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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27 replies »

  1. ” 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?

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

  3. 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 US has tried the government healthcare solution and it is the problem. We have not had a market based solution since the advent of Medicare and Medicaid. Our healthcare has been controlled by the government (State and federal) for 30 years. The solution would have been reasonable federal regulation and open market competition, with financial subsidies for the underclass and a care mechanism, such as home physician visits and community centers, to bring in the un-cared for. The commercial engine, even in healthcare creates low cost quality. Lastly, we all pay for the un-cared in the end through lost productivity and other ills. So it makes sense both for compassion and for financial reasons to help make the underclass healthy.

  4. 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.

  5. 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.

  6. “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.

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

  8. 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 executive making $120,000 — all these persons would have to experience higher taxes.

    Some of them are Democrats. For that reason I do not agree that Obama had unlimited political capital with the ACA.

  9. “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.

  10. 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.

  11. “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 led to believe that the political cost of the ACA was high, that Obama spent a lot of progressive chips to get it. Yet we ended up with something that is arguably worse than the current system.”

    “In the wake of the financial crisis anything seemed possible. Obama enjoyed nearly endless political capital assuming he had the cojones to wield that authority. In this he failed miserably, assuming he at least intended trying to fulfill some campaign promises in good faith. Obama could have passed virtually anything and we ended up with this convoluted, unfair, dishonest, and divisive mess. Medicare for All is clearly better than the ACA but, based on what we’re seeing, there is a legitimate question about whether the current 2013 era system is better than Obamacare. It is time that Democrats honestly open this debate before Republicans gain such a large majority that their voices no longer matter.”

  12. 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.

  13. 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.

  14. 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.

  15. 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 the argument for this outcome from the beginning. Also thank industry lobbyists and their hold on Congress. In that way the opposition is class driven – those with subsidies already in place and those without subsidies.

  16. 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 on Main Street. Those in the middle got nothing good out o the deal — their wages have gone down and their living costs have gone up. ObamaCare only compounds this problem facing the middle class.

    A healthcare system funded through income taxes is the only way to get the rich to pick up some additional burden of our nation’s healthcare costs; otherwise, the burden on the middle class will be so great that the middle class will cease to exist. This is a very real possibility and it must be stopped before we have nothing left in terms of a middle class.

  17. 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 to spend money on the poor and minorities.

    However there is one point that I do not think is being made energetically enough.

    The ACA exchanges are not such a great safety net for any of the working poor!

    Yes a bronze policy is close to free at lower incomes…………..but that policy has high deductible and coinsurance.

    A bronze policy does protect against things like cancer and strokes — but is that a great improvement? Many of the uninsured have received treatment for these major items and the bills have been forgiven. There are the ugly outliers like the Yale hospital serving wage garnishments on janitors. Did we need the whole ACA in order to stop that kind of cruelty?

    Seems to me that the ACA is a lot weaker safety net than Medicaid. That is what I would like to focus on.

  18. 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.

  19. 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 agenda of the Democrats is beyond contempt! That is not a racist comment, it is an American citizen’s opinion. But, are those now outlawed too by the United States of Democrat Rule?

    Hmm, USDR, getting closer to USSR every day?

  20. 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 to label me “racist,” have at it. The public is now well aware that such rhetoric is employed to conceal a partisan agenda.

  21. I have to say, for some, this is not just about Obamacare. There is an undercurrent of racism that still permeates the country – for that matter, any country. People are tribal and when they feel threatened, fear opens up a Pandora’s Box of character defects which include hatred, cynicism, deceit, anger etc. Most opponents don’t have a Plan B for reform, they just don’t like this legislation and since it is highly imperfect, it’s easy pickings.

    What annoys me is ndividuals who have been opposed to the President from the beginning, citing him as a ” socialist”, “foreign operative “, or perhaps an “inexperienced community organizer with a razor thin resume that got over-promoted”, go on to dismiss the notion of racial prejudice in the US simply because the President is now President.

    “Hey, you’ve got an African American that has now successfully aspired to the highest office in the world” — thought being: any institutional barriers or embedded racial impediments do not exist anymore or are certainly not worrying about because the President is President. Ergo, America is no long prejudiced. I’m not sure those on the other side of Trayvon Martin decision are ready to concede that fact.

    The ACA is very flawed and needs more work than an antebellum fixer-upper on This Old House. However, the absence of civilized discourse and the forgotten notion that 50M Americans will have access to some form of safety net is worthy of debate to try to do something — a debate where opponents don’t get labeled as racist and proponents don’t get crushed for caring enough to try to make it work. Its a democracy and the last time I checked, the majority rules. Not the most snarky, acerbic, poison pen in the email thread.

    As a fiscal conservative, our timing for reform stinks. As a former CEO, I see only one way out of our crisis and it is a combination of spending to try to stimulate GDP and some increases in taxes. This includes the taxation of employee benefits. Even without reform, Medicare has us on a collision course with defaulting on debt or entitlements. When any safety net becomes a hammock, we begin to have problems.

    I understand the frustration of those who would like to criticize the President for his neophyte leadership and worry about policies that create more debt and too many dependent on the government dole. These people should not be accused of being racist. However, diversity and an aspiration to be a net importer of talent and an exporter of democratic ideals has always been the signature part of America.

    We can’t dismiss those who feel that they have been subject to policies of oppression. The last ten years have not exactly been a great period for the middle class and even worse for minorities. Racism happens every day. It manifests itself in neglect, indifference, subconscious division and a cycle of poverty that is iron clad and hard to break. We have 2M black young men incarcerated and 60+% chance a black child will grow up in a home raised by one parent or grandparents. Big problems for big people to solve — no one better to try than Americans. I like our chances to muddle through and eventually find the common ground that continues to define us as a country – a nation that tries to do the right thing versus the easy thing.

  22. Dr. Ubel,

    It has nothing to do with racism. Households have a certain amount of income and want to protect as much of it as possible for their own usage. This is human nature not racism.

    Even if all people magically became altruistic the assumption that govt. spends money well is not the case.

    Now I think everyone should have access to medical care, but you have to be intelligent about achieving this.

    I’d also say people that espouse certain liberal ideologies are the real racists, but not consciously so. Take welfare and food stamps for example – very necessary when people are hurting, but eventually you want to get them up and working.

    A lot of money has been thrown at the inner cities for decades yet for many this has not helped them advance rather via govt dependence they remain stuck. This guarantees their vote. Other problem is the fix is beyond an election cycle rather would take 20-30 years.

    As per the VA, lots of vets coming home from Iraq/Afghanistan are not getting proper treatment for PTSD and terrible injuries. So I assume you mean the state of Virginia and not the Veteran’s Administration.

  23. Such self-indulgent posturing is one of the reasons the tide has begun to run against you. According to the most recent Kaiser Health News poll (11-22), 49% now have an “unfavorable” view of AHC, and only 33% “favorable.” It was common sense, and not “racism,” that led to the conviction that private insurance was not an appropriate and cost-effective mechanism for improving the quality of care of the indigent and uninsurable. Our resources could have been directed, with far better efficiency, to expanding the capabilities of community facilities. But we just couldn’t resist the partisan appeal of “insurance for all,” could we, especially when its true costs could be so easily concealed? Your high moral tone does not comport well with the duplicity and chicanery that perfected this fraud upon an unsuspecting public.

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