Universal health care would ease disparities of race, class

Previously simmering racial and class disparities in health, education and income have boiled over from the heat of COVID-19. People cooped up at home for months, worrying about what a viral contagion would do to their health and economic future, have reacted to the killing of George Floyd with a pent-up mix of anger and violence. People of color have experienced more than twice as many COVID-19 infections and deaths per age-adjusted population in the United States as Caucasians, probably from differences in health and economic risk factors.

Even as COVID-19 restrictions are lifted and the economy improves, we are unlikely to see the boiling pot of disparities return to the low simmer of the preCOVID era. Solutions to problems need to be initiated.

One of the problems of disparity that begs for a solution and cuts across all racial, economic and age groups, is health care. Fixing this problem is within our reach and would go a long way toward improving the relationship we have with each other and with our governance.

Fixing the problem in health care does not solve all issues of disparity but would contribute significantly toward improving the economic lives of everyone in the population at large and the businesses that drive our economy.

The journey toward improved racial and class disparities starts with a single step, but the problems posed by health care access and cost have such widespread effects on people and the economy, that the single step is the length of a marathon.

The American College of Physicians (ACP), the organization of internal-medicine physicians and the second-largest physician organization in the U.S. after the American Medical Association, has endorsed universal, mandatory, health insurance coverage using either single-payer (government) or private insurance with public option. Neither of these approaches would suggest that the government should become the deliverer of healthcare, only the payer.

As the Governor of the ACP chapter in Florida, I encourage all of us to recognize the benefits to individuals as well as to the economy from taking this step. By taking this step, we would meaningfully begin reducing disparities in medical care access and income that have contributed to the unrest and anger we have witnessed. While it is obvious why universal health insurance coverage improves medical care access, it isn’t so obvious why it helps the economy as well.

Medical care in the United States consumes 17% of our Gross Domestic Product (GDP), the highest percentage in the world. Yet it does not achieve universal coverage, even with the Affordable Care Act (ACA) of the Obama administration. Canada, one of our two nearest neighbors, only spends 10% of GDP on medical care.

Racial disparities in health insurance coverage, even after the ACA, are significant. Uninsured Caucasians (8.5%), Blacks (14%) and Latinos (25%) face uphill battles getting needed care while trying to provide for other needs of their families.

While medical care is only one modest component contributing to the health of people, it is universally desired: witness the attention to the medical community during the COVID-19 coverage. Medical care in the U.S. is paid for by a collage of sources. The split in percent cost between public and private-individual sources is about 50-50 in the US compared to 90-10 in most other advanced countries.

Businesses, especially small businesses, have struggled to pay for the rising cost of medical insurance for employees, resulting in suppressed employment and wages. Employers seeking to avoid medical insurance costs have increased part-time and on-demand employees to avoid medical insurance costs.

Paying for universal health care coverage might seem overwhelmingly complex, except that we have an excellent model: Medicare. Expanding this model is only one of several options for paying for universal coverage.

As a society and a country in turmoil, fueled by racial disparities at several levels, we should expect our leaders to recognize and react to an obvious need in health care and support a solution to some of the worst of the social disparities we face.