OP-ED

Is Opposition to Obamacare Racist?

It is pretty easy to be against Obamacare these days.

The federal government can’t come up with a working website to help people buy health insurance. The President misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act – the individual mandate – will be implemented for the first time.

Lost amidst all this controversy is the very strong likelihood that once Obamacare is fully implemented, and the disastrous healthcare.gov website is functioning properly, the law will mean health insurance for millions of previously uninsured Americans.

And the people most likely to benefit from this law, according to a recent study, are blacks and Hispanics who not only have higher rates of uninsurance, but also frequently demonstrate greater need for medical care.

Which raises a question: is it racist to oppose the Obamacare efforts to increase health insurance in the United States?
The authors of the study point out that “not only are Hispanics and Blacks more likely to be uninsured [than whites], they also report worse health at most ages.” This partly explains why African-Americans have shorter life expectancy than Caucasians, and spend more of their adult years in poor health. In fact, the authors have an analysis illustrating the chance of going without health insurance according to age, race and ethnicity, based on data from 2008, before Obamacare was passed into law:

This picture reminds us that a major goal of Obamacare was to reduce unjust disparities in access to healthcare, access that can mean the difference between pursuing versus not being able to pursue one’s life goals. I understand people’s concerns about creating an expensive new government “entitlement.” I know why many of my politically conservative friends and relatives are suspicious about federal efforts to reform something as massive and complex as the US healthcare system. Indeed, the ridiculously incompetent launch of healthcare.gov confirms many of these suspicions. But as a physician, I cannot stand the thought that we allow people to suffer needlessly for lack of access to affordable healthcare. Having practiced medicine in the VA health care system from 20 years, I have seen the benefits of providing decent Americans with solid healthcare coverage.

I also understand the concerns of my politically liberal friends who criticize Obamacare for not pushing us into a single payer system, and instead relying upon private insurance companies to help solve the problem. It is very likely that “Medicare for all” could have been launched much more smoothly than the health insurance exchanges which we are trying to get running now. But as a political moderate, and also as someone who has read extensively about the history of health reform efforts in the United States, I understand why the Democrats tried to work within the system we have, rather than impose a politically untenable single-payer system that never would have come into being. No politician who values her chance at re-election would vote to eliminate a whole industry, like the health insurance industry. Health care reform must always operate within the possible.

Now back to the question I pose in the title of this post: given that Obamacare will help blacks and Hispanics more than other segments of the American population, is it racist to oppose the law?

The answer is: mainly no, but occasionally yes. There are some racist people who oppose the law because they hate seeing their tax dollars used in ways that benefit blacks and Hispanics. They oppose the law because they believe that black and Hispanic people who lack health insurance simply need to stop being so lazy, and get better educations and better paying jobs so they can buy insurance on their own. But most people who oppose the law do not do so for such explicitly crass reasons. They do so because they are worried about government spending. They do so because they don’t trust the federal government to administer the system effectively and efficiently.

Nevertheless, people who oppose the law for these other, more legitimate, reasons need to at least recognize that efforts to thwart the law, if they succeed, will disproportionately harm blacks and Hispanics. That is what is so disturbing about the many Republican efforts to repeal The Affordable Care Act without coming up with a legitimate alternative that offers all Americans decent and affordable health insurance. I am not saying that alternative plans do not exist. I’m just saying they have not been the focus of most repeal efforts.

To oppose the Affordable Care Act without coming up with a way of benefiting the neediest people among us – I have a hard time respecting that.

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E VandenbergCarolPeter1CynthiaBob Hertz Recent comment authors
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archon41
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archon41

The charge of “racism,” at the losing end of an argument, is the last, sordid refuge of the Obamaphile.

E Vandenberg
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E Vandenberg

Dr. Ubel, it is a thoughtful discussion. I don’t think of the un-cared as race based but more class based. Probably in some rural Southern counties, whites are more likely to be un-cared for by medical professionals. Secondly, the data is probably not very useful in coming up with a solution. I think the problem is more the way the under-class access the system. Waiting until conditions become chronic, lack of transportation, mobility when chronically disabled, child care, language and culture barriers may even outweight financial barriers. Afterall, there are many free services now. Solutions? The truth is that the… Read more »

Peter1
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Peter1

” The truth is that the US has tried the government healthcare solution and it is the problem.”

It has? Do you mean Medicare and Medicaid?

“The commercial engine, even in healthcare creates low cost quality.”

It does? Do you have examples? Don’t we have a “commercial engine” now, where insurance companies and providers compete for your business?

Bobby Gladd
Guest

More fundamentally:

“Is Opposition to OBAMA Racist?”

To a significant degree, yes. I don’t think anyone can deny that.

http://www.jlcauvin.com/wp-content/uploads/2009/09/Copy_of_obamacare.JPG

Carol
Guest
Carol

Has there ever been majority support in this country for single payer? I ask because the left always opines that there obviously is, which would be a surprise to me.

Peter1
Guest
Peter1

Seems there is wide spread support for subsidized health care of some fashion – for me but not for the other guy. The left is just ahead of its time.

Bob Hertz
Guest
Bob Hertz

Note to Cynthia and Peter: The ACA did actually raise income taxes on the top 3% or so of taxpayers. Any family with income over $250K pays an extra Medicare tax, and capital gains/dividends now also have a small Medicare tax. All together these new taxes are projected to raise about $40-50 billion a year. In order to fund health reform totally from income taxes, I think you would have to raise taxes on a lot more people than just the top few. The family with two civil service workers making $170,000, the retiree with a pension of $90,000, the… Read more »

archon41
Guest
archon41

Perhaps Obama can turn this fiasco around by revealing that it is properly viewed as an exercise in “reparations,” and that its true purpose, costs and effects had to be carefully concealed, to avoid congressional opposition. Not sure how the Supreme Court would react to that. Equal Protection Clause, and all that.

Peter1
Guest
Peter1

“Perhaps Obama can turn this fiasco around by revealing that it is properly viewed as an exercise in “reparations,” ”

Yes, 40 acres and a mule sort of thing.

Peter1
Guest
Peter1

“Michael Olenick in Naked Capitalist on ‘Comprehensive Review of Obamacare” Thanks for the link Bob. I also found this in another Michael piece in the Naked Capitalist. The 1% must be laughing their heads off. “Instead of using political capital to push through Medicare for All, charitably ssuming that’s what the political class wanted, it’s become clear what we got instead is using insurance buyers as financial human shields. We’re foaming the runway again, this time for a healthcare industry that costs more and delivers less than in every other advanced nation and plenty of so-called developing countries. We were… Read more »

Bob Hertz
Guest
Bob Hertz

Note to BC —

My point on the bronze plans was this —

they actually do a decent job covering the ‘big things’ like cancer.

But what poor people need more is a low-deductible policy that covers diagnostic tests and drug overdoses and pregnancy from dollar one.

That is what bronze plans do not do. See the article by Michael Olenick in Naked Capitalist on ‘Comprehensive Review of Obamacare.’ He computed that on a normal pregnancy, a bronze plan would leave the insured owing $5,000 on a $7500 bill.

BC
Guest
BC

Bob – sorry I read your response too quickly. Your point on the deductible being too high is accurate.

Peter1
Guest
Peter1

“But what poor people need more is a low-deductible policy that covers diagnostic tests and drug overdoses and pregnancy from dollar one.”

Bob, I think they get screwed from both ends. I looked up eHealth plans as example. The deductibles are atrocious. Get a subsidy, but not for the deductible. As usual in American health care, it’s a great system if you don’t need it.

Peter1
Guest
Peter1

The fact that blacks and hispanics have been economically depressed partly because of institutionalized racism (especially in the South) naturally leads to their need for the ACA. But I think the flaws in the ACA touch everyone and my take right now is this opposition is not race driven. If those people who self pay for insurance did not scream at being told their policy was cancelled and the replacement would cost more, we would only be pointing fingers at the web site debacle. Thank the President for this situation and his lack of insurance 101 advisors for not making… Read more »

BC
Guest
BC

Another thing that needs to be mentioned is a big part of the website fiasco is how the government procures things.

The regulations are a nightmare and beltway companies have teams of lawyers to wade through the paperwork. Add to this the beltway guys are buddy buddy with Congress people so they have an inside edge.

Companies outside the beltway are decidedly disadvantaged.

My gut is tech companies outside the beltway would have done a way better job. This said hard to say how much lack of clarification of the law or incompetence at HHS hurt the project.

Bob Hertz
Guest
Bob Hertz

The expansion of Medicaid very definitely benefits persons of color. And since Medicaid is paid for by income taxes, and since white persons have generally higher incomes, then one could say that this program is a form of redistribution. It is no accident that in some southern and western states, Medicaid has been doled out in the stingiest possible fashion. Even today, all that a white politician has to say is that Medicaid might raise your taxes, and a large bloc of white voters know exactly what is meant. This is nothing new. The ACA did not create this reluctance… Read more »

Cynthia
Guest
Cynthia

One of biggest criticisms of ObamaCare is that it benefits the upper class and the poor at the expense of the middle class. If our healthcare system was funded through income taxes, instead of through the private insurance industry, much of these benefits would shift away from the upper and lower ends of the income spectrum and towards the middle of this spectrum. Following the credit collapse of 2008, the rich got richer by pouring money into Wall Street, the poor improved their lot in life by receiving more public assistance, while those in the middle got squeezed slaving away… Read more »

BC
Guest
BC

Bob,

I think it’s a big problem if bronze plans do not cover cancer, strokes and the like. So if a bronze plan holder gets cancer how do they get treatment?

My view of insurance is that it’s main focus should be to cover expensive treatments and hospital stays.

Perry
Guest
Perry

If Hilary Clinton proposed Hilarycare would we be misogynists if we don’t agree?

Saurabh Jha
Guest
Saurabh Jha

I believe Dr. Ubel is saying that it is not racist to oppose Obamacare, even whilst acknowledging that the law favours historically-disadvantaged ethnic groups.

It’s actually quite a sensible message and the author seems to be getting scant appreciation for stating a truism that badly needs to be stated.

Bobby Gladd
Guest

Is alleging racism against Obama “racist”?

Joel Hassman, MD
Guest
Joel Hassman, MD

Wow, after Americans talk about health insurance needs at the Thanksgiving table, as instructed by the President, then they can move on to the racist card. Umm, isn’t asking this question alone stroking the racist card issue?! Isn’t it reverse discrimination to challenge people who are simply disagreeing with a minority person or action because the agenda is seen as wrong? I guess the rhetoric will deteriorate soon to charges that if you don’t agree with Democrat policy, as now Census figures show that Democrats are a minority population among registered voters, you are being racist by party position? The… Read more »

archon41
Guest
archon41

If you push an agenda because it confers a benefit on racial minorities at the expense of Whites, you’re the racist. One would have to be blind, deaf and dumb not to be aware that a struggle between Collectivism and the Market Economy is taking place here. How often, on these pages, have the praises of a collectivized, “universal single payer” system been trilled? Just what we need, an equal dose of homogenized health care rationed to all alike. I would despise Lenin not a whit more had he been Black. But if if somehow gratifies your sense of superiority… Read more »