Is racism rampant in the American healthcare system?

[marylander1940]

I watched her interview, and I recalled a black friend of mine being distrustful of going to the free clinic, later on skeptical about HIV-AIDS and in recent years concerned about the Covid-19 vaccine. 

Dr. Blackstock on racism & prejudice in U.S. health care | CNN

WWW.CNN.COM

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CNN’s Jake Tapper speaks with Dr. Uché Blackstock.

 

Edited January 28 by marylander1940

[mike carey]

Dr Blackstock has entered into a serious debate about the apparently entrenched attitudes of medical professionals towards people they don't see as being capable of making accurate assessments of their symptoms. It's not a new observation that doctors make that assumption about anyone who is not a middle to upper class straight white male, and that it's not necessarily a conscious bias on their part. The same issues have been raised in this country but mainly in relation to women, race not being as salient issue here as it is in the US. The rev-head wife of a mechanically illiterate man would recognise a similar experience if she were in the workshop or car show-room with him.

As she notes it is a two-way issue with people starting to doubt their own ability to understand their bodies, and so their 'permission' to question the doctor. There is also the distrust of the medical profession to contend with, the Tuskegee syphilis experiments that she mentions being one of the more notorious sources of that distrust. There is a parallel type of distrust here among indigenous communities, of government officials from police to child welfare, because of their historical roles in the removals of, especially mixed race children from indigenous families during the stolen generation. Older women, now grandmothers are the among the elders in those communities and many of them were among the children who were removed, so the distrust is visceral.

My take from the interview that it is mainly the attitudinal change she and others see as being needed in the medical profession that she is seeking to address, less so the suspicion level of patients. The issues affect the quality of health care that those subjected to them, women, POC and other minority and disadvantaged groups, are likely to receive. I also didn't get the impression that she was looking at casual racism in health care settings. They are likely to be no more or less prevalent there than in any other facets of life, and although they too can affect the quality of care, they are less likely to be systemic, and so less amenable to the systemic change she advocates.

[SouthOfTheBorder]

the root cause of inequitable healthcare is the basic setup of the American healthcare system - meaning no universal healthcare for all people. This inordinately affects minority populations with worse health outcomes because they have less access.
none of this is new information and the US healthcare system is notoriously (among rich developed peer countries) inefficient, costly and with the worst overall healthcare outcomes.  
you need to look no further than the declining life-expectancy in the US among all groups - white, black, urban & rural. this same trend of declining life-expectancy is just not happening in other rich developed countries. Even relatively poor countries have higher life-expectancy than the US now. 

when healthcare is based on money & profits, instead of delivering quality basic healthcare to all people this is what you get.  nothing will change relative to US healthcare until universal healthcare is delivered to all & that won’t happen during any of our lifetimes.
 
Aside from inequitable healthcare based on race, there also are startling disparities based upon the state of residence - which may have a correlation to race.  Mississippi, West Virginia & Louisiana have the lowest life-expectancies while Hawaii, Washington & Minnesota have the highest.  Between Mississippi & Hawaii - there is almost a 9 year difference.  

my European friends frequently ask me if the things they hear about US healthcare are true - mainly it’s two points: is is true some people have no access to healthcare & is it true that even people with insurance have enormous medical bills that can cause financial devastation.  Yes on both.  

Something is very wrong when the richest country on earth somehow cannot figure out basic healthcare.  Unless of course, they really don’t want to figure it out because there is too much money on the table as is for invested parties. 

And then there’s the food - which also plays a huge part in health outcomes.  The US is an outlier lacking the same food standards such as the EU which bans many preservatives & additives negatively affecting health.  Again - it’s about money & the payments to US politicians which prevents any real change.  Unhealthy food will make a population of unhealthy people - not complicated. 

Americans like to think they have the best of everything & in some areas, they do. Healthcare is not one of them. It’s basically like buying a new Mercedes and getting a used car that’s been in an accident & missing parts.  And yet, a large segment of the population doesn’t want any change - because they don’t know any better.  They’re all in on the propaganda fed to them by those in power & making money on the system as is. 

 

Edited January 28 by SouthOfTheBorder

[BSR]

1 hour ago, SouthOfTheBorder said:

is is true some people have no access to healthcare

Who in America has no access to healthcare?

[mike carey]

Moderator's Note

Gentlemen, a reminder that this topic is about racism in the delivery of healthcare. The OP didn't specify whether his question was about the US, but the interview and the book are specific to that country. It is not about access to the heath care system in general nor about the politics of health care in the US.  Please stay on topic and steer clear of politics. And yes it is possible to discuss the issue that way.

[marylander1940]

1 hour ago, mike carey said:

Moderator's Note

Gentlemen, a reminder that this topic is about racism in the delivery of healthcare. The OP didn't specify whether his question was about the US, but the interview and the book are specific to that country. It is not about access to the heath care system in general nor about the politics of health care in the US.  Please stay on topic and steer clear of politics. And yes it is possible to discuss the issue that way.

I just edited it, thank you!

Folks can also bring examples of racism from other countries to this thread. 

[Bokomaru]

Fresh Air (NPR) did a 40 minute podcast interview with Dr Blackstone. It’s very interesting and she’s persuasive  about the topic.
One problem, in my opinion, is that there’s a bit of overreach. She won’t win people to her cause by saying things like, “Race cannot be a risk factor because it is a social construct.” Wait, what? Implying that doctors shouldn’t consider race when looking at a case is quite a leap. Yes we need to counteract unconscious bias. But doctors also have to apply the facts as currently understood. 

[+ Vegas_Millennial]

10 hours ago, SouthOfTheBorder said:

the root cause of inequitable healthcare is the basic setup of the American healthcare system - meaning no universal healthcare for all people. This inordinately affects minority populations with worse health outcomes because they have less access.

With this same logic, then we should be seeing no difference in educational attainment across a school district, since all students have the same access to public K-12 education.  Sorry, there's more to it than that.

[+ Vegas_Millennial]

10 hours ago, SouthOfTheBorder said:

when healthcare is based on money & profits, instead of delivering quality basic healthcare to all people this is what you get.  

Comparing again to education, then we should see public K-12 education providing better education then private or charter K-12 schools who operate at a profit.  Minorities who cannot afford for profit education should be thriving under our universal K-12 public/non-profit system.  But they are not.  Parents are choosing to enroll their children in for-profit schools.  The same is true for healthcare.

[SouthOfTheBorder]

19 minutes ago, Vegas_Millennial said:

Comparing again to education, then we should see public K-12 education providing better education then private or charter K-12 schools who operate at a profit

preventative & basic healthcare for all is not in any way comparable to education. Healthcare is necessary to survive.  Thus, the dismal outcomes & declining life-expectancy in the US compared to other rich developed countries.

i happen to have excellent insurance in the US - and have still been hit with staggering out-of-pocket expenses that are just not an issue in other countries.  I can afford to pay - but many cannot. 

and back to topic - minority populations are less able to pay the exorbitant out of pocket fees. So, many avoid basic healthcare on that reason alone 

Edited January 28 by SouthOfTheBorder

[+ Vegas_Millennial]

3 minutes ago, SouthOfTheBorder said:

Thus, the dismal outcomes & declining life-expectancy in the US compared to other rich developed countries.

The other factors that go into life expectancy are important too:  Diet, exercise, drugs, alcohol, smoking, stress, and happiness to name a few.  It's not a systematically racisst healthcare system if certain groups partake in more drugs and alcohol, or work more stressful or more dangerous jobs, and therefore have lower life expectancy.

[SouthOfTheBorder]

1 minute ago, Vegas_Millennial said:

The other factors that go into life expectancy are important too

yada yada yada - the fact is for whatever reason, the richest country in the world has a declining life-expectancy while other countries do not.  and it’s not unique to anyone one group - all groups are experiencing decline.  
Maybe the question to ask is why do so many need to use drugs, commit suicide and are otherwise unhealthy?  There’s a reason it’s unique to the US - it’s not a fluke and it’s not random. 

[+ Vegas_Millennial]

4 minutes ago, SouthOfTheBorder said:

yada yada yada - the fact is for whatever reason, the richest country in the world has a declining life-expectancy while other countries do not.  and it’s not unique to anyone one group - all groups are experiencing decline.  
Maybe the question to ask is why do so many need to use drugs, commit suicide and are otherwise unhealthy?  There’s a reason it’s unique to the US - it’s not a fluke and it’s not random. 

To keep the topic on point, I don't think that has to do with racism.  After visiting other Developed countries in the world, it is obvious that the United States is not any more racist than other Developed countries, especially in its delivery of healthcare.

[+ augustus]

On 1/28/2024 at 2:16 PM, SouthOfTheBorder said:

i happen to have excellent insurance in the US - and have still been hit with staggering out-of-pocket expenses that are just not an issue in other countries.  I can afford to pay - but many cannot. 

If you can afford to pay, and have claimed you are wealthy, then the out-of-pocket expenses shouldn't be "staggering". 

[+ nycman]

On 1/28/2024 at 2:31 PM, SouthOfTheBorder said:

the richest country in the world has a declining life-expectancy while other countries do not.

And there you’ve inadvertently hit the nail on the head. It’s because we’re the richest country in the world, not in spite of being the richest country in the world that we have a shitty life expectancy. We can afford to be obese, lazy, drug abusing pigs. The truth is America has the best healthcare system in the world. Liberals don’t like that fact because it doesn’t match their socialist dogma, so they constantly try to put it down. Yes, socialized medicine leads to longer lives. If that’s your only goal, then yes, socialism rules. Personally, I’ll pick quality over quantity any day.

Theres a reason wealthy individuals from countries with idealized socialist healthcare, flock to America when they get sick. They’re not stupid. 

On 1/28/2024 at 2:16 PM, SouthOfTheBorder said:

i happen to have excellent insurance in the US - and have still been hit with staggering out-of-pocket expenses

All that tells me is you’re a bad little Socialist. In socialized medicine you MUST follow the rules as decided by your government. You chose to break the rules enforced by your "excellent" insurance. You know….because you could. It’s called freedom. It’s tastes damn good, but it’s expensive. So, it’s back to Young Pioneers training camp for you, comrade!

[mike carey]

Mod's reminder

Folks, this thread is about racism in health care delivery not the cost, general availability or choices in the US compared to elsewhere. Keep to the topic at hand. 

[+ JEC]

As someone who works in healthcare, our Healthcare system is designed by rich white STRAIGHT men, for rich white STRAIGHT men.  We put the best hospitals ckinics and clinicians in affluent areas (we call it a "good payer mix", payers being insurance).  We schedule services during normal working hours.  Majority of information is in English, and staff are English speaking.  We don't really attempt to understand peoples' cultures, norms, preferences, or unique factors that affect their health.  Research dollars disproportionately go to solve problems of rich white STRAIGHT men.  Visiting hours don't accommodate ppl who work odd hours, or multiple jobs.  It's hard to even get a routine lab draw done outside of "normal working hours".  I could go on and on.

I'll offer you an example.  I had a minor surgery recently where I stayed overnight in the hospital.  I brought my usual daily meds with me including my PREP (Truvada).  Well, the fact that I brought my own meds triggered a huge drama.  A nurse manager was called, then a pharmacist was called to the room.  They held the plastic ziplock bag up "what's this blue pill"?.  They took the pills away for investigation.  They came back 2 or 3 times to ask more questions.  Meanwhile, they must have said the word Truvada (at full volume) what felt like 100 times....in my 10X10 room with a STRAIGHT roommate whose family was visiting.  It sounded and felt like Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada.   All while recovering from anesthesia.  No consideration about my privacy, or that being on that particular med might be sensitive information.  THAT is what a healthcare system designed by rich white STRAIGHT men looks and acts like.  

[+ Vegas_Millennial]

2 hours ago, JEC said:

As someone who works in healthcare, our Healthcare system is designed by rich white STRAIGHT men, for rich white STRAIGHT men.  We put the best hospitals ckinics and clinicians in affluent areas (we call it a "good payer mix", payers being insurance).  We schedule services during normal working hours.  Majority of information is in English, and staff are English speaking.  We don't really attempt to understand peoples' cultures, norms, preferences, or unique factors that affect their health.  Research dollars disproportionately go to solve problems of rich white STRAIGHT men.  Visiting hours don't accommodate ppl who work odd hours, or multiple jobs.  It's hard to even get a routine lab draw done outside of "normal working hours".  I could go on and on.

I'll offer you an example.  I had a minor surgery recently where I stayed overnight in the hospital.  I brought my usual daily meds with me including my PREP (Truvada).  Well, the fact that I brought my own meds triggered a huge drama.  A nurse manager was called, then a pharmacist was called to the room.  They held the plastic ziplock bag up "what's this blue pill"?.  They took the pills away for investigation.  They came back 2 or 3 times to ask more questions.  Meanwhile, they must have said the word Truvada (at full volume) what felt like 100 times....in my 10X10 room with a STRAIGHT roommate whose family was visiting.  It sounded and felt like Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada.   All while recovering from anesthesia.  No consideration about my privacy, or that being on that particular med might be sensitive information.  THAT is what a healthcare system designed by rich white STRAIGHT men looks and acts like.  

My few hospital visits in Las Vegas have been the opposite experience.  Quick service during graveyard shift.  Private rooms.  Doctors, nurses, and staff very quietly and sensitively asking appropriate questions when I tell them about HIV prevention medications.  These have been hospitals on two different networks.

As for research dollars, disproportionately more money is donated towards women's breast cancer research then heart disease, even though heart disease is the largest killer for men.  And while HIV funding donations are small, they still proportionally larger than the deaths from HIV compared to other diseases that need research.  Of course, this is private donations and not public tax dollars.  But perceptions aren't always reality.

 

Edited February 7 by Vegas_Millennial

[+ APPLE1]

On 2/6/2024 at 4:15 PM, JEC said:

As someone who works in healthcare, our Healthcare system is designed by rich white STRAIGHT men, for rich white STRAIGHT men.  We put the best hospitals ckinics and clinicians in affluent areas (we call it a "good payer mix", payers being insurance).  We schedule services during normal working hours.  Majority of information is in English, and staff are English speaking.  We don't really attempt to understand peoples' cultures, norms, preferences, or unique factors that affect their health.  Research dollars disproportionately go to solve problems of rich white STRAIGHT men.  Visiting hours don't accommodate ppl who work odd hours, or multiple jobs.  It's hard to even get a routine lab draw done outside of "normal working hours".  I could go on and on.

I'll offer you an example.  I had a minor surgery recently where I stayed overnight in the hospital.  I brought my usual daily meds with me including my PREP (Truvada).  Well, the fact that I brought my own meds triggered a huge drama.  A nurse manager was called, then a pharmacist was called to the room.  They held the plastic ziplock bag up "what's this blue pill"?.  They took the pills away for investigation.  They came back 2 or 3 times to ask more questions.  Meanwhile, they must have said the word Truvada (at full volume) what felt like 100 times....in my 10X10 room with a STRAIGHT roommate whose family was visiting.  It sounded and felt like Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada Truvada.   All while recovering from anesthesia.  No consideration about my privacy, or that being on that particular med might be sensitive information.  THAT is what a healthcare system designed by rich white STRAIGHT men looks and acts like.  

I am not trying to belittle your experience, but unfortunately, YOU let them take your Ziploc baggie of meds, and YOU entertained their bullshit by answering questions.

Experience has taught me that I am the primary advocate for MY health. Generally that means, when I take my bag of pills along for a hospital stay, I only have to ASK 3 questions:

1) The chart lists current meds and supplements, right?

2) I haven't been declared not competent to make my own medical decisions, right?

3) My primary indicated I would be managing my own regular meds while I am here, right?

Once, a hospitalist tried to question my primary's orders on letting me manage my meds. It didn't go over well. My primary got loud and ugly. The hospitalist lost, quickly. I can't even imagine if it was a pharmacist and a nurse manager questioning the orders he wrote.

Edited February 8 by APPLE1

[marylander1940]

On 1/28/2024 at 2:31 PM, SouthOfTheBorder said:

yada yada yada - the fact is for whatever reason, the richest country in the world has a declining life-expectancy while other countries do not.  and it’s not unique to anyone one group - all groups are experiencing decline.  
Maybe the question to ask is why do so many need to use drugs, commit suicide and are otherwise unhealthy?  There’s a reason it’s unique to the US - it’s not a fluke and it’s not random. 

and the richest country on Earth also produces new medicines and develops new treatments that are enjoyed by the rest of the world. 

 

[marylander1940]

On 2/2/2024 at 6:11 AM, nycman said:

And there you’ve inadvertently hit the nail on the head. It’s because we’re the richest country in the world, not in spite of being the richest country in the world that we have a shitty life expectancy. We can afford to be obese, lazy, drug abusing pigs. The truth is America has the best healthcare system in the world. Liberals don’t like that fact because it doesn’t match their socialist dogma, so they constantly try to put it down. Yes, socialized medicine leads to longer lives. If that’s your only goal, then yes, socialism rules. Personally, I’ll pick quality over quantity any day.

Theres a reason wealthy individuals from countries with idealized socialist healthcare, flock to America when they get sick. They’re not stupid. 

All that tells me is you’re a bad little Socialist. In socialized medicine you MUST follow the rules as decided by your government. You chose to break the rules enforced by your "excellent" insurance. You know….because you could. It’s called freedom. It’s tastes damn good, but it’s expensive. So, it’s back to Young Pioneers training camp for you, comrade!

One more time:

 

[rvwnsd]

Moderator's Note: After two (2) moderator's notes, the message to stay on topic didn't resonate. The thread is now locked.