By Toby Terwilliger, M.D.
The (Newark, N.J.) Star-Ledger, September 16, 2020
A number of recent high-profile police killings of Black citizens, most notably the May 25th murder of George Floyd, have forced a national reckoning with our history of racism and injustice. The Black Lives Matter movement has dramatically shifted public opinion and has awakened a renewed sense of urgency to confront racism head-on. The movement has rightfully been indignant of police brutality and a broken criminal justice system. But the fight for racial justice cannot stop there. Black lives must be seen to matter in education, housing, the workplace, and all other facets of life if we can ever hope to achieve racial justice.
Perhaps no institution has stolen more Black lives than our broken healthcare system. Every year, 45,000 Americans die due to inadequate health insurance, a disproportionate number of whom are Black. This has resulted in significant disparities in health and longevity. Blacks are more likely to suffer from chronic illnesses, to die from preventable causes, and to die during pregnancy or childbirth than other race. Perhaps most starkly, the life expectancy of a Black man in his 40s today is six years shorter than that of a white man of the same age.
Not only does the current system cut years off of Black persons’ lives but it also disproportionately disadvantages Black families. Blacks are more financially burdened by medical costs and declare bankruptcy at higher rates due to medical bills than other races. In this way, similar to mass incarceration, our broken healthcare system steals parents away from their children, casts families into financial ruin, and perpetuates a cycle of poverty. It is time to treat racial justice as inextricable from health justice.
How can we achieve health justice? The answer is complicated and starts with investment in black communities, reforming medical education to train more black health care providers, and redesigning clinical trials to include more minority participants. But one thing is certain: we cannot hope to achieve health justice without providing universal, affordable healthcare and this is best accomplished through a single-payer healthcare system.
Single-payer engenders equity in several ways:
First, it eliminates uninsurance as a barrier to care. Currently, one in five Black persons is uninsured, meaning that millions of Black Americans go without primary care or preventive health services every year. It is time we guarantee access to these services to everyone. Doing so will go a long way toward reducing disparities in health outcomes.
Second, it eliminates out-of-pocket expenses, helping many Black families break free from the cycle of poverty and improving health outcomes. Parents would no longer be forced to choose between putting food on the table or paying for their child’s medications and, crucially, no family would ever again be forced into bankruptcy because of medical debt. When families no longer have to worry about medical bills, they are free to invest those resources into their children and their community.
And third, it eliminates the marriage of insurance with employment. Single mothers working multiple part-time jobs will be able to afford healthcare for their children. Others may choose to become self-employed or start a business when the burden of employer-sponsored insurance is lifted. This will help to achieve an economy in which blacks can fully and equitably participate, especially in sectors from which they have been historically excluded.
This new wave of anti-racist activism is still in its infancy. The Black Lives Matter movement has made it impossible to ignore the inequalities in policing and criminal justice any longer. A necessary corollary to this movement must be the demand for health justice. We must press our elected leaders to support legislation that promotes health justice, most saliently of which are proposals for single-payer healthcare. For if we truly hope to make black lives matter, then we must create a healthcare system that values the lives of black patients as much as the lives of white ones.
Dr. Toby Terwilliger is a Jersey City resident and a physician at the Rutgers New Jersey Medical School in Newark.