The Philadelphia Inquirer
Posted on Fri, Dec. 18, 2009
Health reform's true colors
The real racial issue in this debate is not about Obama. It's about inequality.
The "tea party" protests that started last spring sparked a debate over whether racism was motivating the opposition to President Obama's health-care reform proposals. The issue was revived by a recent Internet advertisement depicting regular folks who oppose health-care reform saying facetiously, "I guess I'm racist."
While this offers another opportunity to have a national conversation about race and health care, I fear that we are once again going to fail to discuss the most important racial aspect of health care.
Rather than focusing on whether health-care reform opponents are somehow motivated by racism, we should be focusing on the fact that African Americans and Latinos have the most to gain from health-care reform - and the most to lose from its failure.
After the election of the first African American president, we shouldn't be surprised that race enters our national debates more easily. The "guess I'm racist" ad reflects frustration over the fact that criticisms of presidential initiatives are caught in that web. Sometimes legitimate policy criticism can be carelessly linked with the racist motivations of a small minority - such as those who forwarded e-mails depicting the president as an African witch doctor.
But race is part of the health-care debate in a more important way. Health care reveals our racial divide. Almost all of our institutions - including those involved in the delivery and financing of health care today - were built on a legacy that treated people of color as second-class citizens. While we have made great strides to move past this legacy, people of color are still paying the accumulated costs of past discrimination today.
Forty-six million Americans do not have health insurance, according to the most recent census estimates. About one in 10 whites is in that group, compared with two in 10 African Americans and three in 10 Latinos. And these disparities start early in life: While children are covered at higher rates than the U.S. population as a whole, racial inequality occurs in all age groups.
Thus, while all 46 million uninsured Americans would benefit from health-care legislation promoting high-quality, affordable health care, twice the share of the African American population and three times the proportion of Latinos would benefit. For people of color, health-care reform is not just important; it's urgent.
While the nation fretted about the total unemployment rate passing 10 percent last month, African Americans had passed that point more than a year earlier, with current rates reaching close to 16 percent. Latinos, meanwhile, face unemployment rates around 13 percent. The unemployed are, of course, far less likely to have health coverage.
Furthermore, both African Americans and Latinos are disproportionately represented in service-sector jobs that offer less security and fewer benefits, making it likely that any recovery will come later and be less complete for those groups.
Racism in our country has been defined by actions. But racism can also take the form of inaction in the face of inequality. In 1899, W.E.B. DuBois wrote in The Philadelphia Negro that the "most difficult social problem in the matter of Negro health is the peculiar attitude of the nation toward the well-being of the race. There have, for instance, been few other cases in the history of civilized peoples where human suffering has been viewed with such peculiar indifference."
Those fighting health-care reform now are showing the same "peculiar indifference" toward the welfare of blacks and Latinos in this country at the beginning of the 21st century that DuBois identified at the end of the 19th.
I doubt that most critics of health-care reform today are motivated to criticize the president because of his race. But without health-care reform, people of color will suffer the most. Is that outcome an acceptable by-product of inaction? That is the conversation about race and health care that we should be having.
Michael Bader is a Robert Wood Johnson Foundation Health & Society Scholar
and a senior fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania. He can be reached at mbader@wharton.upenn.edu.
