S. population. Focusing on adults 18 years or older, Dr. Cai and his colleagues tabulated office and outpatient department visits to each physician specialty by each racial/ethnic minority group compared with the white population and adjusted for age.
The researchers included 132,423 individuals in their analysis. They found that Black individuals had low visit rates compared with white individuals to most specialties (23 of 29 versus 17 of 29 specialties). Among specialties with many visits, the Black versus white disparities were especially marked in dermatology (ARR 0.27), otolaryngology (ARR 0.38), plastic surgery (ARR 0.41), general surgery (ARR 0.55), orthopedics (ARR 0.59), urology (ARR 0.62), and pulmonology (ARR 0.63).
Black individuals had higher visit rates to nephrologists (ARR 2.78) and hematologists (ARR 1.65) and similar visit rates to internists, geriatricians, and oncologists.
The visit ratios for Hispanic and Asian/Pacific Islander individuals compared with white individuals were lower than 1.0 for 26 of 29 (89.7%) and 26 of 27 specialties (96.3%), respectively, and significantly lower for 20 of 29 (69.0%) and 21 of 27 specialties (74.1%). Similar patterns were seen for American Indian and Alaska Native individuals, although the 95% confidence intervals were wide.
The disparity among Hispanic versus white individuals was marked for dermatology (ARR 0.39), otolaryngology (ARR 0.47), and pulmonology (ARR 0.55). For Asian/Pacific Islander versus white individuals, ratios were markedly low for hematology (ARR 0.18), pulmonology (ARR 0.26), and otolaryngology (ARR 0.39).
“This study gives us a very detailed view into racial and ethnic disparities in the use of specialty care, which is an incredibly important metric of health care access given the rising proportion of U.S. adults with chronic conditions and multiple comorbidities,” said Jamie Daw, an assistant professor of health policy and management at the Columbia University Mailman School of Public Health in New York City. “The findings are even more troubling given that people of color have higher rates of chronic conditions such as diabetes, stroke, and heart disease, which require specialist care. Yet, the authors find that communities of color are using these services less than white patients.”
Daw believes the big problem is inequities in health care.
“The U.S. health insurance system is likely a significant driver of these disparities. A disproportionate share of people of color are enrolled in Medicaid or uninsured,” Daw said in an email. “Because Medicaid pays lower prices than private insurance, fewer doctors take Medicaid patients, especially specialists. It would have been interesting for the authors to look at whether these disparities persisted within Medicaid or private insurance, or if the disparities were reduced after age 65, when Medicare eligibility begins,” he noted.
“Health inequities in the U.S. are fundamentally driven by an unequal and unjust allocation of power and resources in the health care system and society at large,” Daw said. “Addressing these disparities will require acknowledging that both interpersonal and structural racism drive differences like those found in this study, and developing policies that can fundamentally shift the distribution of resources and social attention to meet the needs of people of color.”
“This important research shows that non-white individuals are less likely to see specialists, particularly ones who focus on procedures. Structural factors, including structural racism, may play a role in this disparity,” said Dr. Carol Horowitz, a professor of population health and of medicine, and director of the Institute for Health Equity Research at the Icahn School of Medicine at Mount Sinai in New York City.
“I think it also points out limits of focusing on health care as sole driver of health disparities,” Dr. Horowitz added. “For example, life expectancy is significantly greater in Asian populations in large part because of reduced deaths from heart disease and cancer. Yet, Asian populations were much less likely to see the oncology, cardiology, internal medicine and family doctors who primarily prevent and treat these diseases. Black populations who were just as likely to see these doctors have higher heart disease and cancer death rates. This means we must also look beyond differences in who sees doctors that do procedures, and focus on the non-health drivers of health disparities that stem from generations of structural racism, including poverty, lower quality education, pollution and stress.”
By Isabel Ostrer, M.D.
As a first-year internal medicine resident, I entered the hospital eager to both treat patients’ acute illnesses and empower them to stay healthy outside the hospital. But only weeks into residency, it’s already abundantly clear that very little of a patient’s health and well-being is tied to their hospital stay. Sure, we gather comprehensive histories, run tests, think critically about a patient’s medical problems, and dole out diagnoses and drugs to treat a patient’s immediate clinical crisis. But the best critical thinking and immediate pharmacologic management can only go so far if ongoing care is suboptimal. And I’m learning how insurance can dictate medical options.
Mr. Y came into the hospital after experiencing crushing chest pain for many hours. By the time he arrived, his heart attack had likely been in full swing for half a day. He had his blocked heart vessel opened with a stent, but in the interim he lost blood flow to a significant portion of his heart muscle, killing some cells. He ended up developing an abnormal heart rhythm, atrial flutter, where the top chambers of the heart don’t pump blood effectively. He needs a specific medicine to prevent him from developing blood clots that can lead to a stroke. Between two nearly identical (from a medical perspective) options, I prescribed the one that could be taken once a day, instead of twice a day. More convenient, I thought, and moved on. I have no idea how much the medicines I prescribe cost patients. Luckily, I got a message from the clinical pharmacist asking if I would consider the other option because it would cost my patient $17/month, instead of $200/month. A 92% reduction. For many of the patients I see, a seemingly inconsequential medical decision I make can quite literally mean financial ruin. This compromise to convenience seems reasonable enough, but what if the pharmacist hadn’t called?
Ms. M, another patient I cared for in the hospital, has end-stage heart failure. She came into the hospital in cardiogenic shock – her heart was so weak it couldn’t pump enough blood to the rest of her body. She ultimately recovered well enough to go home. Like Mr. Y, she needs to be on life-saving medicines to keep her heart failure symptoms in check, or else she will be hospitalized again and again. I wanted to set her up for success so messaged the case manager on my hospital team – an incredible patient advocate – to ask if we could enroll her in a home health program where she would get help managing her medicines – to keep her alive and out of the hospital. His reply read, “Sure, I can try, but she has really poor insurance, so it might be tough to arrange home health.”
As a doctor in training, I’m soaking up all the medical knowledge I can so that I can give my patients the best medical care possible and the greatest chance of staying healthy outside of the hospital. I’ve quickly realized this is hard work in a system that is short-sighted. Acute interventions in healthcare, especially inpatient, are very well-reimbursed. But the longer, harder work of “health” — making sure patients can access medications and manage their chronic conditions — often falls by the wayside.
Medicare for All would offer patients a better chance at success, by assuring high quality insurance for everyone. An insurance system that focuses on patient well-being over profit is one that meaningfully negotiates drug prices to ensure that life-saving medications are affordable for patients. It is also a system that treats care at home as a necessary service that isn’t limited by whether you’re privileged enough to have “good” insurance.
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By George Bohmfalk, M.D.
Aspen (Colo.) Daily News, Letters, July 21, 2021
Editor:
Your Monday story on ACRA’s presentation of a new health care alternative (“ACRA early to highlight health care alternative during May meeting,” July 19) was a challenge to comprehend, as is the proposed new alternative itself. As best I can determine from further reading, an ICHRA (Individual Coverage Health Reimbursement Arrangement) is nothing more than yet another attempt to reduce the amount that employers are obligated to pay for their employees’ health care. This is another step in “cost-shifting” this expense onto employees. I appreciate that Mr. Laird saved some money for the Third Street Center, but inevitably this cost his employees in either dollars or adequacy of coverage. There is no free lunch.
But there is a much better one that can cost everyone less — Medicare for All. Rather than sifting through the complexities of byzantine plans like ICHRAs, and dumping responsibility on employees, why not have a single plan — one size that indeed fits all needs — and pay less for it? Employers, employees, self-employed, and unemployed would all have guaranteed, comprehensive health care coverage, equitably paid for by progressive taxes, with no restrictive provider networks, deductibles or other out-of-pocket costs. Employers could focus on their businesses rather than health care insurance.
Ask the next foreign visitor you encounter whether they would trade their current health care coverage for an ICHRA. Be prepared for them to laugh at the idiocy of what we do here, or cry in sympathy for you.
Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess, KHN, July 2, 2021, by Julie Appleby
The Health 202: Biden Says He’ll Enforce Trump-era Rules Requiring Hospitals to Post their Prices, Washington Post, July 12, 2021, by Alexandra Ellerback with Paige Winfield Cunningham
“Ultimately, the unanswered question is whether price transparency will lead to overall lower prices.” – Appleby
By Hannah Leibson and Allison K. Hoffman, J.D.
Efforts to increase price transparency in health care have become a policy obsession of academics and policymakers alike, despite little evidence it provides any benefit to patients.
On January 1, 2021, the Trump Administration finalized the Transparency in Coverage final rule and drank the Kool-Aid. This rule requires hospitals to disclose publicly what they charge uninsured patients for items and services as well as the rates they negotiate with insurers. The Administration hoped that the rule would force insurers to compete with each for lower priced items and services, driving down the overall cost of health care.
The rule’s roll out has not gone as anticipated. Up to 83 percent of hospitals are not fully complying with the rule. For hospitals that have disclosed prices, they are often hidden deep on their websites – shielded from patients’ view. This week, the Biden Administration urged the Department of Health and Human Services to boost their enforcement of the rule.
But as Appleby and Ellerback have highlighted, the rule overlooks a key reality. Even when consumers have greater access to information, they generally do not use it to shop medical care as policymakers imagine. Empirical research has shown that consumers are unwilling to price compare, and even when they do, it does not drive their choices.
Instead, the role of referring physicians plays a far greater role in patient choice and decisionmaking. This is unsurprising. Price data says little about quality, which is just as or more important to people, and assessing quality and making price/quality tradeoffs is a herculean task for most of us. Various studies have shown that giving people price information, even in a fairly digestible form and even with regard to reasonably fungible services, does little. Consider just two:
One study examined the consumer choices of people with easy access to price shopping for lower-leg MRIs, where quality does not vary wildly. The researchers concluded that only 14 percent of consumers went to the lowest-cost MRI provider within thirty minutes of their home, often bypassing six lower-priced providers between their home and location of their chosen scan. They went to the location their doctor suggested.
Another recent study assessed whether consumers changed their behavior after a transparency tool was introduced in the California Public Employees’ Retirement System (CalPERS). The interface showed consumers the prices for lab tests, office visits, and imaging services. The researchers found that only 12 percent of people used the interface in the first fifteen months after it was introduced, and most did not choose a lower-priced service after use.
Given this reality, it is likely that the Transparency in Coverage final rule will have a trivial effect on lowering the overall cost of health care through consumer-driven behavior. Regulations like the Transparency in Coverage rule are rooted in a fallacy that when we make the market work better, patients can navigate in the front seat. And they perpetuate that fallacy.
More direct price regulation or central budgeting, like what occurs under the Medicare program, is the only way to rein in escalating prices going forward. Without such measures, we will continue to face rapidly rising health care costs.
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When Is Tinkering with Safety Net Programs Harmful to Beneficiaries?, National Bureau of Economic Research, July 2021, by Jeffrey Clemens & Michael J. Wither
Interactions between redistributive policies can confront low-income households with complicated choices. We study one such interaction, namely the relationship between Medicaid eligibility thresholds and the minimum wage. A minimum wage increase reduces the number of hours a low-skilled individual can work while retaining Medicaid eligibility. We show that the empirical and welfare implications of this interaction can depend crucially on the relevance of labor market frictions. Absent frictions, affected workers may maintain Medicaid eligibility through small reductions in hours of work. With frictions, affected workers may lose Medicaid eligibility unless they leave their initial job. Empirically, we find that workers facing this scenario became less likely to participate in Medicaid, less likely to work, and more likely to spend time looking for new jobs, including search while employed. The observed outcomes suggest that low-skilled workers face substantial labor market frictions. Because adjustment is costly, tinkering with safety net program parameters that determine the location of program eligibility notches can be harmful to beneficiaries.
By Don McCanne. M.D.
Who should be deprived of health care? Likely most would agree that nobody should, and, ideally, everyone should agree.
With our dysfunctional, fragmented system of financing health care, a special funding program must exist to cover those who do not have the resources to pay for health care, thus we established Medicaid. But what threshold do we establish for eligibility? Is it all-or-none financing? Does minor tinkering invoke all-or-none decisions?
In the real-world example presented, an increase in minimum wage reduced the number of hours that a low-skilled worker could work and still maintain eligibility for Medicaid. The result was both less employment and less Medicaid. Such all-or-none decisions could be disastrous for the health care or income of an affected low-wage worker. Last year, evidence from Arkansas showed that a work requirement decreased Medicaid enrollment without increasing work.
Suppose we had a single payer Medicare for All system. Everyone would automatically have financial barriers removed from medical care. There would be no need to establish a special medical welfare program such as Medicaid. Controlling costs for the indigent would be accomplished by funding the entire system though progressive taxes. That way, everyone could have health care in a system that is affordable for each of us. The complexity and injustices of segregating patients into a Medicaid program would no longer be necessary.
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FOR IMMEDIATE RELEASE: July 19, 2021
Contact: Christopher Cai, M.D., ccai4@partners.org
Samuel Dickman, M.D., samuel.dickman@austin.utexas.
Clare Fauke, Physicians for a National Health Program communications specialist, clare@pnhp.org
People of color are underrepresented in the outpatient practices of most specialist physicians, according to a study appearing today in JAMA Internal Medicine. Black, Hispanic, Asian/Pacific Islander and Native Americans received much less care (measured by outpatient visit rates) from surgical specialists such as orthopedists or medical subspecialists such as pulmonary (lung) specialists. Disparities persisted even after accounting for patients’ insurance, income, education and health status. In contrast, primary care physicians saw patients of color and white patients at roughly equal rates.
The study, carried out by a team of researchers at Harvard Medical School, The City University of New York at Hunter College, Planned Parenthood South Texas, and Tufts University, analyzed data from 132,423 respondents to the Medical Expenditure Panel Survey, a national survey of healthcare use. Compared to white patients, Black patients were underrepresented in the practices 23 out of 29 physician specialties. For example, Black patients’ visit rates to orthopedic surgeons, urologists, pulmonologists and cardiologists were 59%, 62%, 63%, and 81% those of white individuals, respectively. Native American patients were also markedly underrepresented in most specialties’ practices, as were Hispanic- and Asian/Pacific Islander-Americans. Notably, nephrologists — who care for patients with end-stage kidney disease, almost all of whom are covered by Medicare, and many of whom are people of color — provided significantly more care to minority groups than to whites.
“Black Americans die nearly 5 years younger than white Americans and are more likely to have chronic illnesses, due to discrimination and poverty. Yet physicians who could close these gaps are far less likely to see Black patients,” said Dr. Christopher Cai, the study’s lead author and a resident physician at Brigham and Women’s Hospital and Harvard Medical School. “Inequities in health insurance are probably the main culprit for the racial disparities we found. White people are far more likely to have private insurance, which pays doctors higher fees. In addition, white patients are more often able to afford copayments and deductibles for visits. Our insurance system tells doctors that people of color are worth less than white people, a pernicious form of structural racism.”
Dr. Samuel Dickman, the study’s senior author and Director of Primary Care at Planned Parenthood South Texas, noted, “Black patients’ experiences of mistreatment by the health care system in the past may lead them to avoid seeking care. People of color may feel more comfortable seeing physicians from their own communities, but medical schools are not training nearly enough Black-, Latino- and Native-American physicians. Location is an important factor too, since relatively few specialists have offices in communities of color.”
Study co-author Dr. Steffie Woolhandler, a Distinguished Professor at CUNY’s Hunter College and Lecturer in Medicine at Harvard Medical School added, “One hopeful finding was that kidney specialists saw patients of color at rates commensurate with their high rates of severe kidney disease. Almost all patients who need dialysis or a kidney transplant qualify for Medicare, even if they are under 65, and hence bring doctors the same fees. Universal and equal insurance could go a long way toward equalizing care.”
“Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties,” Christopher Cai, M.D.; Adam Gaffney, M.D., M.P.H.; Alecia McGregor, Ph.D.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; and Danny McCormick, M.D., M.P.H.; Samuel Dickman, M.D. JAMA Internal Medicine.
Published online first, July 19, 2021 at 11:00 AM EST.
The full text of the article is available to media professionals upon request. Please contact mediarelations@jamanetwork.org.
Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 24,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.