Beyond the Spin: The high cost of inequality

If Congress is serious about lowering health-care costs in this country, it must address racial and ethnic disparities that cost thousands of lives and millions of dollars each year.

The report "Equal Health Care for All," published this month by the Center for American Progress, notes, "Health-care disparities generate a significant human and economic cost that is borne directly by the individuals involved and indirectly by all Americans. As minorities become an increasing percentage of the American population, ... the costs of failing to tackle health-care disparities will result in higher total health care spending."

The report notes that:

Infant mortality, one of the most important indicators of a nation's health, was at 6.86 per 1,000 births in 2005. For African Americans, the rate was nearly double that, at 13.63, followed by Native Americans (8.06), whites (5.76), Asian Americans (4.89), and Hispanics (4.42 to 5.53).

Life expectancy at birth in 2005 was 81 years for white females, 77 years for African American females, 76 years for white males, and 70 years for black males. Native Americans have a life expectancy of less than half the national average.

Minorities also have higher rates of chronic illnesses. African Americans suffer 67,000 more deaths from them each year than whites do, one study found.

Although African Americans and Hispanics represented only 26 percent of the population in 2001, they accounted for 66 percent of adult AIDS cases and 82 percent of pediatric cases.

A study conducted by researchers at Johns Hopkins University and the University of Maryland for the Joint Center for Political and Economic Studies, a Washington think tank, calculated that the elimination of health inequities would have saved the U.S. economy $1.2 trillion between 2003 and 2006. That's more than the gross domestic product of India.

"I'm big on advising people about healthy lifestyles," said Dr. David Satcher, a former surgeon general. "I feel strongly about the need to be physically active and to consume fresh fruits and vegetables. But the fact of the matter is that some people live in communities where it's not safe to walk out on the porch, let alone go jogging, whereas other people have walking trails and parks. We're not equal when it comes to healthy lifestyles."

Dr. Willarda V. Edwards, president of the National Medical Association, said the medical community needs to reorder its priorities.

"The National Medical Association has always said we need to work on wellness, not 'sick care,' " she said. "Bring in our insurance companies - who is going to benefit more? It will decrease the incidence of illnesses and really put more emphasis on wellness."

The current emphasis on the back end of care is costly.

"There is a huge percentage of the population that becomes bankrupt because of health-care costs," said Dr. Georges Benjamin, executive director of the American Public Health Association. "So you have a population which has already been disproportionately affected by these diseases. They don't have the funding to take care of themselves. ... Then when they do, they lose everything that they own. That's a real problem."

And that's not the only real problem. An Institute of Medicine report found that among the non-elderly, 31 percent of Hispanics, 32 percent of Native Americans, 19 percent of African Americans, and 18 percent of Asian Americans are uninsured, compared with 11 percent of whites.

In 1980, the Department of Health and Human Services established the twin goals of increasing the quality and years of life, along with eliminating health disparities, by 2010. As 2009 comes to a close, we are not close to reaching either goal.

"Since we launched Healthy People 2010 and the goal of eliminating disparities in health, eight million more people have become uninsured in this country," Satcher said. "... Not only that, but there are more people who are poor. Whether you look at the social determinants in terms of poverty and income, or when you look at access to care in terms of insurance, we have gone backward."

He added that we are also going backward morally.

"We have a responsibility to see that people are not left behind hanging and depending on emergency rooms for what should be primary care," Satcher said. "Those are really ethical issues, and we as a nation have not addressed them."

Nor have we addressed racial and ethnic disparities. Satcher said: "I don't think we're ever going to get health-care costs under control until we get disparities under control."