Does Race Affect Health Care in America?
FARAI CHIDEYA, host:
Vista Health System, which operates the hospital where Beatrice Vance died, declined to participate in today's show, but they did provide a statement that reads: We are aware of the outcome of the inquest. Because this is an ongoing investigation it would be inappropriate to make public comment on this matter beyond extending our continued sympathies to the Vance family. The hospital will continue to cooperate fully with the authorities in this matter.
Whatever the legal outcome of this case, a simple question remains: Did the fact that Ms. Vance was African-American play a part in her having to wait for care?
Lester Spence says absolutely. He's an assistant professor of political science at Johns Hopkins University and an expert on health disparities. He says our health care system is out of balance.
Professor LESTER SPENCE (Professor of Political Science, Johns Hopkins University): Differences in death rates, differences in care, difference in actually getting diseases, difference in the severity of the diseases. On a number of indicators the research has shown time and time again that whites and non-whites, there are different levels as far as those issues are concerned.
Going back to Vance's case. Looking specifically at heart attack and heart attack treatments, the research suggests that blacks are less likely than whites to get a variety of treatments even when the treatments are appropriate. And then the research also suggests that when blacks receive treatments, they receive treatments at a far slower pace than whites do.
CHIDEYA: Now is this because there is racial bias on behalf of the caretakers or the caregivers? Or is this because black folks, for example, end up at hospitals that are less well equipped?
Prof. SPENCE: It's a combination of factors. So I think part of it is the hospital. But I think in this case I don't think that comes into play. Lake County at least is one of the richest counties in the country, at least as of the 2000 Census. It was like 31st on that list.
But what also comes into play are the fact that blacks are poorer on average than whites and often have to use the emergency room as a sort of place for routine treatment because they're more likely to be on Medicaid. And then another factor that comes into play is those politics of care I alluded to earlier.
Where staff - even when blacks present them with clear symptoms, for a number of reasons staff are just less likely to listen to them, less likely to give them the same type of care they would white counterparts.
CHIDEYA: This hospital in this very wealthy county had just been bought by a for-profit company. What effect, if any, does the increasing privatization of emergency rooms have on care?
Prof. SPENCE: Well, if we think about the Declaration of Independence where it says we've got a right to life, liberty and the pursuit of happiness, what conservatives often say is that we don't really have a right to happiness. That is we don't have a right to certain types of outcomes; we have a right to just the pursuit of those outcomes.
But what it does say is that we have a right to life. Health is a public resource. So what happens when you introduce private or market-based incentives into the allocation of a public resource, what ends up happening is you end up reducing the level of care in order to pursue profit and everybody ends up suffering, even people who have the resources to pay for the care.
CHIDEYA: I personally don't know whether Ms. Vance, who died in Lake County, was insured. But either way it's clear that from this homicide ruling that local officials believe that her death was unnecessary. So what could be done about a situation like this, going forward?
Prof. SPENCE: Let's assume she may have been insured. She was in an emergency room. And because a number of people who are not insured are using those emergency rooms, it places even more a burden on hospital staff. A few things can be done as I'm thinking about it.
One is people can organize to get more resources for emergency rooms so they can deal with people who are uninsured, and at the same time be able to make sure that people who are insured get care. Looking at this from a health disparities perspective, what people can begin to organize around is actually making those times transparent.
So we know that Ms. Vance, it took two hours for them to see her. How long does it take black female patients to see the staff compared to white female patients? And then to make some of those same comparisons across various demographic groups so hospital staff can know what they need to work on and then individuals can know, regular citizens like you and me, can know what we need to push them on.
CHIDEYA: You're basically saying, if I understand you right, that there needs to be more accountability.
Prof. SPENCE: Yep. Transparency and accountability. So we can say with some degree of accuracy that we're not going to have national health insurance tomorrow. Even given that, there are a number of steps we can do between where we are now and where want to be that could increase the level transparency and accountability so the number of events like this dwindles to little to none.
CHIDEYA: Lester, thank you.
Prof. SPENCE: Thank you very much.
CHIDEYA: Lester Spence is assistant professor of political science at Johns Hopkins University.
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CHIDEYA: Coming up, Bill Cosby says everyone should pay for a U.S. slavery museum, and there's football again in the Superdome for the first time since Katrina. We'll discuss these and other topics on our Roundtable next.