Thanks for that, Linda. Here's a rebuttal written by Courtland Milloy in
1/21 edition of the Washington Post
Jacquelyn A. Brown, MPH
Program Officer
Consumer Health Foundation
1400 16th Street, NW, Ste. 710
Washington, DC 20036
202.939.3393 phone
202.939.3391 fax
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www.consumerhealthfdn.org
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How to Slap A Happy Face On Misery
By Courtland Milloy
A recent federal report on racial disparities in health care was quite
uplifting to read, sort of like a State of the Union address on medical
treatment. As Health and Human Services Secretary Tommy G. Thompson sees it,
the disparities in health care aren't so bad, and the situation is getting
better every day.
"Never before have Americans had so many primary care providers,
specialists, hospitals, and health plans from which to choose," says the
report, which was released by HHS last week. "Except in the most remote
frontier areas, some form of health care is available 24 hours a day, 7 days
a week."
And if you're living in a remote frontier area, like, say, Southeast
Washington, where access to health care dropped precipitously with the
closure of D.C. General Hospital, you can take heart from this:
"Recognizing the superiority of the U.S. system, patients come from around
to globe to benefit from health care available nowhere else," the report
says.
Now doesn't that make you feel better?
The National Healthcare Disparities Report was supposed to be a
comprehensive look at inequalities in health care and the reasons for them.
An earlier draft of the executive summary found that the problem was
national in scope and that race played a major role.
Thompson didn't like the tone, however. He wanted disparities played down
and successes played up.
"That's just the way Secretary Thompson wants to create change," said
Karen Migdail, a spokeswoman at the Agency for Healthcare Research and
Quality, the HHS unit that prepared the report. "The idea is not to say, 'We
failed, we failed, we failed,' but to say, 'We improved, we improved, we
improved.' "
It was the old glass half-full instead of half-empty -- except that if you
looked more closely at the glass, you found that it was pretty much empty.
Consider an example of "success" cited in the HHS executive summary: Asian
and Pacific Islanders, American Indians and Alaska Natives have a
lower-than-average death rate from all types of cancer.
Inside the report, however, statistics suggest that we hold the applause.
A review of the American Indians and Alaska Natives served by the Indian
Health Service found that their infant mortality rate was 24 percent higher
than for the overall U.S. population; the rate of death from alcohol-related
causes was 67 percent higher; from diabetes, 318 percent higher; from
accidents, 180 percent higher; from suicide, 92 percent higher; and from
homicide, 110 percent higher.
Could it be that cancer death rates are lower among American Indians and
Alaska Natives because fewer of them live long enough to die of cancer? But,
hey, that's such a downer.
Let's look on the bright side. If the Bush administration can propose a
plan to allow more air pollution and call it a "clear skies initiative" and
encourage more logging and call it a "healthy forest initiative," why can't
Thompson close the racial disparity in health care by ignoring it?
"In effect, they whitewashed the issue away, even though they were told
that health care disparities are a national problem and pervasive and carry
a significant personal and societal price," Rep. Henry A. Waxman (D-Calif.)
told The Post.
Obviously, Waxman is not a true believer. He noted that problems mentioned
in the summary tended to be those that are "less alarming." The summary says
some people didn't get their cholesterol checked as often as they should,
for instance, or that they used hospitals for primary care.
More serious findings were omitted from the final draft. The omissions
include: Blacks and poor people have higher-than-average death rates from
cancer; late-stage breast cancer and colorectal cancer are more likely to be
diagnosed in minorities than in white people; and racial and ethnic
minorities and poor people have an above-average risk of dying of HIV.
Before anything can be done about such problems, they must be
acknowledged. Then again, maybe HHS is banking on the problem taking care of
itself. The report says, "People of lower socioeconomic status (SES) and
racial and ethnic minorities have in the past [italics added] experienced
poor health and challenges in accessing high quality care."
But it's better now. A lot of them have already died.
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